Which of the following should be avoided in hemiplegia positioning?

• A. Shoulder abduction and external rotation
• B. Elbow extension
• C. Shoulder adduction and internal rotation
• D. Wrist extension

Answer: (C)

In hemiplegia, the position of the shoulder greatly affects risk of contracture, pain, and joint instability. Placing the arm in shoulder adduction and internal rotation tends to tighten the internal rotators and addctors (like subscapularis and pectoralis major) and keep the arm pulled in toward the body. Over time this promotes a fixed contracture, limits external rotation and abduction, and can contribute to shoulder pain and glenohumeral instability or subluxation. Keeping the shoulder in a more neutral position with gentle abduction and external rotation helps maintain better alignment of the humeral head in the glenoid, lengthens the tight internal rotators, and reduces the risk of these complications. Elbow extension and wrist extension are generally beneficial or neutral in this context, as they support the limb without promoting spastic flexors or adductors.