Pain

 

Shoulder pain and subluxation

"Estimates of the prevalence of shoulder pain after stroke range from 17% of patients initially, increasing to 25% at 6 months. It is usually rated as moderate to severe. It is often associated with subluxation (instability) of the joint and, in the later stages, spasticity. Shoulder subluxation is not always associated with pain."

(ISWP, 2012 p94)

 

A painful shoulder may be referred to as ‘frozen shoulder’, ‘capsulitis’, or ‘adhesive capsulitis’

• A subluxed shoulder occurs when the muscles become weak after stroke resulting in the shoulder joint sliding partially out of place i.e the muscles no longer act to pull the shoulder joint together hence you can often see and/or feel a gap over the shoulder joint. Any hemiplegic arm requires careful handling, positioning and care hence a physiotherapist assessment is essential
• Shoulder pain can limit activities such as rolling in bed, performing transfers, putting on clothes and self-care (e.g. bathing)

Pain may be reduced by:

• Correct positioning and handling; pillows may be used to support the arm; the use of overhead arm slings should be avoided
• Mobilising the shoulder with physiotherapy
• Analgesia