Post-stroke shoulder pain in the medical rehabilitation phase (pilot study)

Introduction . Post-stoke shoulder pain (PSSP) commonly occurs within the first 2-3 months after stroke, interferes with the recovery of motor function, prolongs hospital stay, is associated with depression, and limits daily activities and proper participation in rehabilitation programs. Aim. To identify the features of post-stroke shoulder pain before and after the rehabilitation course, taking into account the rehabilitation methods used. Materials and methods . The study observed 37 patients (average age of 63 years, 17 men and 13 women), of which 32 patients were in the early recovery period after acute cerebrovascular event (ACVE) and 5 patients were in the late recovery period. The study evaluated the type of post-stroke pain syndrome, characteristics of pain syndrome in post-stroke arthropathy and neurological status of patients before and after rehabilitation activities. Results . Of the 37 patients examined, 30 patients had post-stroke arthropathy (81.1%); 4 patients (10.8%) had central post-stroke pain syndrome and 3 patients (8.1%) had pain syndrome associated with a painful spasm in the spastic muscles of paretic limbs. Stroke patients with severe and pronounced arm paresis more often developed post-stroke shoulder pain. Patients had significantly limited range of motion within the shoulder joint due to pain syndrome. The shoulder’s range of motion in the shoulder joint when measured with a goniometer before rehabilitation activities averaged 1100 with the arm in fixed flexion, and 880 with the arm in passive abduction. At the time of discharge, patients who underwent traditional rehabilitation activities combined with the use of botulinum toxin type A showed better results compared to patients without botulinum therapy. Conclusions. Early diagnosis of post-stroke shoulder pain and a thorough approach to rehabilitation activities are needed, as specific mechanisms may require personalized therapeutic interventions.