Hand Pain And Stroke: Is There A Link?

A stroke can cause hand pain, along with other symptoms such as numbness, weakness, and a reduced range of motion. The shoulder joint is particularly vulnerable to the effects of a stroke, which can cause partial dislocation, inflammation, and damage. This can lead to pain with movement and a sensation that the shoulder is out of joint. Further, a stroke can cause muscle weakness, tightness, or a lack of feeling in the arm, which can result in hand pain. Treatment for hand pain after a stroke includes pain-relieving medication, physical therapy, slings, and botox injections.

Shoulder pain and partial dislocation are common after a stroke

Shoulder pain is a common problem after a stroke, usually occurring on the side of the body affected by the stroke. This pain is often caused by a partial dislocation of the shoulder joint, known as shoulder subluxation. This happens when the ball of the upper arm bone, the humerus, partially comes out of the glenoid socket in the shoulder.

Stroke survivors with weak rotator cuff muscles, which connect the upper arm bone to the shoulder blade, are particularly susceptible to shoulder subluxation. When the rotator cuff is weak, gravity pulls the arm down and away from the shoulder blade, causing the shoulder joint to become partially dislocated. Slumped posture caused by weak back muscles can further increase the likelihood of shoulder subluxation.

As many as 84% of stroke survivors develop shoulder pain associated with shoulder subluxation and motor weakness. The pain may be localized to one area of the shoulder joint at first, but if left untreated, it can become a severe, generalized pain. Shoulder subluxation can also lead to reduced range of motion in the arm and, in some cases, permanent shortening of the muscles, known as contracture.

To prevent and manage shoulder pain and partial dislocation after a stroke, proper shoulder support and positioning are key. This may include the use of slings, braces, or other support devices to keep the arm in the correct position and reduce the risk of further injury. Physical therapy, including specific exercises and movements, is also crucial for improving function and strength in the affected arm and reducing the risk of shoulder subluxation.

In addition to physical therapy, other treatments such as pain medication, electrical stimulation, and botulinum toxin injections may be used to manage shoulder pain and improve arm function after a stroke.

Strokes can cause arm paralysis and reduced range of motion

A stroke can cause paralysis and reduced range of motion in the arm, specifically in the shoulder and hand. Paralysis is a common symptom after a stroke, especially in the upper limb. This can lead to a reduced range of motion in the arm. Additionally, sensory disorders and depression can lead to inattention to the affected arm or hand, which can further reduce the range of motion.

To prevent and treat these issues, proper arm care after a stroke is crucial. This includes techniques such as correct positioning of the arm, using devices like a sling or brace, and preventing further injury. It is important to work with a healthcare team to design a treatment plan specific to individual needs, which may include physical therapy and exercises to improve strength, endurance, and range of motion.

One of the key problem areas after a stroke is the shoulder joint. The shoulder blade and upper arm bone form the shoulder joint, which is shaped like a ball and socket. Stroke can cause problems with the shoulder muscles, leading to a partial dislocation or subluxation. This happens when the muscles that normally hold the joint in place are weakened, and the weight of the arm pulls and stretches the soft tissues. This partial separation can cause pain and a reduced range of motion, with some muscles becoming permanently shortened – a condition called contracture.

To prevent and treat shoulder issues, correct positioning of the arm is vital. This includes placing the arm in a sling or harness, using pillows for support, and ensuring correct positioning when lying down, sitting, or sleeping. Electrical stimulation of the muscles and brain may also be used to treat arm paralysis and reduced range of motion.

In summary, strokes can cause arm paralysis and reduced range of motion, particularly in the shoulder and hand. Proper arm care, including correct positioning and the use of supportive devices, is essential to prevent and treat these issues. Treatment plans may include physical therapy, exercises, and electrical stimulation to improve strength, flexibility, and range of motion.

Spasticity and contracture can lead to permanent limitations in mobility

Spasticity is a symptom of certain neurological conditions, such as stroke, that can cause muscles to contract all at once. This can range from mild muscle stiffness to severe, uncontrollable muscle spasms. It can affect movement, speech, and gait. Spasticity can lead to muscle contractures, which refer to a shortening of muscle length due to a decrease in the number of sarcomeres. This results in permanent contraction of the muscle and tendon, causing joint immobility and reduced range of motion.

Spasticity and contractures can lead to permanent limitations in mobility, making it difficult to perform daily activities and basic care. The affected individual may experience extreme pain and sleep disruption due to painful spasms or muscle tightness. The risk of developing pressure injuries (bedsores) is also increased, which can lead to infection and sepsis.

In addition, untreated spasticity can result in partial or full dislocation of joints. The shoulder joint, for example, may experience partial separation or subluxation due to the weight of the arm, causing pain and reduced range of motion. This can further lead to permanent shortening of some muscles, known as contractures.

To prevent and manage spasticity and contractures, proper positioning of the affected arm or hand is crucial. This includes placing the arm in a sling or brace and ensuring correct positioning when lying down or sitting up. Physiotherapy, medication, and botulinum toxin injections are also effective treatments for spasticity. Maintaining muscle length through passive or active exercise, stretching, and splinting can help manage spasticity and prevent contractures.

Treatments include pain-relieving medication, physical therapy, and splinting

Hand pain can be caused by a stroke, and there are various treatments available to help manage the pain and correct the problems causing it.

Pain-Relieving Medication

Over-the-counter painkillers such as acetaminophen (paracetamol or Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen sodium (Aleve) can help reduce hand pain, swelling, and inflammation. If symptoms are severe, a doctor may prescribe a higher dosage of an NSAID or a different medication altogether. For instance, corticosteroids such as cortisone and prednisone may be prescribed to reduce pain, swelling, and inflammation within the hand and finger joints and the surrounding soft tissues. These can be administered in pill form, as a topical ointment, or injected directly into the joints or tendons of the hand.

Physical Therapy

Physical therapy can help relieve hand pain by improving joint mobility, range of motion, and hand strength. A physical therapist can also recommend other modalities like heat or cold therapy, paraffin wax application, or electrical stimulation to help decrease pain, stiffness, swelling, and inflammation.

Splinting

Hand splints and braces can be worn to support the wrist and finger joints, allowing them to rest and heal as inflammation subsides. Splinting can also keep the joints aligned to prevent further damage and joint irritation.

Preventative measures can help reduce the risk of hand pain after a stroke

Correct Positioning

One of the most important aspects of preventing hand pain after a stroke is ensuring the correct positioning of the affected arm and hand. This is especially crucial for individuals with paralysis or numbness in the arm, as improper positioning can cause damage without one's knowledge. Here are some general guidelines for correct positioning:

• When using a wheelchair, ensure the affected arm or hand is rested on a table or arm support with a soft surface, such as a towel.
• Place the affected hand palm down on the table.
• Sit up straight to maintain a physiological joint position in the shoulder.
• Ensure the affected hand is within the patient's field of vision.
• Avoid prolonged periods of poor sitting posture to prevent putting strain on the shoulder.
• When lying down, stretch the arm at a 90-degree angle at the side of the body, with the wrist elevated to the level of the heart to prevent blockages and ensure lymphatic return.

Splints and Orthoses

Splints are crucial, especially in the early stages after a stroke. They help with safe positioning and protect the wrist during active movements. Custom-made splints can be provided by occupational therapists and orthopaedic technicians, or ready-made splints are also available in various sizes.

Exercises and Movement

Active or passive movement is vital to preventing pain in the upper limbs. Patients should work with therapists in occupational or physical therapy to perform specific movements. Additionally, patients can attempt to move the affected hand themselves by guiding it with their healthy hand, ensuring movements are slow and careful. It is important to only make movements within the pain-free range of motion. Regular active movements help strengthen the muscles, improve coordination, and increase sensitivity, thereby preventing pain syndromes.

Support and Rehabilitation

Stroke patients often require support from caregivers and therapists, especially if they suffer from "neglect," where they ignore the affected side of their body. Caregivers must closely monitor positioning to prevent injuries that can lead to severe pain and delay recovery. Rehabilitation devices and technologies, such as robot-assisted rehabilitation, can also aid in the recovery process.

Frequently asked questions