Review
Management of shoulder pain in patients with stroke
K Walsh
Colchester General
Hospital, Colchester, UK
Correspondence to: Dr Kieran Walsh, Basildon Hospital, Nethermayne, Basildon, Essex SS16 5NL, UK
Submitted 21 March
2001;
Accepted 15 May 2001
Shoulder pain affects from 16% to 72% of patients after
a cerebrovascular accident. Hemiplegic shoulder pain causes
considerable distress and reduced activity and can markedly hinder
rehabilitation. The aetiology of hemiplegic shoulder pain is probably
multifactorial. The ideal management of hemiplegic stroke pain is
prevention. For prophylaxis to be effective, it must begin immediately
after the stroke. Awareness of potential injuries to the shoulder joint reduces the frequency of shoulder pain after stroke. The
multidisciplinary team, patients, and carers should be provided with
instructions on how to avoid injuries to the affected limb. Foam
supports or shoulder strapping may be used to prevent shoulder pain.
Overarm slings should be avoided. Treatment of shoulder pain after
stroke should start with simple analgesics. If shoulder pain persists, treatment should include high intensity transcutaneous electrical nerve
stimulation or functional electrical stimulation. Intra-articular steroid injections may be used in resistant cases.
Keywords: shoulder pain; stroke
© 2001 by The Fellowship of Postgraduate Medicine
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