Hemiplegic Shoulder Pain After Stroke

Good shoulder stability is a prerequisite for practical hand function and performing multiple tasks involving reaching, ambulation, and activities of daily living.

A common sequela of stroke is hemiplegic shoulder pain, with some studies reporting an incidence of 84%. The usual onset is 2-3 months post-stroke. The pain can be intense and result in reduced functional recovery and increased disability. In addition, the pain itself can have genuine adverse effects resulting in depression, loss of sleep, loss of self-worth, anxiety and irritability.

Studies have failed to establish a substantial cause and effect of hemiplegic shoulder pain, so the reason is suspected to be multi-factorial. The most frequently suspected causes include subluxation (due to weakness of the rotator cuff muscles), trauma (often if the arm is pulled on), contractures (due to prolonged positioning), complex regional pain syndrome, rotator cuff injury and spastic muscle imbalance of the shoulder joint.

Once established, hemiplegic shoulder pain can be challenging to treat, so early intervention is indicated. Assessment by a neurological physiotherapist will ensure you gain the best advice and treatment early after your stroke. Treatment can include education, slings and supports, positioning, functional electrical stimulation, range of movement and strengthening exercises. It’s essential to assess a neurological physiotherapist if you have shoulder pain after a stroke. Management is vital to ensure the best arm recovery.

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