Epidemiology of hemrplegic shoulder pain after stroke

  • Malambo Passmore



Hemiplegic shoulder pain has been reported to delay upper limb functional recovery after stroke. Aim

A  review of articles was  conducted to determine the incidence,  risk factors  and causes of hemiplegic  shoulder  pain after stroke.


The search of articles was identified using MEDLINE, SCIRUS, CINAHL, SCIENCE  DIRECT and manuai search. A total of 23 references were used in this study.


The study reviewed that 80% of stroke patients complained of hemiplegic shoulder pain. The associated risk factors to hemiplegic shoulder pain were; neglect/ loss of sensibility, repeated trauma, depress ion, spasticity and limited range of motion in external rotation of the affected shoulder . However, subluxation was not associated to hemiplegic shoulder pain in this study. The causes were adhesive capulitis, injury to rotator cuff muscles and subacromial bursitis.


Early identification of risk factors and causes of hemiplegic shoulder pain would help to plan for treatment and reduce the high incidence shoulder pain.


Bender , L. & Mckenna, K. (2001). Hemiplegic shoulder pain: Defining the problem and its management. Disability and Rehabilitation, 23(16), 698-705.

Bohannon, R.W. (1988). Relationship between shoulder pain and selected variables in patients with hemiplegia. Clinical Rehabilitation, 2, 111-117.

Bohannon, R.W., Larkin, P.A., Smith, M.B. & Horton, M.G. (1986). Shoulder pain in hemiplegia: Statistical relationship with five variables. Archives Physical Medicine Rehabilitation, 67, 514- 516.

Dursun, E., Dursun, N., Eksi, U.C. & Cakci, A . (2000).

Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients. Archives Physical Medicine Rehabilitation, 81, 944-946.

Gamble, G.E., Barberan, E., Laasch, H.U., Bowsher, D., Tyrrell, P.J. & Jones, A .K.P. (2002). Post stroke shoulder pain: A prospective study of the association and risk factors in 152 patients from a consecut ive cohort of 205 patients presenting with stroke. European Journal of Pain, 6, 467-474.

Gould, R. (2004). Shoulder and hemiplegia. Retrived 4'h March, 2004 from, http:www.emedicine.com/pmrltop ic 132.htm

lkai, T., Tei, K., Yoshida, K., Miyano, S. & Yonemoto, K. (1998). Evaluation and treatment of shoulder subluxation in hemiplegia. American Journal of Physical Medical and Rehabilitation, 77(5), 421-426.

Jespersen. H.F., Jorgensen, H.S., Nakayama, H & Olsen, T.S. (1995) . Shoulder pain after a stroke. International Journal of Rehabilitation Research. 18(3), 273 - 276.

Joynt, R.L. (1992). The source of shoulder pain in hemiplegia. Achieves physical medicine rehabilitation, 73, 409-413.

Kaplan, M.G. (1995). Hemiplegic shoulder pain - early prevention and rehabilitation. The Western Journal of medicine, 162(2), 1- 3.

Kong, K.H., Woo, V.C. & Yang, S.Y. (2004). Prevalence of chronic pain and impact on health-related quality of life in stroke survivors . Archieves Physical Medicine Rehabilitation, 85 , 35- 40.

Kumar, R., Metter, F.,Melltar-A.J & Chew,T. (1990). Shoulder pain in hemiplegia: The role of exercises. American Journal of Physical Medicme and Rehabilitation, 69,205-208.

Lo, S.F., Chen, S.Y., Lin, H.X., Jim, Y.F., Meng, N.H & Kao, J.

(2003). Arthrographic and clinical findings in patients with hemiplegic shoulder pain. Achieves physical medicin e rehabilitation 84, 1786-1791.

Mclean, D.E. (2004). Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Achieve Physical Medicine Rehabilitation, 85, 466-469 .

Ouwenaller, C.V., Laplace, P.M. & Chantraine, A. (1986). Painful shoulder in hemeplegia. Archieves Physical Medicine Rehabilitation. 67,23-25.

Poulin de Courval, L., Barsauskas, A., Berenbaum, B., Dehaut, F., Dussault , R., Fontaine F.S., Labrecque , R., Leclerc, C. & Giroux, F. (1990). Painful shoulder in the hemiplegic and unilateral neglect. Achieve Physical Medicine Rehabilitation, 71, 673-676.

Ratnasabapathy ,Y., Broad, J. , Baskett,J.,Pledger,M., Marshall, J. & Bonita, R. (2003). Shoulder pain in people with a stroke: A population - based study. Clinical Rehabilitation. 17. 304-311.

Rizk, T.E., Christopher, R.P., Pinals, R.S. Salazar, J.E. & Higgins, C. (1984). Arthrographic studies in painful hemiplegic shoulders . Archiv es physical medicine rehabilitation, 65, 254- 256.

Roy, C.W., Sands, R.M. & Hill, L.D. (1994). Shoulder pain in acutely admitted hemiplegics. Clinical rehabilitation, 8, 334-340.

Shai, G., Ring, H., Costeff , H. & Solzi, P. (1984). Glenohumera l malalignmnet in the hemiplegic shoulder. Scandinavian Journal of Rehabilitation Medicine, 16, 133-136.

Snels I.A.K., Beckerman, H., Lankhorst, G.L. & Bouler, L.M. (2002). Risk factors for hemiplegic shoulder pain: A systemic review. Clinical Reviews in Phys ic Re!Jabil{tation fyfedicine, 14(3&4), 223-233.

Turner - Stokes, T. & Jackson, D. (2002). Shoulder pain after stroke: A review of the evidence base to inform the development of an integrated care pathway. Clinical Rehabilitation. 16, 276-298 .

Van Ouwenaller, C., Laplace, P.M.& Chantraine, A . (1986). Painful shoulder in hemiplegia. Arch ives Physical Medicine Rehabilitation , 71, 23-25.

Wanklyn, P., Forster, A. & Young, J. (1996). Hemiplegic shoulder pain: Natural history and investigation of associated features. Disability and Rehabilitation, 18, 479-501.

Zorowitz , R.D., Hughes, M.B., lkai, D.I.T. & Johnston, M.V. (1996). Shoulder pain and subluxat ion after stroke: Correlation or Coincidence? The American Journal of Occupational Therapy. 50(3), 194-201.