Different studies have used various terms for shoulder pain, eg, shoulder pain in hemiplegia, hemiplegic shoulder pain, and poststroke shoulder pain. Feb 25, 2015 the best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. All patients had complete clinical data sets and accounted for 45. Shoulder subluxation is a common poststroke complication affecting up to 80% of. Such pain may result in significant disability that may limit a patients ability to reach maximum functional potential and impede rehabilitation.
Shoulder pain is a common complication in hemiplegic patients after stroke. When stroke patients suffer from hemiplegia paralysis in half the body, up to 80% will experience shoulder pain. Stroke patients with hemiplegic shoulder pain can experience greater reductions in shoulder pain and disability index, pain, and improvement in shoulder flexion, external, and internal rotation after 3 weeks of kinesio taping intervention compared with sham kinesio taping. Conclusion almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderate severe pain. Pdf management of hemiplegic shoulder pain following stroke. Clinical examination of the painful hemiplegic shoulder saebo. For prophylaxis to be effective, it must begin immediately after.
It is important that caregivers of stroke patients are properly trained in handling the hemiplegic arm especially when shoulder subluxation is present. Clinical examination of the painful hemiplegic shoulder. Effect of emgtriggered neuromuscular electrical stimulation. When the arm partially dislocates from the shoulder socket, it creates a painful condition known as shoulder subluxation. During the initial period following a stroke, the hemiplegic arm is flaccid or hypotonic. However, the means of preventing hemiplegic shoulder pain hsp is not universally agreed. Hsp can inhibit the muscle contraction and limit efforts of patients to conduct exercise and delay the recovery in the motor function and influence capacity of. Neuromuscular electrical stimulation nmes and transcutaneous electrical nerve stimulation tens are two widely used interventions to reduce pain, but the comparative efficacy of these two modalities remains uncertain.
Pain probably is present later after stroke because after subluxation, fibrous changes or injury can occur in the connective tissue of the ligaments and joint capsule because of the incorrect alignment between the humerus and the scapula. Electrical stimulation in the treatment of hemiplegic. In addition, frozen shoulder can also be observed in up to 77% of patients suffering from hemiplegic shoulder pain. Hemiplegic shoulder pain can occur as early as two weeks poststroke but an onset of two to three months is more typical. Questions about shoulder pain american stroke association. Shoulder exercises for stroke patients from expert ot. When a change in normal muscular function occurs eg after a stroke, this presents a potential risk for subluxation. Sonography of patients with hemiplegic shoulder pain after stroke motor recovery stage. Painful stroke shoulder can negatively affect rehab outcomes as adequate shoulder function is a prerequisite for hand. Effect of kinesiology taping on hemiplegic shoulder pain. When you practice these stroke recovery exercises, aim for at least 10 repetitions each. In a previous article, we looked at the biomechanics, pathoanatomy and pathomechanics of the hemiplegic shoulder. A common sequela of stroke is hemiplegic shoulder pain, which can hamper functional recovery and subsequently lead to disability. Management of hemiplegic shoulder pain springerlink.
Hemiplegic shoulder pain is common in stroke survivors, developing in up to 54% of patients. Hemiplegic shoulder pain and subluxation are common complications after stroke. Observational study of hemiplegic shoulder pain after. Stroke patients who have their arm unsupported andor handled inappropriately by caregivers i. H emiplegia of the upper limb commonly occurs following a stroke turnerstokes and jackson, 2002. Management of shoulder pain in patients with stroke k walsh abstract shoulder pain avects from 16% to 72% of patients after a cerebrovascular accident. Along the next lines, i will explain my distaste for the use of a sling for the shoulder of a hemiplegic patient. Factors cited for the multifactorial basis of hemiplegic shoulder pain include rotator cuff disease, subluxation, spasticity, and reflex sympathetic dystrophy. Pain management of hemiplegic shoulder pain post stroke in. It is important that caregivers of stroke patients are properly trained in handling the hemiplegic arm especially when shoulder. Treatment protocol for hemiplegic shoulder pain full text. Management techniques including shoulder positioning, slings and aids, surgical interventions, injections, and electrical stimulation. Levels of evidence are provided to clarify research based recommendations. The underlying mechanisms include soft tissue lesions, impaired motor function and central nervous systemrelated phenomena.
Constituent ratio % of onset period of hemiplegic shoulder pain in 106 stroke patients. Methods during a 1year period, 416 firstever stroke patients were included in the populationbased lund stroke register. In this webinar, discussion will include prevalence and clinical presentation of the painful hemiplegic shoulder, risk factor groups, evaluation, and evidence based intervention techniques such as mobilizations, nmes, taping, edema management, and mental imagery. Onset has been reported to occur from 2 weeks to several months after the stroke. Journal of neurology, neurosurgery and psychiatric 78. Performing a comprehensive evaluation of patients with the hemiplegic shoulder can enhance the quality and efficiency of patient care while also indicating the most appropriate and effective. Hemiplegic shoulder pain has many underlying causes and is challenging to manage, requiring a team approach. Poduri reports that hemiplegic shoulder pain can begin as early as 2 weeks poststroke but typically occurs within 23 months poststroke. However, it lacks a precise definition, beyond the complaint of pain in the hemiplegic shoulder. However, due to advancements in medical care, more and more americans are surviving the acute event and living with disability of varying degrees. The shoulder muscles are unable to anchor the humeral head within the glenoid cavity, resulting in a high risk of shoulder subluxation.
It is important to thoroughly examine the shoulder if these complications arise after a stroke to determine the best course of treatment. It may occur in up to 80% of stroke patients who have little or no voluntary movement of the affected upper limb. Even if you only have minor harm from your stroke, proper arm care can help keep future problems from occurring. Hemiplegic shoulder pain usually appears within the first few weeks after a stroke. But first, what is shoulder subluxation and what causes it. Shoulder pain is the most frequent secondary complication after stroke, and significantly limits functional performance. Atypical calcific tendinitis involving the long biceps tendon. Its incidence is variable in up to 70% of patients and it often appears in the first few days.
If you suffer from shoulder pain due to shoulder subluxation, frozen shoulder, or spasticity, then talk to your pt about adding electrical stimulation to the mix. Sonography of patients with hemiplegic shoulder pain after. Patients may present with varying degrees of paralysis hemiplegia, which commonly affects the arm. Although many hemiplegic shoulder patients have been suffering from limited range of motion, it is not fully established whether the pathologic biomechanics are same in hemiplegic shoulder pain. Stroke remains one of the leading causes of death in the united states. Shoulder pain is a distressing complication of hemiplegia 1 and is 1 of the 4 most commonly reported medical complications of stroke. A sling is widely used in order to hold the shoulder and the arm of a patient who has suffered a cerebrovascular accident and therefore has a hemiparesis.
Background and purpose shoulder pain is a wellknown complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited. Observational study of hemiplegic shoulder pain after recent. Management of shoulder pain in patients with stroke. Feb 26, 2015 performing a comprehensive evaluation of patients with the hemiplegic shoulder can enhance the quality and efficiency of patient care while also indicating the most appropriate and effective. Treatment protocol for hemiplegic shoulder pain full. Effective interventions for poststroke shoulder subluxation. The incidence of hemiplegic shoulder pain hsp is reported to be approximately 1772% 1 6. Hsp is a shoulder pain that is present at rest, during passive or active movement on the hemiplegic side after stroke with no direct relation to trauma or injury. The secondary aim was to identify other factors associated with healthrelated qualityoflife outcomes.
Deicing the mystery behind hemiplegic frozen shoulder saebo. To prevent a gap that occurs post stroke in the disabled shoulder, here is a taping method taught by our physical therapist to help with this. Shoulder pain resulting from hemiplegia is a common clinical consequence of stroke. Shoulder pain affects from 16% to 72% of patients after a cerebrovascular accident. So, the treatment of hemiplegic shoulder pain is to nip it in the bud.
Listing a study does not mean it has been evaluated by the u. While thats a wide range, it shows that shoulder pain is a common problem after stroke, but why. Its appearance brings pain and limits daily living activities as well as participation in specific neurorehabilitation programs. Hemiplegic shoulder pain in shoulder subluxation after stroke. Hsp is a general term used to describe pain in the paralyzed shoulder in stroke patients. Shoulder pain affects between 1672% of hemiplegic stroke patients. This may involve xrays and ultrasounds to determine the source of the pain. How is hemiplegic shoulder pain caused by subluxation treated. Randomized controlled trial with pretest and posttest design. Hemiplegic shoulder pain hsp is one of the four most common medical complications following stroke. Effect of triamcinolone acetonide injections on hemiplegic.
Treatment of shoulder pain after stroke should start with simple analgesics. Treatment protocol for hemiplegic shoulder pain tphsp the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Management of the painful hemiplegic shoulder in the. As only a few patients developed shoulder pain after 6 months, they were not included in the statistical analysis. The primary aim of this study was to determine the association of hemiplegic shoulder pain with healthrelated quality of life at 12 months after first stroke in a populationbased registry. If i let an inflamed shoulder go and it remains inflamed over three to six months, its going to become a chronic neuropathic pain problem.
Changing practice for acute hemiplegic shoulder care. One factor that has been shown to decrease functional recovery and quality of life in this population is hemiplegic shoulder pain hsp. Shoulder exercises for stroke patients from expert ot flint. This may involve xrays and ultrasounds to determine the source of the pain a fracture, tissue damage or inflammation. Such poststroke shoulder pain has been shown to develop quickly with 17% of patients reporting pain within the first week poststroke event, 20% 1. Frozen shoulder is one of the most significant causes of shoulder pain after stroke. Hemiplegic shoulder pain is a frequent complication after stroke, leading to limited use of the affected arm. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. Jan 24, 2019 combining estim with shoulder exercise to reduce pain. Hemiplegic shoulder pain hsp is a common complication after stroke, which interferes with patient recovery as well as quality of life.
Objective hemiplegic shoulder pain is a common complication of stroke. Stroke is the leading cause of disability in adults in the uk and hemiplegic shoulder pain hsp is a common complication with a reported incidence of 640%. Atypical calcific tendinitis involving the long biceps. Hemiplegic shoulder pain can interfere not only with functional activities, but also motor recovery. Several studies suggest that frozen shoulder may be one of the most significant causes of shoulder pain after stroke. Nov 02, 2010 treatment protocol for hemiplegic shoulder pain tphsp the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Shoulder pain is a common problem following stroke. The aetiology of hemiplegic shoulder pain is probably multifactorial.
Hemiplegic shoulder pain reduces quality of life after. Observational study of hemiplegic shoulder pain after recent stroke spars the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Oct 12, 2015 observational study of hemiplegic shoulder pain after recent stroke spars the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. When the rotator cuff is weak, gravity pulls the arm down and away from the shoulder blade, causing shoulder subluxation. Here are the most common causes of shoulder pain after stroke. To evaluate the effectiveness of a programme of static positional stretches and positioning of the stroke affected shoulder for maintaining shoulder external rotation and decreasing hemiplegic shoulder pain. Without an accurate assessment using proven orthopedicbased diagnostic techniques, pain and disability can persist unnecessarily for months or years. I consider it necessary discussing the true usefulness of such a device and point out some aspects that are not usually taken into consideration hence running the. The muscles might feel tight instead of weak spasticity. Hemiplegic shoulder pain can occur as early as two weeks poststroke but. What are the possible complications of hemiplegic shoulder. The first hypothesis in this study is that acupuncture treatment for shoulder pain after stroke would be significantly more effective than sham. Shoulder pain restricted daily life often or constantly when dressing for 51%31% and when ambulating for 29%% of the patients at 4 and 16 months, respectively. Topics include causes and management of hemiplegic shoulder pain with indepth discussion of shoulder subluxation, spasticity, contractures, and rotator cuff disorders.
A programme of static positional stretches does not reduce. Management of shoulder pain in patients with stroke postgraduate. Hemiplegic shoulder pain causes considerable distress and reduced activity and. Such pain may result in significant disability that may limit a patients ability. Types of poststroke pain include muscle and joint pain, headaches, and painful sensations like tingling. Stroke often causes paralysis hemiplegia or hemiparalysis or weakness of one or more of the muscles in your arm or shoulder. Some people who have a stroke need treatment for trouble with the muscles of their arm or shoulder, and shoulder pain is common. The effect of kinesiology taping on the hemiplegic. A sling for the shoulder of a hemiplegic patient stroke. Feb 08, 2019 a common sequela of stroke is hemiplegic shoulder pain, which can hamper functional recovery and subsequently lead to disability.
To assess the impact of kt on hsp, upper extremity functional outcomes, and the prevention of shoulder soft tissue injury in subacute stroke patients with hemiplegic shoulders during rehabilitation. You may also have numbness or limited feeling in your arm. Kinesio taping may be an alternative treatment option for. Combining estim with shoulder exercise to reduce pain. Most experts agree that prevention of shoulder pain after stroke is an important goal and should be prioritised as an aim of rehabilitation from the first day after a stroke.
The medical literature estimate of the prevalence of chronic post stroke pain ranges from 3242% at four to six months and 1121% at twelve to sixteen months after a stroke. A common sequela of stroke that can hamper functional recovery and subsequently lead to disability is hemiplegic shoulder pain. Shoulder pain is a common complication after stroke. Pain management of hemiplegic shoulder pain post stroke in patients from nanjing, china.
Shoulder pathology occurs in up to 85% of patients with spastic symptoms and 18%. Proper shoulder support is key to prevention and treatment. Up to 72% of stroke patients develop hemiplegic shoulder pain. It is more frequently associated with a spastic than a flaccid stage. Suprascapular nerve block for shoulder pain in the first year. The ideal management of hemiplegic stroke pain is prevention. Shoulder pain can negatively affect rehabilitation outcomes as good shoulder function is a prerequisite for successful transfers. What are the possible complications of hemiplegic shoulder pain.
In general, stroke might increase or decrease the normal tension muscle tone in these muscles. Thus, we designed a randomized controlled clinical trial to investigate whether acupuncture is more effective than sham acupuncture and is safe to use for the treatment of shoulder pain after stroke. Shoulder pain restricts patients daily life after stroke. Oct 23, 2014 management of shoulder pain in patients with stroke. Kinesiology taping kt may provide improvement in hemiplegic shoulder pain and upper extremity function after an acute stroke. Its appearance brings pain and limits daily living activities as well as participation in specific neuro.
Hemiplegic shoulder pain hsp is one of the four most common medical complications following stroke 1. It can occur in up to 25% of individuals suffering a stroke within 6 months. The hemiplegic shoulder pain is common after a stroke. Sep 05, 20 we selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospitals in nanjing, china between february 2007 and january 2012. Effects of kinesio taping for stroke patients with. The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Hemiplegic shoulder pain in shoulder subluxation after. Topics include prevalence, causes, impact, and management of hemiplegic shoulder pain with indepth discussion of shoulder subluxation, spasticity, contractures, and rotator cuff disorders. To the best of our knowledge, calcific deposition in the lbt resulting in hemiplegic shoulder pain after a stroke has not been previously reported. Prevention and management of hemiplegic shoulder pain. Hemiplegic shoulder pain has many underlying causes and is challenging to manage, requiring a team approach, including physicians, therapists and caregivers.