AOCPMR 2024 Mid-Year Meeting-Evaluation and Management of Hemiplegic Shoulder Pain

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Video Summary

This presentation reviews the evaluation and management of hemiplegic shoulder pain (HSP) following stroke, a common condition affecting up to 84% of stroke survivors, often linked to motor impairment severity and duration. HSP arises from spasticity, weakness, mechanical instability, and joint malalignment leading to soft tissue injuries, inflammation, contractures, and neuropathic mechanisms. Key contributors include shoulder subluxation, scapular dyskinesis, rotator cuff dysfunction, and peripheral nerve injury. The diagnosis relies on thorough history and physical exam due to lack of standardized criteria. Common pathologies include adhesive capsulitis, biceps tendinopathy, complex regional pain syndrome (CRPS), and central post-stroke pain, each with distinct features and treatment challenges. Management involves a multidisciplinary approach using physical therapy, positioning, edema control, neuromuscular electrical stimulation, orthotics, and pharmacologic treatments such as Botox and antidepressants. Emerging interventions like ultrasound-guided corticosteroid injections and peripheral nerve stimulation show promising results, with studies indicating sustained pain reduction and functional improvement. Peripheral nerve stimulation devices vary by implant duration and technical application. An evidence-based, algorithmic approach tailored to patient motor strength and pathology optimizes outcomes. Overall, individualized, multimodal treatment is crucial, underscoring the complexity and need for ongoing research in hemiplegic shoulder pain post-stroke.

Keywords

orthopedic sports medicine

shoulder surgery

impingement syndrome

rotator cuff tears

AC joint injuries

shoulder instability

SLAP lesions

adhesive capsulitis

hemiplegic shoulder pain

stroke rehabilitation

shoulder subluxation

rotator cuff dysfunction

neuromuscular electrical stimulation

peripheral nerve stimulation

multidisciplinary management