Arthrographic studies in painful hemiplegic shoulders

The rehabilitation of hemiplegic patients is often prolonged by the problem of painful shoulder. The specific etiology of this problem is controversial and treatment does not always produce the desired results. Thirty hemiplegic patients with painful, stiff ipsilateral shoulder joints were studied. The mean interval from the onset of stroke to the onset of painful shoulder was 3 months. On shoulder arthrography, 23 patients had capsular constriction typical of frozen shoulder (adhesive capsulitis). Seven patients had normal arthrograms. None showed rotator cuff or capsular tears. Electromyography revealed electrical silence in the shoulder musculature at rest. These findings indicate that the painful, stiff shoulder developing after hemiplegia is not caused by rotator cuff tear or by spasticity, but probably has a pathogenesis similar to that of idiopathic frozen shoulder.