Shoulder pain and subluxation after stroke: correlation or coincidence?

Few studies have concomitantly examined shoulder subluxation and other potential causes of shoulder pain in persons who have had a stroke. This study explores whether shoulder pain after stroke is related to shoulder subluxation, age, limitations in shoulder range of motion, and upper extremity motor impairment.

Shoulder pain was measured with a visual analog scale in 20 subjects admitted to a rehabilitation hospital within 6 weeks of onset of their first stroke. Degree of shoulder pain was correlated with vertical, horizontal, and total asymmetries of glenohumeral subluxation; age; shoulder flexion, abduction, and external rotation; and the upper extremity subscore of the Fugl-Meyer Motor Assessment.

Shoulder pain after stroke was not correlated with age (rk = .019, p = .916); vertical (rk = .081, p = .324), horizontal (rk = .126, p = .241), or total asymmetry (rk = -.098, p = .288); shoulder flexion (rk = .049, p = .390) or abduction (rk = -.074, p = .337); or Fugl-Meyer scores (rk = -.123, p = .257). In contrast, shoulder pain was strongly correlated with degree of shoulder external rotation (rk = -.457, p = .006).

These results do not support a strong relationship between shoulder subluxation and pain after stroke. Appropriate precautions should be taken to prevent range of motion limitations that may result in shoulder pain.