Post-stroke shoulder pain, or hemiplegic shoulder pain, affects as many as 72% of stroke survivors in Canada, and is the most common source of pain among stroke survivors. Shoulder pain has a strong influence on functional recovery post-stroke as it can greatly inhibit participation in rehab. Below are some common questions answered:
- Why does it happen?
The most common cause of shoulder pain is due to a subluxation of the shoulder joint. In other words, the shoulder becomes partially dislocated usually due to weakness or paralysis of the rotator cuff muscles after a stroke. The rotator cuff connects the arm bone to the shoulder blade, and is responsible for stabilizing and aligning the shoulder joint. If these muscles are weak, the shoulder joint becomes malaligned and can be painful to move.
- How can it be treated?
There are many different techniques that can be used to treat hemiplegic shoulder pain. In the early stages, it is important to protect and support the shoulder joint to prevent further injury to the arm during rest and functional movement. Some treatment techniques may include, gentle stretching and mobilization, functional strengthening of surrounding musculature and improving alignment of the arm to shoulder to trunk. Electrical stimulation to promote muscle strengthening or for pain relief. Your physiotherapist can provide you with individualized rehab exercises to help treat hemiplegic shoulder pain.
- What should you avoid?
To prevent further injury to the hemiplegic shoulder, pulling on the affected arm should be avoided especially during transfers. You should also avoid passively forcing the arm past a tolerable range of motion. It’s important to ensure the shoulder blade is also moving appropriately if the arm is being passively moved beyond 90 degrees of shoulder flexion or abduction.
- Can adaptive equipment help?
Adaptive equipment may be used as an adjunct to physiotherapy treatments. Your physiotherapist or occupational therapist may recommend equipment which can be used to support the arm, such as arm support trays on wheelchairs and/or pillows. Slings and braces may also be used to support the arm, however some types can restrict functional arm movement (and therefore recovery). Slings/braces that support the shoulder joint without limiting functional movement of the arm are recommended. A great example is a sling such as the one below. Furthermore, taping (i.e. Leukotape or KT tape) to support the shoulder joint may be applicable.
References:
–Rebecca Chow, Registered Physiotherapist
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