Prevention of shoulder pain after stroke

        In recent years, with the development of society, social competition has become more and more fierce, people's life pressure has increased, and people's lifestyles are slowly changing. Cardiovascular diseases are increasing and they are getting younger. The number of patients with hemiplegia caused by stroke is increasing. is on the rise, and its complication, shoulder pain, is also more common.


       Shoulder pain is one of the most common complications in patients with hemiplegia. It usually occurs early after stroke. The most common manifestations are shoulder pain and limited movement, which directly affects the recovery of upper limb motor function. Due to the presence of shoulder pain, patients have reduced active muscle activity in the upper limb of the affected side and are often unwilling to perform functional training of the upper limb. This not only affects the functional recovery of the upper limb, but also hinders the rehabilitation process, thus reducing the quality of life of stroke patients and prolonging the hospital stay. .
        We cannot ignore shoulder pain prevention by thinking that shoulder pain is part of or a symptom of stroke. In contrast, shoulder pain is a preventable, but not inevitable, complication of stroke.



Since we want to prevent shoulder pain, we first need to know the causes of shoulder pain after stroke and what behaviors are likely to cause shoulder pain.

1、 Causes of shoulder pain:

From the anatomical structure of the shoulder joint, it contains a larger joint head and a smaller glenoid socket, which are fixed by a series of tendons and ligaments around it. Ligaments connect bones to bones, and tendons connect bones to muscles. It is precisely because of this structure that the shoulder joint has great flexibility and can move in almost all directions.

However, a joint with high flexibility also means that it is less stable and therefore prone to injury. This complex system is thrown into disarray after a stroke occurs. The consequences of reduced muscle tone, muscle weakness or spasm, prolonged immobilization leading to soft tissue adhesion, joint contracture, and inability of muscles to coordinate and cooperate are:

●Abnormal scapulohumeral rhythm: When the shoulder is flexed and abducted, the scapula cannot fully lift and rotate upward.
●Insufficient external rotation of the humerus: When the shoulder is flexed and abducted, the greater tuberosity of the humerus cannot bypass the acromion.
●The humeral head does not move downward sufficiently within the glenoid.

Various abnormalities cause damage to muscles, tendons, ligaments, joint capsules and even joint surfaces, causing shoulder pain. The response to pain will aggravate the patient's abnormal movements, forming a vicious cycle.

2、Behaviors that can easily trigger shoulder pain:

1. Within the passive range of motion, the scapula does not enter the normal position and the humerus does not rotate externally.


2. Help the patient to stretch his upper limbs when transferring.

3. Improperly lifting the patient toward the back of the wheelchair.
4. Lift the upper limb from the far end during family care activities.
5. Premature application of pulleys for interactive motion.


6. Actively raise your arms too vigorously when practicing.

Only by understanding the causes of stroke shoulder pain and the behaviors that can easily cause shoulder pain can we better prevent the occurrence of shoulder pain.

3、 Rehabilitation measures to prevent shoulder pain:

1. Posture
(1) Supine position: Place your head on the pillow, the height of the pillow should be appropriate, and the thoracic spine should not be flexed. Place a pillow under the affected hip to make the affected pelvis protrude forward to prevent hip flexion and external rotation. Place a small pillow under the affected shoulder joint to make the scapula protrude forward. The elbow joint of the affected upper limb is extended and placed on the pillow, the wrist joint is extended dorsally, and the fingers are extended. Place pillows under the hip, buttocks, and outer thighs of the affected side to prevent hip abduction and external rotation. Place a small pillow in the popliteal fossa to prevent hyperextension of the knee joint. Use this position as little as possible to avoid causing pressure ulcers.

(2) Lying position on the affected side: forward the shoulder girdle, flex the shoulder joint, extend the elbow joint, dorsiflex the wrist joint, and extend the fingers on the affected side. The affected lower limb is extended and the knee joint is slightly flexed. Flex the hip and knee joints of the unaffected lower limb, and place a pillow underneath them to prevent compression of the affected lower limb. Place a pillow on your back and rest your torso on it in a relaxed position. This is the most relaxing position for hemiplegic patients, allowing the limbs to stretch without affecting the use of the unaffected hand. However, maintaining this position for too long can easily cause shoulder pain on the affected side, so attention should be paid to position changes.

(3) Lying position on the healthy side: The upper limb of the affected side is stretched forward, the shoulder joint is flexed at about 90°, the arm is internally rotated toward the body, the fingers are extended, the palm is facing down, and a pillow is used below to support the upper limb of the healthy side. The upper limb of the healthy side can be placed freely. The hip and knee joints of the affected lower limb should be slightly flexed and placed on a pillow. The ankle joint should be supported by a pillow to avoid foot drop. Extend the hip joint of the unaffected lower limb, slightly flex the knee joint, and place a pillow behind your back to make the trunk relaxed.

2. Daily care: In addition to paying attention to avoiding the above 5 behaviors that can easily induce shoulder pain, you should also pay attention to how to put on and take off clothes. The specific method is: put on the upper limb of the affected side first, then put on the upper limb of the healthy side; when taking off clothes, take off the upper limb of the healthy side first, and then take off the upper limb of the affected side.




3. Pay attention to supporting the upper limb on the affected side to avoid letting it sag: This principle applies to the patient himself, caregivers and therapists. You should always use objects and the unaffected limb for support.


4. When patients perform active training, they should perform it at a constant speed and avoid going too fast or using too much force on the unaffected hand. Drag and pull the affected upper limb. Rehabilitation training can be carried out in small amounts and multiple times within a pain-free range.


Other preventive measures include the application of kinesio tape, functional electrical stimulation, scapula loosening, and the use of shoulder braces in patients with hemiplegia.