Shoulder pain is common after a brain injury, not only in the acute phase but also in the chronic phase.

It is often a very severe pain.

 

Especially after a stroke (CVA) in the acute phase, there is a chance of a form of shoulder pain. About 30-40% of people with a stroke got pain in their shoulder within a few days to weeks. This is especially seen in people with half-sided paralysis.

Usually the shoulder pain is on the same side of the body (ipsilateral) as where the stroke occurred in the head. This is also called 'hemiplegic shoulder pain' (HSP).

Shoulder pain also occurs with other brain injuries.

 

It may be caused by:

• A damage to the brachial plexus. The brachial plexus is a cluster of nerve tissues above the collarbone. From there, nerves run to the shoulder, the arm, and the hand.

 

• Frozen shoulder (see below or follow this link)

 

• A tear of the tendon (tendon rupture). The muscle tendon in question tears partially or completely. People often hear a popping sound when an arm is injured. It is accompanied by very severe pain. After that, there is a loss of muscle function. Often a bruise and swelling are visible.
  

 

• Bursitis, inflammation of the bursa
  

 

• Tense muscles of the shoulder girdle

 

• Shoulder-handsyndrome -  form of complex regional pain syndrome (CRPS))

 

• Forced position / contracture. See next paragraph or
  follow this link

 

• A subluxation in the shoulder joint. The upper arm then partially dislocates. See further down this page

 

• Pain due to spasticity

 

• Cramps in muscle groups which can cause pain between the shoulder blades. This is partly due to sensory overstimulation which can lead to temporary changes in the control of muscle groups from the cranial nerves. This can cause muscle cramps and pain.

 

• Neuralgic amyotrophy or brachial plexus neuropathy. This is a disorder of the nerves with characteristic recurring attacks of pain in the shoulder, arm and/or hand. Complete or partial paralysis of the muscles in these areas can then occur. There are many factors that can play a role in the development. All these factors play a role in the immune system. Among other things, stretching and pulling on the nerves of the plexus can make the border between the nerve and the bloodstream less closed and the nerve can thus become more vulnerable to damage by the immune system.

 

• TOS / Thoracic Outlet Syndrome / shoulder girdle syndrome is a collective name for conditions caused by compression of the vascular nerve bundle in the shoulder area. This vascular nerve bundle consists of an artery, a vein and a nerve ganglion. In the vast majority of people with TOS, it is caused by pressure on the arm nerves. In others, it is caused by abnormalities in the vascular system. More information can be found here.

 

• Tendinitis (tendinosis) of the tendon that connects the muscles of the arm to the bones. A tendon can become inflamed by a single or chronic overload. Tendinitis can also be caused by rheumatic diseases, an accident or microtraumas.

 

Shoulder pain can complicate rehabilitation!

 

Some shoulder pain syndromes highlighted

 

• Forced position or contracture
  If someone cannot move or has difficulty moving due to brain damage, joints and muscles can become very stiff. The muscles shrink and become shortened.
  This can lead to a contracture. This is a medical term for a movement restriction in the joint or muscles. After a while, someone can no longer use the muscles properly or straighten the arm or fingers.
  A contracture is very painful and hinders normal functioning.
  Examples: a hand that is in a forced fist position can no longer be used. A shoulder that is stuck makes it impossible to get dressed or grab something.

 

• Shoulder-Hand Syndrome (SHS)

Important information about shoulder-hand syndrome can be found via the link.

 

• Frozen shoulder

A frozen shoulder is not necessarily a result of brain injury. It turns out that there is a high chance that someone with brain injury will develop a 'frozen shoulder'.

A person with brain injury may develop a frozen shoulder or another type of shoulder pain on the paralyzed, affected side or on the unaffected side due to differences in posture and overload.

 

A frozen shoulder is a very painful adhesion of the shoulder capsule (capsulitis adhesiva) that can occur spontaneously or through overload.
The term 'frozen' does not refer to the temperature of the shoulder but to the severe stiffness of the shoulder joint.
People with diabetes and Parkinson's have a high chance of developing a frozen shoulder.

 

The capsule shrinks and as a result not only can one experience severe pain, but the movements of the arm are also severely limited.

One can hardly or not at all use the arm due to the pain.

The arm can no longer be raised or rotated, which means that the arm can no longer reach above the shoulder or behind the back. One can also not sleep on the arm or shoulder without severe pain.

 

Stages

• Stage 1 - usually lasts between two and nine months. The pain begins in the joint along with a feeling of stiffness and limited mobility/stiffness before becoming very painful. This pain is felt more at night and when the person lies on the affected side.

 

• Stage 2 - usually lasts between four and twelve months. All movements of the shoulder are affected as it becomes increasingly stiff, but the movement most affected is the outward rotation of the arm. Pain can increase significantly during this 'sticky' stage.

 

• Stage 3 - usually lasts between five and twelve months. During this 'recovery' stage, the shoulder gradually becomes more mobile as the stiffness disappears. The associated pain also decreases. Not all movements can be restored, although they can be performed less painfully.

 

A frozen shoulder will heal on its own within 10 months to three years. However, early treatment of a frozen shoulder can be important because it can help prevent long-term stiffness in the joints from increasing. It is important to see your doctor if you experience pain in your shoulder that interferes with your normal range of motion.

 

Possible therapy
Let the arm hang down as much as possible and then make a moving movement guided by the pain. Lift the affected arm up with the healthy arm to the pain threshold and let it drop again. Physiotherapy advice is highly recommended!
Try to keep the shoulders low and not to pull them up, not even during a movement. KEEP SHOULDERS LOW is the advice.

 

An injection into the capsule with corticosteroids that inhibit inflammation. The disadvantage is that this cannot be done too often, the risk of osteoarthritis in the joint is greater.
Stretching the capsule under anesthesia. This can be done with a laparoscopy or by moving the arm under anesthesia.

Physiotherapy is very important after such an operation.

 

• Subluxation of the shoulder
  

With a subluxation of the shoulder joint, the upper arm partially dislocates.
This is a common occurrence shortly after a stroke. The weakened muscles and low muscle tension (tonus) cause a gradual overload of the joint capsule. This can then lead to an incorrect position of the head of the upper arm (humerus). This can cause the arm to dislocate.