Painful Hemiplegic Shoulder

Shoulder pain resulting from hemiplegia is a common clinical consequence of a focal cerebral insult resulting from a vascular lesion (ie. hemorrhagic or ischemic stroke). Painful hemiplegic shoulder can occur as early as 2 weeks post stroke but an onset time of 2-3 months post stroke is more typical. Shoulder pain can negatively affect rehabilitation outcomes as good shoulder function is a prerequisite for successful transfers, maintaining balance, performing activities of daily living and for effective hand function. Similarly, complex regional pain syndrome is pervasive in hemiplegic patients and can lead to significant medical complications. This review summarizes the existing literature with regard to hemiplegic shoulder pain after stroke. Topics include causes and management of hemiplegic shoulder pain with in-depth discussion of shoulder subluxation, spasticity, contractures, and rotator cuff disorders. Management techniques including shoulder positioning, slings and aids, surgical interventions, injections, and electrical stimulation along with other miscellaneous treatments are addressed. Finally, a full discussion of the physiology, incidence, and treatment of shoulder hand syndrome is included.