Shoulder Pain in Stroke Survivors: How to Identify Common Causes and Solutions

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Sep 16, 2020

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Know a stroke survivor with shoulder pain? Its a common complaint, and a major source of anxiety for survivors and caregivers alike. Shoulder pain affects stroke survivors independence and long-term quality of life. Yet, survivors often struggle to have their pain adequately addressed. The following is a discussion of 2 frequent contributors to shoulder pain in stroke survivors, how to recognize them, and potential methods of treatment.
Contributor 1: Physical injury. Physical damage to the shoulder can pre-date stroke, but may also occur due to accidental mishandling/poor positioning of the limb. Stroke survivors commonly experience changes in muscle tone, sensation, or both. Structures that are too loose or tight can easily become torn or injured.
Signs of physical injury: Pain can be pin-pointed. May be triggered with a specific movement, activity, or position. Pain quality may be sharp, sudden, throbbing, or achy.
Contributor 2: Central Pain Syndrome (CPS). CPS is pain resulting from damage to the brain, rather than damage to the shoulder. The stroke survivor perceives pain, but no physical injury is present. This DOES NOT mean that the pain the person feels is not real. CPS is as real as any pain felt following injury to the body.
Signs of CPS: Pain is harder to pin-point. May be constant. May be triggered by gentle touch. Pain quality may be numb, tingly, burning, aching, or sharp.
IMPORTANT: The symptoms for each type of pain are not always straight-forward. Both types of pain CAN exist simultaneously.
So, what can be done?
For pain due to physical injury, the injury must be treated. Depending on available shoulder movement, treatment might include targeted exercise, stretching, manual therapy, task/environmental adaptation, positioning, and modalities.
For pain due to CPS, methods such as mirror therapy, meditation, and sensory re-education might be used. Because pain causes are complex, experienced therapists use a customized combination of methods to achieve the best results.
Whatever underlies pain, its imperative that the survivor be treated with compassion and empathy. Easing painful shoulders after stroke requires a high level of skill. Showing you care is easy, and can also provide welcome relief.
Author, Emilia Bourland, is an occupational therapist and the owner of AIPC Therapy, a mobile therapy practice serving the greater DFW area. You can contact her by calling 469-998-1245 or sending an e-mail to

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