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Shoulder Pain after Neurological Injury
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| Cause | History Features | Examination Findings | Investigations | Management |
|---|---|---|---|---|
| Hypotonia and Subluxation | Pain at rest (especially if unsupported) and/or movement-related pain | Low tone, inferior subluxation evident | X-ray shows inferior subluxation; Ultrasound may show rotator cuff tears or tendinosis | Strengthening exercises, neuromuscular electrical stimulation, kinesiology taping; corticosteroid injections if inflammation is present; surgical referral in refractory cases |
| Spasticity | Pain and/or stiffness; spasticity may worsen with pain | Velocity-dependent increase in tone, internal rotation, and adduction; anterior subluxation of the humeral head | X-ray may show anterior subluxation; Ashworth scale used for severity | Address aggravating factors, therapist-led positioning, botulinum toxin, oral spasticity medications; surgical release in severe cases |
| Subacromial Pain Syndrome | Pain worsens with or after lifting the arm | Malalignment of the shoulder joint; poor scapulohumeral rhythm; worsened pain during/after lifting | X-ray may show osteoarthritis or osseous abnormalities; Ultrasound shows tendinopathy, tears, bursitis | Supervised exercise program, corticosteroid injection, surgical referral for refractory cases (e.g., decompression, rotator cuff repair) |
| Frozen Shoulder | Pain-dominant early phase, stiffness-dominant later phase | Gradual loss of active and passive range of motion, particularly external rotation | X-ray to exclude skeletal pathology; Ultrasound shows thickened capsule and diminished axillary recess | Stretching and strengthening exercises, intra-articular corticosteroid injections, hydrodilatation; surgical options include manipulation or arthroscopic release |
| Shoulder-Hand Syndrome | Allodynia, hyperalgesia, pain at night; dystonia or tremor possible | Swelling, discolored and cool skin, altered sensation, dystrophic skin | Clinical diagnosis; imaging to rule out other conditions | Neurorehabilitation referral, multidisciplinary pain management, suprascapular nerve block for acute cases |
| Other Factors (e.g., Central Post-Stroke Pain) | Burning pain, hypersensitivity; may accompany stroke-related deficits | Misinterpretation of sensory inputs, allodynia, hyperalgesia | Thalamic or medullary stroke on imaging | Neuropathic pain medications (e.g., amitriptyline, gabapentin); psychological support; multidisciplinary approach |
