Which of the following should be avoided in positioning a patient with hemiplegia?

• A. Prolonged shoulder abduction
• B. Prolonged shoulder adduction and internal rotation
• C. Prolonged elbow extension
• D. Prolonged wrist extension and adduction

Answer: (B)

Avoiding positions that lock the shoulder into adduction and internal rotation is crucial in hemiplegia. When the arm rests in this combined position, the internal rotators and adductors of the shoulder (like pectoralis major and teres major) tend to tighten, pulling the arm further inward. This promotes contracture and makes the glenohumeral joint unstable, increasing the risk of inferior subluxation of the humeral head and subacromial impingement, which can cause pain and limit range of motion.

Positioning the arm to be neutral or with gentle external rotation and slight abduction supports better scapular mechanics and keeps the rotator cuff muscles more functional, reducing the chance of contracture and joint irritation. While other joints can be placed in comfortable positions, the shoulder’s alignment has the most direct impact on long-term function and comfort in someone with hemiplegia, which is why this specific positioning is emphasized.