1.

 Stroke
34

  TABLE 1–8  Post-Stroke Shoulder Pain

CRPS Type I Adhesive Capsulitis
Inferior Subluxation Rotator Cuff Tear (RSD) (Frozen Shoulder) Impingement Syndrome Biceps Tendinitis

EXAM • Acromio-humeral • Positive • MCP com- • External rotation • Pain with abduction of • Positive
separation ­abduction test pression test less than 15° 70°–90° Speed’s/
• Flaccid • Positive drop • Skin changes • Early decrease in • End-range pain with Yergason test
arm test color scapular motion ­forward flexion • Flaccid or
• Flaccid or spastic • Flaccid or • Spastic • Usually spastic spastic
spastic

DIAGNOSTIC • X-ray in standing • X-ray • Triple phase • Arthrogram • Subacromial injection of • Tendon sheath
TEST position • Arthrogram bone scan lidocaine ­injection of
• Scapular plane • MRI • Stellate lidocaine
view • Subacromial ­ganglion
­injection of block
lidocaine

TREATMENT • Sling when upright • Steroid injection • Oral cortico- • PT/ROM • PT/ROM • Tendon sheath
• FES • PT/ROM steroids • Debridement • Scapular mobilization ­injection of
• Possible surgical • Stellate manipulation • Subacromial steroid steroids
repair ­ganglion • Subacromial/GH injection
• Reduction of block steroid injections • Reduction of internal
internal rotator • Intra-articular rotator cuff tone
cuff tone steriods
• Oral steroids
• Reduction of inter-
nal rotator cuff
tone

Note: CRPS I = complex regional pain syndrome type I; FES = functional electrical stimulation; MCP = metacarpophalangeal; MRI = magnetic resonance imaging;
RSD = reflex sympathetic dystrophy; PT/ROM = physical therapy/range of motion.
Source: Adapted from Black-Schaffer et al., 1999.