How is hemiplegic shoulder pain prevented?

Updated: Feb 08, 2019
  • Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

Wheelchair armrests, lap trays, or forearm troughs are commonly used while the patient is in his or her wheelchair. Rigid armboards often are preferred to the use of slings while the patient is in the wheelchair because they allow the humeral head to approximate the glenoid fossa at a more natural angle and are less restrictive. Armrests also benefit the patient as the arm is in a nondependent position, thereby decreasing the incidence of edema. Armrests also can be used as an alternative for patients with decreased trunk control.

Even though optimal positioning is mandated, Kaplan suggested that judicious ROM exercises (through therapy) should be started within 24 hours poststroke. [34]

When moving patients in bed, or transferring them in and out of the wheelchair, positions of dependent arm traction should be avoided. When passive transfers are performed, the hemiplegic arm needs to be supported by holding the scapula rather than pulling on the arm.

About one third of stroke patients studied by Wanklyn and colleagues required assistance during transfers and tended to be at risk for incorrect handling by their caregivers, subsequently predisposing them to the development of shoulder pain. [25] Traction and excessive shoulder movement need to be avoided in order to prevent impingement or a rotator cuff tear.


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