What is the role of glenohumeral capsulitis in the etiology of hemiplegic shoulder pain?

Updated: Feb 08, 2019
  • Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Glenohumeral capsulitis is postulated to play an important role in hemiplegic shoulder pain. Patients usually present with pain and limited passive movement of the shoulder, especially external rotation and abduction.

Joynt reported that adhesive changes may reflect a later stage in the recovery process, when chronic irritation or injury, inflammation, or lack of movement eventually results in adhesions. [32]

When Rizk and colleagues performed shoulder arthrography in 30 patients with hemiplegic shoulder pain, they found changes in 77% of patients that were consistent only with capsular restriction typical of adhesive capsulitis. [33] This finding suggests an association between adhesive changes and shoulder pain.

A study by Wanklyn and coauthors found an association between reduced ROM (specifically, external rotation) and hemiplegic shoulder pain, with an incidence as high as 66%. [25] This association was believed to be due to abnormal muscle tone or structural changes, namely adhesions. Because diminished ROM resulting from either shoulder spasticity or from adhesive capsulitis presents similarly, it is often difficult to distinguish whether pain in the limited hemiplegic shoulder is arising from capsulitis or spasticity, or from a combination of both.

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