What is it?
Painful shoulder is a complication that frequently appears in patients with hemiplegia secondary to ischemic or hemorrhagic stroke. It usually appears 2-3 months after the stroke, although sometimes it appears early, in the first 2 weeks. The painful shoulder interferes with rehabilitation as it limits participation in physical therapy and the performance of basic activities of daily living, such as dressing or toileting.
The cause is probably multifactorial, involving shoulder joint injuries (gleno-humeral subluxation, rotator cuff injuries, bursitis, tendonitis) and neurological involvement (spasticity, altered sensation).
Treatment should include:
- Early postural measures. Maintaining proper posture of the upper extremity reduces the possibility of subluxation and subsequent contractures. The most indicated posture is with the arm in abduction, external rotation and shoulder flexion.
One way to keep the arm in a correct position during sitting is the use of a table adapted to the wheelchair on which the arm is supported while keeping the shoulder in external rotation and the elbow partially extended.
- Physiotherapy with gentle passive and active exercises to reduce pain. Intense exercises, with pulleys, should be avoided because they can worsen the pain.
- Shoulder orthoses, useful in the initial phases, when the patient is in standing position, in order to reduce the effect of gravity on the gleno-humeral joint.
- Treatment with botulinum toxin, when the pain is secondary to spasticity of the shoulder musculature.
[toggle_item title=””AUTHOR”” active=””true””]
Dr. E. Riva
Neurologist, Director of the Neurorehabilitation and Rehabilitation Unit and member of the team of the[/toggle_item]
Jenifer Carey
Jenifer Carey, Physiotherapist specializing in neurorehabilitation and member of the team of the Uniad de Neuro-Rehabilitation.
