The Shoulder following Stroke: Preserving Musculoskeletal Integrity for Function

A major role of the upper limbs is in actions involving reaching for objects in order to interact with the environment. After stroke, the primary motor impairment is decreased motor unit activation, which results in muscle weakness or paralysis. As a result of lack of use of the limb and persistent positioning in its resting position, secondary adaptive changes occur that result in muscle stiffness and length-associated changes. Shoulder pain is common, negatively affecting outcome. This article discusses the mechanisms causing the painful stiff glenohumeral joint and subluxation and argues the need for preventing these sequelae by early active training of the limb, together with vigorous methods of preserving muscle length and mechanical flexibility. If pain develops, early diagnosis of pathological mechanisms and appropriate treatment should take place as in the nonstroke population.