Hemiplegic Shoulder Pain Management After Stroke

Hemiplegic shoulder pain (HSP) is a frequent and debilitating complication following stroke, affecting up to half of survivors and impeding upper limb recovery. It arises from a combination of factors including paresis, spasticity, soft tissue injury and glenohumeral subluxation. Patients typically experience pain during passive movement, interference with rehabilitation and diminished quality of life. Effective management demands a multidisciplinary approach that encompasses accurate assessment of motor impairment and musculoskeletal integrity, targeted physiotherapy to restore alignment and function, and the judicious use of adjunctive interventions. Rehabilitation programmes focus on gentle mobilisation, shoulder stabilisation exercises and neuromuscular re-education to prevent contractures and maintain joint congruence. Pharmacological strategies may include oral analgesics, muscle relaxants and corticosteroids for acute exacerbations. For persistent or refractory pain, focal treatments such as botulinum toxin injections or nerve blocks are employed to reduce spasticity and nociceptive input. Emerging modalities—ranging from high-intensity laser therapy to functional magnetic stimulation and robotic assistance—show promise in modulating pain pathways and enhancing muscular support of the shoulder girdle. Early recognition of risk factors such as severe motor deficits and neglect is critical to preventing HSP and optimising long-term functional outcomes.

Research from Nature Portfolio

Recent clinical trials have explored high-intensity laser therapy as an adjuvant to conventional rehabilitation. In a randomised controlled study, three sessions of laser therapy per week combined with therapeutic exercise yielded significantly greater reductions in pain scores alongside improvements in shoulder function and grip strength compared with exercise alone. These findings suggest that photobiomodulation can enhance tissue repair and modulate inflammatory mediators, offering a non-invasive option to accelerate recovery in patients with hemiplegic shoulder dysfunction.

Hemiplegic Shoulder Pain Management After Stroke publication trend

The graph below shows the total number of articles in hemiplegic shoulder pain management after stroke across all publications each year (not limited to Nature Index journals).

Technical terms

Hemiplegic shoulder pain (HSP): Pain arising in the shoulder of the affected side following stroke, often associated with weakness, spasticity and joint misalignment.

Spasticity: Increased muscle tone and exaggerated tendon reflexes resulting from upper motor neuron lesions, contributing to joint stiffness and discomfort.

Glenohumeral subluxation: Partial dislocation of the shoulder joint due to muscle imbalance and loss of stability within the glenoid-humeral articulation.

High-intensity laser therapy (HILT): A photobiomodulation technique using concentrated light energy to promote tissue healing and reduce inflammation.

Botulinum toxin A (BTA): A neurotoxin used to induce controlled muscle relaxation by inhibiting acetylcholine release at the neuromuscular junction, thus reducing spasticity.

Suprascapular nerve block (SSNB): Local anaesthetic injection targeting the suprascapular nerve to provide analgesia for shoulder pain without systemic side effects.

References

1. Effectiveness of a high-intensity laser for improving hemiplegic shoulder dysfunction: a randomized controlled trial. Scientific Reports (2024).
2. The Place of Botulinum Toxin in Spastic Hemiplegic Shoulder Pain after Stroke: A Scoping Review. International Journal of Environmental Research and Public Health (2023).
3. Incidence, Prevalence, and Risk Factors of Hemiplegic Shoulder Pain: A Systematic Review. International Journal of Environmental Research and Public Health (2020).
4. Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis. Pharmaceuticals (2021).
5. Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients. BioMed Research International (2018).
6. Robotic therapy for the hemiplegic shoulder pain: a pilot study. Journal of NeuroEngineering and Rehabilitation (2020).