What is the pathophysiology of the synergy stage of hemiplegic shoulder pain?

Updated: Feb 08, 2019
  • Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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If neurologic impairment of the completed stroke progresses, synergy patterns, which tend to worsen with initiated efforts, may emerge. Cailliet proposes that the synergy component that usually occurs first is spastic elbow flexion; the shoulder phase is weaker and usually requires a more reflexive status to occur. [10]

The restrictions created by the synergy patterns create therapeutic challenges to attaining meaningful UE function. UE flexor synergy patterns include the following:

  • Shoulder/scapular depression (downward rotation and retraction)

  • Humeral adduction/internal rotation

  • Elbow flexion

  • Forearm pronation (rarely supination)

  • Wrist/finger flexion (thumb-in-hand position)

When treating patients in flexion synergy, aim therapy at retraining the overwhelmed agonists, stressing the desired components of function, and releasing the uninhibited flexion patterns by initiating opposite movements at the "key points of control."

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