Once the initial emergency of a stroke has passed, the treatment focuses on improving function as the brain recovers. During these months of recovery, the arms and legs might start getting stronger and more coordinated. However in some cases depending on the severity of the stroke, the strength might not fully return to half of the body. This weakened side is called the hemiplegic side because half of the body is paralyzed. If the arm is fully or partially paralyzed, shoulder pain can start to plague the individual after a stroke has occurred.
Approximately 30% of stroke victims will experience hemiplegic shoulder pain, which is pain in the paralyzed shoulder. The likeliness of shoulder pain seems to depend on how weak the arm actually is after a stroke. The weaker the arm the more risk there is of developing shoulder pain. Poor muscle strength tends to lead to rotator cuff tears or inflammation. Poor muscle strength also tends to cause the shoulder to sag and stretch sensitive nerves. Because of these two mechanisms, hemiplegic shoulder pain originates from both inflammation of soft tissues and irritation of sensitive nerves.
The treatment of shoulder pain after a stroke can be a very vexing problem that frustrates patients and doctors alike. In the past, many types of shoulder slings were used to try to support the sagging arm like a Bobath sling. However, studies failed to prove that these devices were really that effective. Lately, clinicians have better outcomes with peripheral nerve stimulation for the really tough cases of shoulder pain. But before such exotic treatments should be considered, physical therapy might be all that is required to eliminate hemiplegic shoulder pain.
A physical therapist can help improve range of motion and direct strengthening exercises too. Sometimes special taping techniques can help provide some extra support to the painful shoulder. A medical device called a TENS unit might also be worth trying as well. The hope is that these conservative measures will help to take the edge of the pain until the arm can regain enough strength to support itself as the brain heals.
Fortunately, the brain does have remarkable capacity to heal. Thus, shoulder pain is usually just a temporary set-back during the recovery process after a stroke. But if the pain lingers, more aggressive and advanced treatment options are being tried like the peripheral nerve stimulation. A good physical medicine and rehabilitation doctor should be able to guide you in all the treatment options for hemiplegic shoulder pain.
Arch Phys Med Rehabil. 2014 Sep 28. pii: S0003-9993(14)01072-7
Am J Phys Med Rehabil. 2014 Sep 23