Painful shoulder in hemiplegia

Abstract

Shoulder pain is probably the most frequent complication of hemiplegia. In this study 219 hemiplegia patients were regularly followed up after their cerebrovascular accident (CVA) for one year (166 men, 53 women, with a mean age of 47 years). Criteria and parameters for evaluation of these shoulders were established at the outset. Distinction was made between flaccid and spastic hemiplegia. Other influencing factors were subluxation reflex sympathetic dystrophy syndrome (RSD), isolated tendon lesion cuff rotator tear or association of some of these. Roentgen examinations were done for each patient. In our series of patients, 72% had shoulder pain at least once during the course of their recovery. This problem occurred more often in patients having spasticity (85%) than in those with flaccidity (18%). An evolution towards spasticity was noted in 80% of the patients in this series, whereas 20% remained hypotonic. Among the other possible causes of shoulder pain, anteroinferior subluxation was incontrovertibly the most frequently cited. The RSD syndrome was present in only 23% of all cases but was seen more often in spastic patients, that is 27% compared to 7% among flaccid patients. Whatever the cause, the subluxation with flaccid paralysis should be corrected and spasticity should be combatted as early and as vigorously as possible.