title: [Painful hemiplegic shoulder in stroke patients: causes and management].
abstract: BACKGROUND
  The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome.
  
  
  METHODS
  We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions.
  
  
  CONCLUSIONS
  Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.
authors.affiliation: Departamento de Neurología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, España. manumurie@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Murie-Fernández
authors.forename: M
authors.initials: M
authors.lastname: Carmona Iragui
authors.forename: V
authors.initials: V
authors.lastname: Gnanakumar
authors.forename: M
authors.initials: M
authors.lastname: Meyer
authors.forename: N
authors.initials: N
authors.lastname: Foley
authors.forename: R
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000203:Activities of Daily Living; D001905:Botulinum Toxins / Q000627:therapeutic use; D006429:Hemiplegia / Q000209:etiology* / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D059408:Pain Management; D026741:Physical Therapy Modalities; D000070599:Shoulder Injuries; D020069:Shoulder Pain / Q000209:etiology* / Q000534:rehabilitation / Q000628:therapy*; D020521:Stroke / Q000150:complications*
chemical_list: D001905:Botulinum Toxins