Treatment Protocol for Hemiplegic Shoulder Pain

Current standard treatment of post-stroke shoulder pain includes joint protection (i.e., slings and protective positioning) and stretching/strengthening exercises through a pain-free range. Although the added movement of the shoulder blade when moving the post-stroke arm has been recommended in the literature, no studies to date have been found which directly looks at the impact of providing synchronized three-dimensional scapular and humeral movement during therapy. Due to the integral relationship between the scapula and the humerus during movement, it is hypothesized that an increase in 3-dimensional shoulder blade mobility in the painful post-stroke shoulder will contribute to increased pain-free 3-dimensional arm movement. This double-blind randomized-controlled study aims to investigate the effectiveness of this 3-D approach at addressing post-stroke shoulder pain.

Inclusion criteria

• diagnosis of shoulder pain secondary to altered alignment and/or neuro-muscular movement patterns post-stroke;
• medically stable and 2-24 months post onset of stroke;
• between stages of 2-5 of the Chedoke-McMaster stages of upper extremity motor recovery;
• not currently receiving any other active neuro-rehabilitation intervention to promote stroke recovery;
• cognitively able to provide informed consent, follow specific testing commands, and communicate their level of pain during assessment and treatment.

Exclusion criteria

• a history of shoulder pain prior to the onset of the stroke;
• shoulder pain which is secondary to any history of trauma, fractures, arthritis or joint instability of the neck, spine, ribs, or shoulder girdle before or after the stroke; possible rotator cuff tears;
• shoulder-hand syndrome; thalamic or central pain; spinal cord pathology; osteoporosis;
• any medical condition which may affect the ability to participate in an active rehabilitation exercise program (i.e., uncontrolled hypertension or angina).