Hemiplegic Shoulder Pain (HSP)

Patient

Q: Before my stroke, I used to live at the gym and I would do lateral raises, shoulder, with 30,40,50 kilo dumbells. So, why is it that my delts are killing me now with using no weight at all, when, I assume, that the muscle mass is still there? I just dont understand. My stroke, very severe, was in 2004. I was 42. I am virtually paralysed. I will not walk again. I have always used a standaid for transfering, so my muscles have been in constant use, so I cannot understand the pain from just raising my arms. I understand the weakness, but not the pain.

Doctor

A:    One of the most common and challenging  problems after a Stroke is Shoulder pain or hemiplegic shoulder pain (HSP), due to mechanical local factors as stiffness (spasticity), lack of mobility and positioning problems. It may have two presentations: Flaccid and Spastic. The management depends on the presentation, for the flaccid shoulder the arm should be supported at all times because the shoulder joint is prone to subluxation and for the spastic, the limitation of the movements is the main problem. These issues may be prevented by early physical therapy, using foam supports, education about the correct positioning and handling of the hemiplegic shoulder. The treatment options usually start with physical therapy mobilizations and transcutaneous electrical nerve stimulation (TENS) while you are thought a routine to exercise your shoulder-arm, keeping the range of motion of the joint. If there is poor or no improvement then, the local injection with corticosteroids or lidocaine might be considered.

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