SHOULDER PAIN IN HEMIPLEGIA - ETIOLOGY, P REVENTION AND THERAPY

Shoulder pain is a frequent and major obstacle in motor rehabilitation of the upper extremity in stroke patients. In most cases, shoulder pa in comes up between the second and the eighth week post-stroke, The pr esent paper discusses the influence of mechanical and muscular factors , including spasticity, on the stability of the glenohumeral joint. In the absence of muscular function, shoulder subluxation develops soon after stroke and may - together with uncautious manipulation of the af fected arm - cause unphysiological stretching of the joint capsule as well as impingements of periarticular soft tissue. Several types of ar m supports, particularly the Harris-sling, are recommended to improve glenohumeral alignment. All members of the therapeutic team, the patie nts and their relatives should be informed in detail about the mechani sms that contribute to the development of shoulder pain. Functional el ectrical stimulation (FES) as well as early physiotherapeutic approach es aiming at facilitating activity in the supraspinatus and deltoid mu scles proved effective in reducing the severity of shoulder subluxatio n and pain. Possible additional pharmacological interventions are disc ussed.