Hemiplegic Shoulder Pain: A Narrative Review

Abstract

Hemiplegic shoulder pain is a common post-stroke complication that negatively affects functional recovery. It is caused by both mechanical and neurological factors. Prevention focuses on proper positioning, patient education, and maintenance of motion. Treatment remains largely conservative; with increasing research surrounding injection therapies, including intra-articular corticosteroid injection, subacromial hyaluronic acid injection, suprascapular nerve blocks, and botulinum toxin injection, all of which have demonstrated improved pain control. Functional electrical stimulation appears to be beneficial, and adjunct therapies such as supportive devices and robotic training may further enhance conventional treatment. Herewith, evidence regarding medications and acupuncture remains limited. Emerging treatments including high-intensity laser therapy and repetitive transcranial magnetic stimulation are promising; however, large-scale trials are needed to confirm their efficacy.