Mishandling?
Improper handling of the hemiplegic arm may cause trauma to the shoulder complex. We don’t know the exact cause of Mr McTavish’s shoulder pain but the complex nature of his care pathway may have exposed him to handling by many people which could increase the risk of him developing a painful shoulder. Care must be taken not to pull the patient by the affected arm during transfers, repositioning or care procedures.
Poor positioning?
We don’t know the exact cause of Mr McTavish’s shoulder pain but the complex nature of his care pathway may have exposed him to inappropriate positioning which could increase the risk of him developing a painful shoulder. The arm must be well-supported using foam supports, pillows and or a table when the patient cannot move it.
Subluxation of the shoulder joint?
Mr McTavish has low muscle tone around the left shoulder and when unsupported the joint partially dislocates potentially causing pain. The arm should always be moved slowly and in the correct anatomical alignment so as to prevent damage to the shoulder joint. Strapping, TENS and Functional Electrical Stimulation may be considered as treatments along with simple non-steroidal analgesia.
Pre-existing orthopaedic co-pathology?
Prior to his stroke, Mr McTavish was an avid golfer and did not report any shoulder problems causing pain.
Inability to shrug the affected shoulder?
Mr McTavish has severe hemiplegia with inability to move the shoulder girdle is this is associated with developing HSP.
Loss of range of motion?
Mr McTavish has reduced lateral rotation of the glenohumeral joint. This is associated with pain and so gentle movements to maintain range of motion should be used under the guidance of the therapist.
Central post stroke pain (CPSP)?
While HSP has been associated with CPSP, Mr McTavish has not reported pain likely to be of central origin.
Fall causing injury to the shoulder?
There was no history of trauma to the shoulder in this case.
Page last reviewed: 25 Feb 2021
