Shoulder pain in the patient with hemiplegia

Shoulder pain in the affected upper extremity of patients with hemiplegia is of fundamental concern to occupational therapists who are working for increased independence of patients. The author interviewed several other occupational therapists, reviewed recent literature and completed a survey of charts of 30 patients. The literature and the therapists' responses indicated a higher frequency of pain than the author anticipated. The chart review was completed (1) to determine objectively the frequency of shoulder pain or subluxation in patients with hemiplegia, and (2) to ascertain the use of the upper extremity and the performance of functional activities of those patients who had shoulder pain or subluxation. Although the number in the sample of charts was too small to yield more than an indication of problems, 3 group patterns emerged based on the differences in functional use of the upper extremity. These 3 patterns of function were compared with findings in the literature. Further study is suggested to assess pain and its responses to occupational therapy, during both the acute and chronic phases of care. The goal of research would be to better predict which patients would develop shoulder pain, thereby helping to prevent long-term complications.