Shoulder subluxation is a common complication after a stroke, particularly in people with significant weakness or paralysis of the arm. It occurs when the upper arm bone partially slips out of its normal position in the shoulder joint due to weakness of the muscles that normally hold it in place. Shoulder subluxation can cause pain, limit arm movement and make rehabilitation more difficult. Learn why shoulder subluxation happens after a stroke, how it is treated and what can help support recovery.

After your stroke...

Your arm feels weak.

Perhaps it hangs differently than before.

You may notice a gap between your shoulder and upper arm.

Or perhaps...

Your shoulder feels painful, heavy or unstable.

You begin wondering...

"Has my shoulder become dislocated?"

Or...

"Will my shoulder recover?"

The good news is...

Shoulder subluxation is a recognised complication after stroke, and there are treatments that can help reduce pain, improve support and protect recovery.

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The Good News

Many stroke survivors experience some degree of shoulder subluxation during recovery.

For some people, the problem improves as muscle strength returns.

Early recognition and appropriate management can help reduce pain, protect the shoulder joint and support long-term recovery.

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What Is Shoulder Subluxation?

The shoulder is a ball-and-socket joint.

Normally, muscles around the shoulder keep the upper arm bone firmly positioned within the socket.

After a stroke, weakness or paralysis may cause these muscles to stop working effectively.

As a result, the upper arm bone may partially slip downward.

This partial separation is known as shoulder subluxation.

Unlike a complete dislocation, the joint is not fully separated.

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Why Does Shoulder Subluxation Happen After a Stroke?

After a stroke, the muscles responsible for stabilising the shoulder may become weak or paralysed.

These include:

✓ The rotator cuff muscles.

✓ The deltoid muscle.

✓ Muscles around the shoulder blade.

Without adequate muscle support, gravity can pull the arm downward.

This increases stress on the joint and surrounding tissues.

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Who Is Most at Risk?

Shoulder subluxation is more common in people who have:

✓ Significant arm weakness.

✓ Flaccid paralysis of the arm.

✓ Reduced muscle tone.

✓ Severe mobility difficulties.

✓ Limited movement during the early stages of recovery.

It often develops during the first weeks after a stroke.

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Symptoms of Shoulder Subluxation

Symptoms vary from person to person.

You may notice:

✓ Shoulder pain.

✓ A feeling of heaviness in the arm.

✓ A visible gap beneath the shoulder.

✓ Difficulty moving the arm.

✓ A sensation that the shoulder feels loose or unstable.

✓ Increased pain when the arm hangs unsupported.

Some people have significant subluxation with little pain, while others develop considerable discomfort.

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Does Shoulder Subluxation Cause Pain?

Sometimes.

Pain may develop because:

✓ Soft tissues become stretched.

✓ Muscles become strained.

✓ Abnormal movement patterns develop.

✓ Other shoulder problems occur alongside the subluxation.

Pain can interfere with rehabilitation and reduce confidence in using the affected arm.

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Can Shoulder Subluxation Affect Recovery?

Yes.

Pain and instability may make it more difficult to:

✓ Participate in therapy.

✓ Practise arm exercises.

✓ Perform daily activities.

✓ Use the affected arm.

However, appropriate treatment can often help improve comfort and function.

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How Is Shoulder Subluxation Diagnosed?

A healthcare professional will usually diagnose shoulder subluxation through physical examination.

They may assess:

✓ Arm strength.

✓ Shoulder position.

✓ Muscle tone.

✓ Pain levels.

In some cases, imaging may be used if another injury is suspected.

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Treatment for Shoulder Subluxation After Stroke

Treatment aims to support the shoulder, reduce pain and encourage recovery.

Proper Positioning

Supporting the arm during sitting, standing and lying can reduce strain on the joint.

Arm Support Devices

Slings or other support devices may be recommended in certain situations.

These should only be used under professional guidance, as prolonged use may sometimes discourage arm movement.

Physiotherapy

Physiotherapy often focuses on:

✓ Improving shoulder stability.

✓ Strengthening muscles.

✓ Encouraging safe movement.

✓ Preventing stiffness.

Electrical Stimulation

Functional electrical stimulation (FES) may help activate weakened shoulder muscles in some individuals.

Pain Management

Pain relief measures may include medication, positioning strategies and gentle rehabilitation exercises.

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Important Precautions

To help protect the shoulder:

✓ Avoid pulling on the affected arm.

✓ Do not lift someone by the affected arm.

✓ Support the arm during transfers.

✓ Follow handling advice provided by therapists.

Improper handling can worsen pain and increase injury risk.

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Can Shoulder Subluxation Improve?

Yes.

Many people experience improvement as muscle strength and control return.

Recovery depends on:

✓ Stroke severity.

✓ Degree of arm weakness.

✓ Rehabilitation intensity.

✓ Pain levels.

✓ Overall health.

Some people recover significant shoulder stability, while others continue to require ongoing support.

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When Should You Seek Medical Advice?

Arrange an appointment with your healthcare professional if:

✓ You develop shoulder pain.

✓ Your shoulder feels unstable.

✓ You notice increasing arm weakness.

✓ You develop a visible change in shoulder position.

✓ Movement becomes increasingly difficult.

Early treatment may help prevent complications.

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My Perspective

After a stroke...

The arm can sometimes feel forgotten.

People naturally focus on walking.

But shoulder problems can have a huge impact on comfort and confidence.

Protecting the shoulder early is important.

Gentle handling.

Proper support.

And consistent rehabilitation...

Can make a significant difference over time.

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Frequently Asked Questions

Is shoulder subluxation the same as a dislocated shoulder?

No.

A subluxation is a partial separation of the joint, whereas a dislocation is a complete separation.

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Does shoulder subluxation always cause pain?

No.

Some people experience significant pain, while others notice little discomfort.

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Will my shoulder return to normal?

Many people improve as muscle control returns, although recovery varies considerably.

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Should I wear a sling?

Some people benefit from arm support devices, but these should only be used under professional guidance.

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Can physiotherapy help?

Yes.

Physiotherapy often plays an important role in improving shoulder stability and reducing complications.

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Key Takeaways

✓ Shoulder subluxation is a common complication after stroke.

✓ It occurs when weakness allows the upper arm bone to partially slip downward.

✓ Symptoms may include pain, heaviness and instability.

✓ Early management can help protect the shoulder and reduce complications.

✓ Proper positioning and handling are extremely important.

✓ Many people experience improvement with rehabilitation and recovery.

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Related Articles

Continue learning about arm recovery after stroke with these helpful guides:

Shoulder Pain After a Stroke – Learn why shoulder pain develops and how it can be treated.

Arm Weakness After a Stroke – Understand why weakness occurs and what rehabilitation can help.

Arm Paralysis After a Stroke – Discover why paralysis happens and what recovery may look like.

Hand Swelling After a Stroke – Learn why swelling can occur in the affected arm.

Can Arm Function Return Years After a Stroke? – Understand how recovery can continue long after the initial injury.

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Final Thoughts

After a stroke...

A painful or unstable shoulder can feel like yet another obstacle in recovery.

But shoulder subluxation is a recognised complication.

And importantly...

There are ways to manage it.

Protect your shoulder.

Support it properly.

And seek help early if problems develop.

Recovery may take time.

But every step you take to protect your shoulder helps create the best possible conditions for healing and long-term arm recovery.