Multifactorial Shoulder Pain After Stroke With Associated Hemiparesis - Page #1

Author: Sara Walker, MD, MS
Co Author #1: Keith Cummings, DO Department of Physical Medicine and Rehabilitation, University of Utah
Co Author #2: Theodore Paisley, MD Department of Family and Preventive Medicine, University of Utah
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Janie Gibson, MD

Patient Presentation:
Patient is a 63-year-old woman who presents to a sports medicine clinic with right shoulder pain four months after a left internal capsular stroke with right-sided hemiparesis.

She had a history of multi-level degenerative disc disease, most prominent at C5-6 and C6-7 with associated right neck/arm pain. Four years earlier, she had a right C6-7 transforaminal epidural steroid injection which resulted in resolution of her pain. One month before our visit, she met with neurosurgery who offered an additional epidural steroid injection. She agreed and the injection was scheduled for the week following our initial appointment. At our visit, she reported multiple falls over the past few months, as well as episodes of accidentally hitting her right shoulder against doors/other objects. She stated that most movements caused pain, but lifting her right arm overhead was the greatest challenge.

Physical Exam:
MSK: A comprehensive right shoulder exam was performed. No muscle atrophy or skin changes were noted. Patient was able to forward flex to 90 degrees on right, 170 degrees on left. She externally rotated to 35 degrees bilaterally. She could abduct to 90 degrees on right, 170 degrees on left. She could internally rotate to L3 on the right. No improvement with passive range of motion, even with persistent pressure being applied. Mildly increased tone in fingers, wrist, and elbow on the right. Rotator cuff testing was 4+/5 in all muscles, no pain with resisted movements. Empty-can and Speed's testing were negative, O’Brien's was positive.

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