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Shoulder pain after a stroke

The occurrence of shoulder pain after stroke is quite common in hemiplegia with an estimated incidence between 16% and 84%. This so-called Post Stroke Shoulder Pain, or PSSP can impede rehabilitation and interfere with both function and quality of life. It may not only interfere with shoulder function, but also with balance, walking, transfers and performance of self-care activities. PSSP is a general term that is used in relation to the occurrence of shoulder pain after stroke and it could be caused by known afflictions such as adhesive capsulitis, impingement due to rotator cuff tears and subluxation of the glenohumeral joint. What exactly causes PSSP is as yet unclear. Most likely, PSSP is caused by damage to the structures around the glenohumeral joint due to a muscular imbalance (rotator cuff tears, spasticity, and paralysis), a disturbance in positioning of the GH joint (impingement, or upward migration of the humeral head, or inferior subluxation) or damages due to a disturbed sensibility, possibly related to unilateral neglect. Damage to the upper trunk of the brachial plexus has also been cited as a possible cause of pain and subluxation in the hemiplegic shoulder. Downward subluxation may produce traction on the axillary nerve as it winds round the surgical neck of the humeral shaft. Also entrapment of the suprascapular nerve could cause shoulder pain, but some reports contradict this finding. Some authors have described shoulder pain after stroke as a special form of Reflex Sympathetic Dystrophy (RSD), possibly caused by subluxation of the glenohumeral joint but also other precipitating factors, including immobilization of the upper extremity, trauma to the joint structures, rotator cuff tears and spasticity of the shoulder musculature have been mentioned as a possible cause. This thesis was an attempt to get a better grip on the causes of PSSP by focusing on the relationship between stroke and shoulder kinematics and shoulder musculoskeletal proprioception. Starting from the assumption that stroke will lead to a disturbed motion pattern in the upper extremity, it was attempted to quantify the magnitude of this disturbance relate it to the existence (and on the longer term the development) of PSSP. Additionally, the disturbed motion pattern will probably lead to length changes of the shoulder muscles. Therefore muscles lengths during rest and shoulder movements are quantified and related to known muscle-related causes of shoulder pain. Disturbances in shoulder kinematics are only one (assumed) aspect, or better, effect, of …