Hemiplegic shoulder syndrome: possible underlying neurophysiological mechanisms

• Published in: Physical therapy reviews 2005-03, Vol.10 (1), p.51-58
• Main Authors: Fotiadis, F., Grouios, G., Ypsilanti, A., Hatzinikolaou, K.
• Format: Article
• Language: English
• Subjects: CAUSES; DIAGNOSIS; HEMIPLEGIC SHOULDER SYNDROME; NEUROPHYSIOLOGICAL MECHANISMS; PAIN
• ISSN: 1083-3196; 1743-288X
• DOI: 10.1179/108331905X43445

Secondary musculoskeletal complications, resulting in glenohumeral subluxation, stiffness and shoulder pain, are particularly common after stroke. Estimated prevalence of stroke patients with shoulder pain of up to 84% have been cited, and shoulder pain is recognised as a substantial cause of poor recovery of upper limb function after stroke. Pain occurs either as a result of muscle imbalance with loss of joint range, impingement of the shoulder capsule through the range of movement, improper muscle stretching, tendonitis, altered sensitivity, or sympathetic changes. Several neurophysiological mechanisms, such as weakness, muscle imbalance, spasticity or abnormal patterns of activation, have been identified as the underlying causes behind the clinical manifestations of shoulder pain. It seems that a number of neurophysiological mechanisms, as well as a wide range of clinical conditions are masked under the term 'hemiplegic shoulder syndrome'. Careful differential diagnosis, early intervention, and standardisation of terminology amongst health professionals seem to be the key to more effective management, and a better outcome for such patients.