Good shoulder stability is a prerequisite for effective hand function, as well as being able to perform multiple tasks involving reaching, ambulation and activities of daily living.
A common sequalea of stroke is hemiplegic shoulder pain, with some studies reporting incidence as high as 84%. The usual onset is 2-3 months post stroke and the pain can be intense and result in reduce functional recovery and increased disability. The pain itself can have very real negative effects resulting in depression, loss of sleep, loss of self worth, anxiety and irritability.
Studies have failed to establish a strong cause and effect of hemiplegic shoulder pain and so the cause 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 difficult 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 important to have an assessment with a neurological physiotherapist if you have shoulder pain after stroke. Management is important to ensure the best arm recovery.