Recent advances in the management of hemiplegic shoulder pain

Stroke is a debilitating neurological disorder with hemiplegia as most common presentation. Hemiplegic shoulder pain (HSP) affects a large number of stroke survivors and is associated with significant morbidity and low quality of life (QoL). The etiology is multifactorial and therefore the management is multipronged. Traditionally, oral analgesics have been advised with physical therapy and intra-articular steroid injections. This narrative review discusses emerging treatment strategies for HSP. It focuses on four key new treatments; electric stimulation, the use of robotics, intraarticular injections of novel anti-inflammatory agents, and pulsed radiofrequency treatment. Multiple studies have assessed the efficacy of these techniques and have found the efficacy and side effect profile to be comparable or superior to current management strategies for HSP. Integrating these interventions in the multidisciplinary rehabilitation programmes for stroke patients, can improve the management of HSP and reduce stroke related morbidity and disability.