Hemiplegia is a total or partial paralysis in one side of the body, most often caused by a stroke. Researchers believe that hemiplegia can predispose the affected shoulder to new injuries or aggravate pre-existing conditions such as arthritis and tendonitis. Shoulder pain and stiffness can begin as early as two weeks after the stroke, but typically occur two or three months later. After a year following the stroke, approximately a quarter of patients develop hemiplegic shoulder pain. Rehabilitation can help reduce pain in most cases.
Positioning
Gravitational stress exacerbates shoulder pain, and so proper positioning and handling of the shoulder before or after the onset of hemiplegia are necessary for its prevention and treatment. A medical professional or some other carefully instructed observer must analyze and correct the position of the patient according to strict procedures from a doctor, and then provide adequate support and protection for the shoulder. This individual or group of people will lift and move the patient out of bed or assist the patient into a sitting position.
Immobilization Devices
The doctor may recommend a splint for the shoulder to protect the brachial plexus, an arrangement of nerves near the shoulder, until regeneration of the nerves can occur. For the most part, however, many immobilization devices aren't necessarily more effective in preventing or reducing subluxation, which is the dislocation of a joint, and may actually cause overcorrection in the shoulder. If the patient is confined to a wheelchair, then devices such as a padded arm trough, lapboard and overhead sling remain questionable, as immobilization can contribute to the deterioration in the flexibility and strength of the shoulder.
Drugs and Stimulation
Your doctor may work to control the pain through analgesics, medication, nerve blocks, nonsteroidal anti-inflammatory drugs and intra-articular injection of corticosteroids, meaning an injection into the joint. Corticosteroids regulate inflammation, metabolism and the immune response. Other treatments, including ultrasounds and electrical stimulation, often accompany a physical therapy regimen. They work by decreasing pain and increasing sensory feedback during recovery.
Physical Therapy
Because range of motion is lost quite early, the patient will embark upon a physical therapy routine in the first few days following the stroke. Preserving of the range of motion in the joint happens through early passive exercise. The therapist will at first limit the range of the exercise to pain-free movements. Over time, he or she will introduce weight-bearing and more active exercises as the pain dictates. Preventing spasticity, or an increased tightness in the muscles, is one of the main goals, since shoulder pain has the capacity to complicate the rehabilitation process. Eventually, physical therapy should increase muscle strength and mobility. A therapist or doctor who has specific knowledge of biomechanical principles will recommend specific exercises for you.
