“…Roy described Van Ouwenaller et al's (1986) report as the most reliable estimate of shoulder pain, with as much as 72% of the population with hemiplegia reporting pain. Other potential causes of shoulder pain are spasticity (Van Ouwenaller et al, 1986); limited shoulder range of motion (ROM), especially in the degree of shoulder external rotation (Ikai et al, 1998;Zorowitz et al, 1996); brachial plexus injuries, especially axillary nerve compression (Shai, Ring, Costeff, & Solzi, 1984) from overstretching of the periarticular tissue (Van Langenberghe & Hogan, 1988) and other impingement syndromes (Ridgway & Byrne, 1999); adhesive capsulitus (frozen shoulder; Ikai et al, 1998;Ridgway & Byrne, 1999); tendonitis (Ridgway & Byrne, 1999), possibly from rotator cuff injuries and tears (Dromerick, Edwards, & Kumar, 2008) or in the long head of the biceps (Dromerick et al, 2008); complex regional pain syndrome (Griffin & Reddin, 1981); and poor position and mishandling (Andersen, 1985;Davis, 2001;Runyan, 1995), especially forcing movement of the arm past 90°of shoulder flexion or abduction before placing the head of the humerus into place or performing ROM on a patient's arm when the scapula is not gliding (Davis, 2001;Griffin & Reddin, 1981). It appears that if a correlation exists between pain and subluxation, it is the result of the increased risk of trauma from improper handling of the subluxed hemiplegic shoulder and overstretching of tissue, possibly leading to impingement problems and tears.…”