Management of Hemiplegic Shoulder Pain

Maxwell, Ann Miller W.; Nguyen, Vu Q.

doi:10.1007/s40141-012-0001-y

Cited by 7 publications

(2 citation statements)

References 51 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Upper extremity spastic muscle overactivity has been identified as one of the most common causes of HSP and may appear in the acute phase (56). Regardless of the pathology, a review found that HSP is higher than normal in patients with PSS (57). HSP patients showed significantly more spasticity in affected limbs compared to limbs that are pain-free (58).…”

Section: Discussionmentioning

confidence: 99%

A Novel Approach to New-Onset Hemiplegic Shoulder Pain With Decreased Range of Motion Using Targeted Diagnostic Nerve Blocks: The ViVe Algorithm

Fitterer¹,

Picelli

Winston

2021

Front. Neurol.

View full text Add to dashboard Cite

Introduction: Hemiplegic shoulder pain (HSP) is the most common pain disorder after stroke with incidence estimates of 30–70% and associated with reductions in function, interference with rehabilitation, and a reduced quality of life. Onset may occur as soon as a week after stroke in 17% of patients. Management of HSP represents a complex treatment pathway with a lack of evidence to support one treatment. The pain has heterogeneous causes. In the acute setting, decreased range of motion in the shoulder can be due to early-onset spasticity, capsular pattern stiffness, glenohumeral pathology, or complex regional pain syndrome (CRPS). As contracture can form in up to 50% of patients after stroke, effective management of the painful shoulder and upper limb with decreased range of motion requires assessment of each possible contributor for effective treatment. The anesthetic diagnostic nerve block (DNB) is known to differentiate spasticity from contracture and other disorders of immobility and can be useful in determining an appropriate treatment pathway.Objective: To create a diagnostic algorithm to differentiate between the causes of HSP in the stiff, painful shoulder in the subacute setting using diagnostic techniques including the Budapest Criteria for CRPS and DNB for spasticity and pain generators.Results: Examination of each joint in the upper extremity with HSP may differentiate each diagnosis with the use of an algorithm. Pain and stiffness isolated to the shoulder may be differentiated as primary shoulder pathology; sensory suprascapular DNB or intra-articular/subacromial injection can assist in differentiating adhesive capsulitis, arthritis, or rotator cuff injury. CRPS may affect the shoulder, elbow, wrist, and hand and can be evaluated with the Budapest Criteria. Spasticity can be differentiated with the use of motor DNB. A combination of these disorders may cause HSP, and the proposed treatment algorithm may offer assistance in selecting a systematic treatment pathway.

show abstract

Section: Discussionmentioning

confidence: 99%

A Novel Approach to New-Onset Hemiplegic Shoulder Pain With Decreased Range of Motion Using Targeted Diagnostic Nerve Blocks: The ViVe Algorithm

Fitterer¹,

Picelli

Winston

2021

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…As a cohort analysis, this study had no control arm, but we can compare our results with those in the published literature. Although there is an extensive literature on response rates to individual interventions (19) (1). These two studies showed a response rate of 14-27%.…”

Section: Discussionmentioning

confidence: 99%