Hemiplegic shoulder pain: an approach to diagnosis and management

Phys Med Rehabil Clin N Am. 2014 May;25(2):411-37. doi: 10.1016/j.pmr.2014.01.010. Epub 2014 Mar 14.


Stroke is a significant source of mortality and long-term disability in the United States. Of persons who survive a stroke, approximately 50% will have hemiplegia, half of whom will live with a nonfunctional arm. Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, reduces participation and worsens outcomes in rehabilitation. Management of HSP is challenging because its causes are multifactorial and there is limited, conflicting, or nonspecific evidence in support of most treatments. This article develops an effective approach for diagnosis and treatment using the best available evidence to aid practitioners in obtaining optimal results.

Keywords: Hemiplegic shoulder pain; Poststroke shoulder pain; Shoulder subluxation; Stroke rehabilitation.

Publication types

  • Review

MeSH terms

  • Analgesics / therapeutic use
  • Combined Modality Therapy
  • Diagnostic Imaging / methods*
  • Exercise Therapy / methods
  • Female
  • Hemiplegia / complications*
  • Hemiplegia / diagnosis
  • Hemiplegia / rehabilitation
  • Humans
  • Male
  • Orthotic Devices
  • Pain Measurement
  • Prognosis
  • Range of Motion, Articular / physiology
  • Risk Assessment
  • Severity of Illness Index
  • Shoulder Pain / diagnosis*
  • Shoulder Pain / etiology
  • Shoulder Pain / rehabilitation*
  • Stroke / complications
  • Stroke / diagnosis
  • Stroke Rehabilitation
  • Treatment Outcome


  • Analgesics