Prevalence and Factors Related to Post Stroke Shoulder Pain in Hemiplegic Patients Receiving Home-based Rehabilitation in Post-acute Phase


  • Iamsoontorn K Department of Rehabilitation Medicine, Phatthalung Hospital, Phatthalung,Thailand


shoulder pain, shoulder subluxation, stroke, exercise, home-based rehabilitation


Objectives: To study the prevalence of shoulder pain and related factors in stroke patients with home-based rehabilitation in the post-acute phase.

Study design: Cohort study.

Setting: Phatthalung Hospital, Thailand.

Subjects: Stroke patients who had a home-based rehabilitation program and monthly follow-up for 6 months at Rehabilitation outpatient clinic from February 2019 to January 2020.

Methods: Demographic and medical data including types of stroke, motor power, sensation, the Brunnstorm’s arm recovery stage, shoulder subluxation, shoulder pain, self-care activities and home exercises, were recorded. Causes of shoulder pain was identified and treated until resolved. Factors such as using an overhead pulley for range of motion exercise and not using a shoulder sling while walking, were evaluated and analyzed.

Results: Of 110 patients, 58% reported shoulder pain, mean age was 64.14 (SD 13.91) years old, 80.9% had ischemic stroke, 58% had left side weakness, 52.7% had impaired sensation, 41.8% had the Brunnstorm’s arm recovery stage 1, and 50% had shoulder subluxation. Of those with shoulder pain, 64.1% developed shoulder pain within a month after onset. The most common diagnosis of shoulder pain was impingement syndrome (57.8%). Impaired sensation (adjusted OR=17.52; 95% CI 4.74-64.78), using an overhead pulley for range of motion exercise (adjusted OR = 33.92; 95% CI 3.35-343.39 ), and walking without a shoulder sling (adjusted OR = 11.68; 95% CI 1.28-106.88), were significantly associated with post stroke shoulder pain (p < 0.05).

Conclusion: Post stroke shoulder pain was common among patients with home-based rehabilitation during post-acute phase. Factors significantly associated with shoulder pain were having an impaired sensation, using an overhead pulley for shoulder range of motion exercise, and not using a shoulder sling while walking. Patient education including using a shoulder sling and not using an overhead pulley for shoulder exercise at home exercise should be emphasized to prevent shoulder pain.


Download data is not yet available.


Gilmore P, Spaulding S, Vandervoort A. Hemiplegic shoulder pain: implications for occupational therapy treatment. Can J Occup Ther. 2004;71:36-47.

Kalichman L, Ratmansky M. Underlying pathology and associated factors of hemiplegic shoulder pain. Am J Phys Med Rehabil. 2011;90:768-80.

Suethanapornkul S, Kuptniratsaikul P, Kuptniratsaikul V, Uthensut P, Dajpratha P, Wongwisethkarn J. Post stroke shoulder subluxation and shoulder pain: a cohort multicenter study. J Med Assoc Thai. 2008;91:1885-93.

Coskun BI, Basaran S. Hemiplegic shoulder pain: a common clinical consequence of stroke. Pract Neurol. 2014;14:88-91.

Wilson R, Chae J. Hemiplegic shoulder pain. Phys Med Rehabil Clin N Am. 2015;26:641-55.

Gamble GE, Barberan E, Laasch HU, Bowsher D, Tyrrell PJ, Jones AK. Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke. Eur J Pain. 2002;6:467-74.

Malhotra A, Mackey S. Outcomes in pain medicine: a brief review. Pain Ther. 2012;1:1-10.

Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155:2545-50.

Lyden P. Using the National Institutes of Health Stroke Scale. Stroke. 2017;48:513-9.

Jeong YG, Jeong YJ, Koo JW. The effect of an arm sling used for shoulder support on gait efficiency in hemiplegic patients with stroke using walking aids. Eur J Phys Rehabil Med. 2017;53:410-5.

Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery. Stroke 2016;47:e98-e169. 000098.

Han SH, Kim T, Jang SH, Kim MJ, Park S, Yoon SI. The effect of an arm sling on energy consumption while walking in hemiplegic patients: a randomized comparison. Clin Rehabil. 2011;25:36-42.

Vasudevan JM, Browne BJ. Hemiplegic shoulder pain: an approach to diagnosis and management. Phys Med Rehabil Clin N Am. 2014;25:411-38.

Walsh K. Management of shoulder pain in patients with stroke. Postgrad Med J. 2001;77: 645-49.

Patcharawiwatpong P. Common problems of upper extremity in stroke patients. J Thai Rehabil Med. 2002;12:44-62.

Kumar R, Metter EJ, Mehta AJ, Chew T. Shoulder pain in hemiplegia: the role of exercise. Am J Phys Med Rehabil. 1990;69:205-8.

Lindgren I, Jönsson A, Norrving B, Lindgren A. Shoulder pain after stroke: a prospective population-based study. Stroke. 2007;38:343-48

Ratnasabapathy Y, Broad J, Baskett J, Pledger M, Marshall J, Bonita R. Shoulder pain in people with a stroke: a population-based study. Clin Rehabil. 2003;17:304-11.

Dabholkar A, Mehta D, Yardi S, Dabholkar T. Assessment of scapular behaviour in stroke patients. Int J Health Rehabil Sci. 2015;4:95-102.

Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017;9:75-84.

Murie-Fernández M, Iragui MC, Gnanakumar V, Meyer M, Foley N, Teasell R. Painful hemiplegic shoulder in stroke patients: causes and management. Neurologia. 2012;27:234-44.

Zhou M, Li F, Lu W, Wu J, Pei S. Efficiency of neuromuscular electrical stimulation and transcutaneous nerve stimulation on hemiplegic shoulder pain: a randomized controlled trial. Arch Phys Med Rehabil. 2018;99:1730-9.

Park S, Kim HJ, Kim DK, Kim TH. Use of oral prednisolone and a 3-phase bone scintigraphy in patients with complex regional pain syndrome type I. Healthcare (Basel). 2020;8(1):16. doi: 10.3390/healthcare8010016.

Shin S, Yang S,Yu A, Yoo J, Lim, Lee E. Effectiveness and safety of electroacupuncture for poststroke patients with shoulder pain: study protocol for a double-center, randomized, patient- and assessor-blinded, sham-controlled, parallel, clinical trial. BMC Complement Altern Med. 2019;19(1):58. doi: 10.1186/s12906-019-2468-x..

Wongsithichai P, Pongurgsorn C. Effect on therapeutic elastic taping in reducing pain in hemiplegic shoulder: a preliminary study. J Thai Rehabil Med. 2014;24:95-102.

Huang YC, Leong CP, Wang L, Wang LY, Yang YC, Chuang CY, et al. Effect of kinesiology taping on hemiplegic shoulder pain and functional outcomes in subacute stroke patients: a randomized controlled study. Eur J Phys Rehabil Med. 2016;52:774-81.

Adel-Walkeling Z, Crotty M, Shanahan EM. Suprascapular nerve block for shoulder pain in the first year after stroke: a randomised controlled trial. Stroke. 2013:44:3136-41.

Boonsong J, Jaroenarpornwattana A. Preliminary study of suprascapular nerve block (SSNB) in hemiplegic shoulder pain. J Med Assoc Thai. 2009;92:1669-74.

Rah UW, Yoon SH, Moon DJ, Kwack KS, Hong JY, Lim YC, et al. Subacromial corticosteroid injection on poststroke hemiplegic shoulder pain: a randomized, triple-blind, placebo-controlled trial. Arch Phys Med Rahabil. 2012;93:949-56.






Original Article