Shoulder Pain And Stroke: What's The Connection?

Stroke patients often experience shoulder pain, which can be caused by a variety of factors, including improper positioning, shoulder subluxation, weakness, and spasticity. The shoulder is a ball-and-socket joint, and the weight of the arm can cause a partial dislocation, leading to pain and reduced range of motion. This is further exacerbated by muscle weakness or paralysis after a stroke, which can cause the arm to droop and the shoulder to become inflamed and damaged. Additionally, spasticity, or muscle stiffness, can result from changes in muscle tone due to stroke and lead to shoulder pain. Proper arm care, including correct positioning, the use of support devices, and early rehabilitation, is crucial for preventing and treating shoulder pain in stroke patients.

Shoulder subluxation

The rotator cuff muscles that support and stabilize the shoulder joint become weak and underactive, which results in the ligaments and joint capsule enduring increased demands as they attempt to hold the upper arm in place. Movements of the arm to the side or overhead can place additional stress on the shoulder joint, leading to subluxation or partial dislocation. The continual pull of gravity on the arm causes further subluxation and results in pain over time.

The most important factor in preventing shoulder subluxation is maintaining proper positioning of the arm and shoulder. This can be achieved through the use of a pillow or table tray under the arm when sitting, or a shoulder sling to support the arm when standing. Electrical stimulation can also be used to improve activation of the rotator cuff muscles and reduce pain.

Shoulder impingement

The symptoms of shoulder impingement include shoulder pain, particularly with movement of the arm, a pinching sensation at the top of the shoulder, and decreased shoulder strength and range of motion. These symptoms can make it difficult to perform daily activities and can worsen over time.

The treatment for shoulder impingement involves early identification, physical therapy exercises to strengthen the shoulder girdle, and pharmacological interventions to reduce inflammation. Physical therapy for shoulder impingement focuses on rotator cuff strengthening exercises and scapular stabilisation exercises. In addition, conservative treatments such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections can help reduce pain and inflammation.

In cases that do not respond to conservative treatments, surgery may be recommended. Surgical procedures for shoulder impingement aim to widen the space around the rotator cuff to prevent friction. One such procedure is arthroscopic subacromial decompression (ASD), which involves acromioplasty, bursal debridement, and resection of the coracoacromial ligament.

Spasticity

To treat spasticity, patients may receive a combination of physiotherapy, injections of botulinum toxin type A (Botox), and other medications. Physiotherapy exercises help to keep muscles and joints flexible and reduce the possibility of contractures. Botulinum toxin type A is given as an injection directly into the muscle, blocking the action of nerves and reducing the muscle's ability to contract. This treatment is often used for post-stroke spasticity in the hands, wrists, and ankles. Other medications, such as muscle relaxants, can also help reduce stiffness and pain associated with spasticity.

In addition to medical treatments, proper positioning of the arm and shoulder is crucial for stroke patients experiencing spasticity. Incorrect positioning can increase stress on the shoulder joint, leading to pain over time. Support devices such as slings, braces, or harnesses may be used to maintain correct positioning and prevent further injury.

Frozen shoulder

To treat frozen shoulder, physical therapy is often required to optimize recovery. Physical therapy exercises for the shoulder and arm are generally the most effective treatment, as they introduce movement into the shoulder and stimulate the brain to rewire neural pathways. Occupational therapy can also be beneficial, providing exercises to improve mobility and fine motor control in the shoulder, wrist, and hand. Electrical stimulation is another treatment option, involving the application of mild electrical impulses to the affected muscles to activate movement.

While frozen shoulder can be challenging, there is hope for improvement and recovery. Early rehabilitation is crucial to reduce symptom severity and prevent further complications. By working closely with a qualified therapist, stroke survivors can develop a treatment plan that addresses their unique needs and helps them regain their range of motion and strength.

Shoulder pain treatment

Shoulder pain is the most common source of pain for stroke survivors, with up to 84% experiencing it. Shoulder pain can result from a variety of factors and requires different treatments. Here are some detailed treatment methods for shoulder pain after a stroke:

Rehabilitation Methods

• Range of Motion Exercises: Gentle passive range-of-motion exercises are recommended initially, progressing to more active exercises. These exercises can help decrease spasticity, improve mobility, and relieve pain. However, caution should be exercised when performing shoulder exercises independently without guidance.
• Electrical Stimulation: Techniques like transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES) can reduce pain signals, improve movement, and promote brain rewiring.
• Mental Practice and Mirror Therapy: Visualising oneself performing shoulder exercises pain-free is a safe and effective way to reduce shoulder pain. Mirror therapy enhances this practice by reflecting the movement of the unaffected arm, giving the illusion of the affected arm moving effectively.
• Robotic-Assisted Therapy and Virtual Reality Interventions: These are newer techniques being researched to relieve shoulder pain and improve functional abilities.

Management Techniques

• Therapeutic Taping: Taping can be used to correct poor positioning of the shoulder, which can increase stress on the joint and lead to pain.
• Shoulder Braces: A shoulder brace can help stabilise the arm and reduce pain caused by shoulder subluxation, especially in cases of hemiplegia.
• Positioning Techniques: Appropriate postures and positioning techniques can help manage pain and prevent contractures, subluxation, and shoulder instability. Wheelchair arm supports, pillows, and slings can be used for additional support.
• Hands-on Techniques: Massage therapy and acupuncture can help relieve muscle tension and spasticity, thereby reducing shoulder pain.
• Medications and Injections: Analgesics, anti-inflammatory medications, and antispastic drugs can provide pain relief. Nerve blocks or injections, such as corticosteroid injections or Botox, can also help reduce pain and improve mobility.

It is important to work with doctors and therapists to determine the root cause of shoulder pain and create an appropriate treatment plan.

Frequently asked questions