Hemiplegic shoulder pain: an approach to diagnosis and management

Stroke is a significant source of mortality and long-term disability in the United States. Of persons who survive a stroke, approximately 50% will have hemiplegia, half of whom will live with a nonfunctional arm. Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, reduces participation and worsens outcomes in rehabilitation. Management of HSP is challenging because its causes are multifactorial and there is limited, conflicting, or nonspecific evidence in support of most treatments. This article develops an effective approach for diagnosis and treatment using the best available evidence to aid practitioners in obtaining optimal results.