Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke

Abstract

Shoulder pain after stroke occurred in 40% of 123 patients surviving, consenting and not too unwell to participate. This included 52 patients of an original cohort of 205 patients presenting with stroke. Eighty percent of patients made a good recovery with standard treatment Patients with sensory and or motor deficits represent at risk sub-groups.

Post-Stroke Pain Syndromes: Clinical Aspects, Diagnostic Criteria, Features of Therapy and Rehabilitation Measures

“…Тем не менее боль чаще всего появляется уже тогда, когда развивается спастичность. Постепенное развитие подвы-виха сопряжено с появлением боли в плече и снижает функциональные возможности пораженной верхней конечности [33]. Возможные осложнения подвывиха также включают КРБС и вторичное повреждение плече-вого сплетения.…”

Persistent shoulder pain after stroke

“…19 Incidences of SHS range from 1.5% to 70%. 10,15,20,31 In SHS, pain is reported in the hemiplegic shoulder as well as the hand and wrist and coincides with edema, coloring and sweating of the hand and wrist, suggesting a role for central sympathetic dysregulation and/or neurogenic inflammation. 7,15 The high variation in reported incidences of post-stroke pain is likely to be the result of differences in pain definitions, timing of assessment and/or study populations.…”

“…However, pain mechanisms may be studied indirectly by relating somatosensory symptoms and signs of clinical pain to those observed in animal or experimental pain studies. For example, animal and experimental models have shown that positive signs such as allodynia 31,33 and secondary 20,33,36,98 or generalized 40,55 hyperalgesia are mediated (partly) by central sensitization processes at the spinal and supraspinal level. However, one has to bear in mind that one mechanism may be responsible for multiple symptoms or signs and a single sign may be served by multiple pain mechanisms.…”

“…34 Indirectly, ongoing pain from the periphery may lead to sensitization of spinal and supraspinal structures. 13 In addition, ongoing pain may induce functional 20 as well as structural 40 cortical reorganization of somatosensory and motor systems, as has been observed in patients with chronic neuropathic or musculoskeletal pain. Moreover, the central processing of somatosensory stimuli has been shown to be impaired in patients with chronic pain in whom pain is suggested to cause a chronic interruption of attentional engagement.…”

“…20,33 The objective of this study was to assess the role of central sensitization and disinhibition in chronic stroke patients (> 6 months post-stroke) with chronic (duration > 3 months) PSSP (n=19), pain-free stroke patients (n=29) and healthy controls (n=23). Positive and negative somatosensory symptoms and signs and were assessed using clinical examination and electrical and mechanical quantitative sensory testing (QST).…”