Treatment of Post-Stroke Shoulder Pain of Multi-Factorial Etiology

Abstract

Case Reportprevalence of 25-50% in stroke patients [4]. Its development is likely multifactorial, involving glenohumeral subluxation, impingement, rotator cuff tears, bicipital tendinitis, and CRPS [4]. Glenohumeral subluxation can occur as a result of weakness in the muscles that surround and provide stability to the shoulder joint. The joint is most vulnerable to subluxation in the period immediately after stroke, when muscle tone in the upper extremity is flaccid [6]. Subluxation itself can result in further complications, including CRPS and secondary brachial plexus injury.The estimated incidence of CRPS after stroke is between 2 and 49% [7,8]. CRPS is characterized by pain, edema, vasomotor abnormalities, and patchy demineralization of bone in an extremity, and is divided into two types based on the absence (Type I) or presence (Type II) of a definable nerve lesion. The majority of stroke patients with CRPS are diagnosed as Type I, however micro-trauma to nerves may in fact explain their are CPSP and Complex Regional Pain Syndrome (CRPS), and CPSP and shoulder pain [4].