Retrospective Cohort Study on the Incidence and Management of Hemiplegic Shoulder Pain in Stroke Inpatients

Painful hemiplegic shoulder (PHS) is a prevalent and challenging complication following a stroke and can significantly impair a patient's engagement in rehabilitation, leading to poorer functional outcomes and extended hospital stays. This retrospective cohort study aims to investigate the incidence, etiology, and management of PHS in stroke inpatients, focusing on the effectiveness of various therapeutic interventions.

We conducted a retrospective analysis of subacute stroke inpatients who developed PHS during rehabilitation at a single center. Medical records were reviewed to assess the incidence of PHS, underlying causes, and treatment modalities. Primary outcome measures included the prevalence of PHS, the distribution of identified etiologies, and therapeutic outcomes associated with different management strategies.

Our findings revealed a significant prevalence of PHS among stroke inpatients, consistent with existing literature. The multifactorial etiology included spasticity, adhesive capsulitis, glenohumeral subluxation, central post-stroke pain, and complex regional pain syndrome, with advanced age, low functional scores, motor and sensory impairments, and comorbidities such as diabetes mellitus identified as key risk factors. Management strategies ranged from conservative approaches, such as physical modalities and slings, to advanced interventions, including intra-articular corticosteroid injections, botulinum toxin type A applications, nerve blocks, and radiofrequency neuromodulation. Corticosteroid injections and electrical stimulation were particularly effective in alleviating pain and improving functional outcomes. Notably, pulsed radiofrequency modulation targeting the suprascapular and axillary nerves showed superior efficacy in enhancing the passive range of motion compared to conventional nerve blocks, although the effectiveness of botulinum toxin type A was inconsistent.

This study emphasizes the multifaceted nature of PHS in stroke inpatients, underlining the importance of individualized and comprehensive treatment strategies. While several therapeutic interventions, particularly corticosteroid injections and pulsed radiofrequency, demonstrated effectiveness, the variability in treatment outcomes highlights the need for further investigation. Future research should focus on larger patient cohorts with extended follow-up periods to better elucidate the progression of PHS and refine management approaches. Despite limitations, including the retrospective study design and a short follow-up period, these findings provide valuable insights into the prevalence, progression, and treatment of PHS in stroke rehabilitation.