Shoulder pain after stroke can stem from a variety causes — and each responds to different treatment techniques.
If you’re struggling with shoulder pain, it’s important to work with a therapist for accurate diagnosis and treatment.
This article will discuss everything you should know about relieving shoulder pain after stroke. We’ll start with the causes and then move onto rehabilitation.
Causes of Shoulder Pain After Stroke
Shoulder pain affects between 16-72% of hemiplegic stroke patients. While that’s a wide range, it shows that shoulder pain is a common problem after stroke, but why?
Here are the most common causes of shoulder pain after stroke:
- Incorrect positioning. Poor positioning increases stress on the shoulder which can result in pain.
- Neglect. If the affected arm is neglected, you may continue to lose mobility in the arm – a phenomenon known as learned nonuse. Less mobility increases risk of poor movement, injury, and pain.
- Spasticity. Muscle stiffness after stroke is often due to a condition called spasticity. When spasticity increases stiffness in the arm and shoulder, it can lead to shoulder pain.
- Arm paralysis. When stroke patients suffer from hemiplegia (paralysis in half the body), up to 80% will experience shoulder pain.
- Shoulder subluxation. When the arm partially dislocates from the shoulder socket, it creates a painful condition known as shoulder subluxation.
- Frozen shoulder. When the shoulder becomes partially dislocated, the pull of gravity stresses the joint and ligaments, leading to a painful condition called frozen shoulder.
- Secondary complications. Other conditions like post-stroke pain and neuropathy can contribute to shoulder pain after stroke. Sensory issues may also exaggerate shoulder pain in some patients.
With so many different causes of shoulder pain after stroke, it’s important to work with a therapist for diagnosis and treatment.
Rehabilitation Methods for Shoulder Pain After Stroke
Here are the rehabilitation methods for shoulder pain that your therapist may suggest:
1. Gentle Physical Therapy Exercises
Therapeutic range of motion exercises can help alleviate shoulder pain over time. Great caution should be taken with any arm or shoulder exercises at home. Incorrect movements can increase pain in the shoulder and lead to injury. Always work with a skilled therapist before practicing exercises at home.
2. High Intensity TENS Therapy
Transcutaneous electrical nerve stimulation (TENS) therapy involves applying electrical stimulation through the skin to stimulate the nerves. High intensity TENS therapy is enough to elicit muscle contraction and an “almost painful sensation.” Although it is uncomfortable, high intensity TENS helped patients significantly improve passive range of motion at the shoulder.
If shoulder pain is caused by poor mobility, this approach could greatly reduce shoulder pain after stroke long-term.
3. Functional Electrical Stimulation
Functional electrical stimulation (FES) also has a track record of improving shoulder pain after stroke – and it also helps improve other shoulder complications like shoulder subluxation.
4. Mental Practice
For even better results, combine mental practice with physical practice. Studies show that using both techniques together helps improve mobility more than just physical practice alone.
Management Techniques for Shoulder Pain After Stroke
During stroke rehabilitation, it’s ideal to treat the root problem instead of just treating the symptom. For example, it’s best to improve shoulder mobility so that range of motion improves and pain decreases long-term.
However, while you are pursuing rehabilitation, you may want to use other management techniques to help alleviate the pain in the meantime. That way, you can reduce the shoulder pain both in the short-term and long-term.
Here are some effective compensation techniques to relieve shoulder pain after stroke:
When shoulder pain is caused by incorrect positioning, taping can help relieve pain. This technique is great for preventing shoulder pain, too. Work with a therapist to learn how to tape your affected arm correctly.
6. Varney Brace (Shoulder Brace)
If your shoulder pain is caused by shoulder subluxation, then a brace may help.
One brace in particular, the Varney brace, can be extremely effective for reducing shoulder pain in patients with shoulder subluxation. In one study, patients experienced relief within just 7 days.
Talk to your therapist to see which shoulder braces may benefit you.
7. Other Positioning Tools
There is a wide range of opinions about how to correctly position to arm to relieve shoulder pain after stroke. Talk to your therapist to get their opinion. They may recommend using pillows or slings to support your arm at home.
Some medications can help relieve shoulder pain after stroke. Talk to your doctor to see if there are medications that may benefit you.
Your doctor may prescribe some medications like analgesics (pain relievers), anti-inflammatory medication, or antispastic drugs.
The type of meditation best suited for you depends on the cause of your shoulder pain, so it’s best to consult both your doctor and your therapist on this one.
Botox is a nerve-blocker that can help temporarily reduce spasticity after stroke. If spasticity in the arm and shoulder are causing pain, then Botox can help provide temporary relieve.
Some patients use this relieve as a “window of opportunity” to practice physical therapy exercises, which address the root problem.
If none of the above rehabilitation and compensation techniques provide relief, your doctor may recommend surgery to help fix your shoulder pain. This is usually a last resort.
Relieving Shoulder Pain After Stroke
Overall, shoulder pain after stroke has a variety of causes. Usually, it’s the result of improper positioning, shoulder subluxation, or poor mobility.
Rehabilitation methods like physical therapy exercises and mental practice help improve mobility to relieve pain long-term. Other techniques, like medication and slings, may provide faster relief.
However, it’s often more effective to use both short-term and long-term methods to reduce shoulder pain. That way you reduce the symptoms and root cause.
Reach out to your local therapist to start improving your shoulder pain after stroke. Good luck!
Featured image: ©iStock.com/ChesiireCat