Course Description:

Shoulder pain in the paretic upper extremity is a common complication of stroke, reported to occur in more than 50% of stroke patients in rehabilitation settings. Many pathologies may lead to poststroke shoulder pain, including rotator cuff disorders, adhesive capsulitis, glenohumeral subluxation, and spasticity of the shoulder muscles. Central pain and central sensitization may also play roles. A clear relationship between poststroke shoulder pain and motor recovery has not been determined; however, poorer motor function has been associated with increased incidence of poststroke shoulder pain, and the presence of shoulder pain significantly influences arm use and hence motor relearning. Aggressive handling, use of the hemiparetic arm to support or pull the patient, and improper positioning may cause iatrogenic pain. Patients with severe impairment tend to need more intensive and prolonged care, with a greater potential for development of soft tissue injuries from handling. The development of poststroke shoulder pain is associated with poorer functional outcomes. The best treatment approach has not been definitely established, in part because of the multifactorial etiology. Treatments vary and may include gentle passive and active assisted ROM, movement therapy techniques such as repetitive, task-oriented practice, and balance and postural control exercises. Prevention of repetitive microtrauma is important.