Pain after a stroke can have many different causes. It is extremely important to know the cause of the shoulder pain. Pain can come from damage or injury to the shoulder joint. Pain can also occur when damage has occurred to the “pain centers” in the brain and from “non-use” of the arm effect by the stroke. Here is a list of the most common causes and management of shoulder pain following stroke.
Pain can occur if the weak shoulder becomes subluxed (partially dislocated) after a stroke. When the shoulder is weak, it becomes extremely unstable. In some cases, the weight of the arm can cause the arm to separate from the the shoulder socket. In most cases, this type of injury is preventable by protecting the shoulder joint and educating care takers on how to assist a patient without pulling on the effected arm.
Adhesive Capsulitis or “Frozen Shoulder”
Another complication that can occur in the shoulder after a stroke is adhesive capsulitis. If the arm stays in one position, sometimes the structures around the joint with “freeze up”. This is where the term frozen shoulder comes from. The capsule around the shoulder joint shortens and will not allow the shoulder to move. If this occurs, the patient usually experiences the most pain with shoulder movement.
Complex Regional Pain Syndrome
Complex regional pain syndrome is a condition that occurs when nerves can become hypersensitive due to “non-use” of the arm. This condition aligns with the old saying “if you don’t use it, you lose it”. This can sometimes happen if the patient experiences pain in the arm early on in the recovery. This sends a message to the brain that “movement causes pain”. Once the brain and the patient associate movement with pain, they may go to great lengths prevent the arm from being moved. In sever cases, they may even stop allowing any kind of touch on the arm. If this continues, the arm will become intolerant to any kind of touch or movement.
How to get the right diagnosis for your shoulder pain
A doctor is the medical professional who diagnoses pain syndromes. A physical therapist may also be able to help identify the cause of the pain. The best case is when the therapist and the medical doctor stay in close communication about your care.
What is the best treatment for shoulder pain?
Figuring out what is causing the shoulder pain is the first step. Neurologic pain and orthopaedic pain will need to be treated differently for the best result. This will include a combination of physical therapy, and medication. It is helpful for your physical therapist and your physician to talk to each other about your shoulder pain. A physical therapist will have valuable information about how your shoulder is moving, what triggers your pain, and what positions and movements help the pain. This can help the physician in diagnosing the pain and recommending the best treatment options.
Managing Stroke Shoulder Pain
Positioning the arm
Correctly positioning the arm is critical to prevent pain and injury.
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Positioning is extremely important. When the shoulder is weak, the weight of the arm will cause the arm to sublux (partially dislocate) from the shoulder joint. In addition to causing pain, shoulder subluxation can damage the muscles making it harder to recover arm movement. The important things to remember when thinking about positioning is to make sure the arm is supported and the lower arm is pointing forward. Medifab has created this positioning system for sale. Pillows can also work to make sure the arm stays in the right position. When Standing, the Givrmorh sling allows the arm to move, to allow for a normal walking pattern while also supporting the weight of the arm.
Slings similar to this don’t allow the arm to move in a normal fashion. This type of sling may also cause the pectoralis muscle and the biceps muscle to become tight which are already at risk for becoming tight after a stroke. This may make voluntary movement more difficult