A stroke is a medical emergency that disrupts blood supply to the brain, causing symptoms like paralysis, confusion, and severe headaches. Post-stroke complications can include shoulder pain due to conditions like subluxation, spasticity, and frozen shoulder, which arise from muscle tone changes and reduced mobility. Proper rehabilitation is essential to manage these complications and improve daily living activities.

1. STROKE ; POST- STROKE SHOULDER
PAIN

2. STROKE
 A Stroke occurs when the blood supply to part of your brain
is interrupted or reduced, preventing brain tissue from
getting oxygen and nutrients. Brain cells begin to die in
minutes.
 A Stroke is a medical emergency, prompt treatment is
crucial. Early action can reduce brain damage and other
complications.

3. SYMPTOMS:
• Paralysis.
• numbness or weakness in the arm, face, and leg, especially on one
side of the body.
• Trouble speaking or understanding others.
• slurred speech.
• confusion, disorientation, or lack of responsiveness.

4. • sudden behavioral changes, especially increased agitation.
• vision problems, such as trouble seeing in one or both eyes
with vision blackened or blurred, or double vision.
• trouble walking.
• loss of balance or coordination.
• Dizziness.
• severe, sudden headache with an unknown cause.
• Seizures.
• nausea or vomiting.

5. CAUSES:
 High blood pressure:
 Tobacco. Smoking or chewing it raises your odds of a stroke.
stroke.
 Heart disease.
 Diabetes.
 Medication.
 Age.
 Family.

6. POST EFFECT OF STROKE:
 CONTRACTURES: This permanent shortening or a muscle or
joint causes the limbs to become fixed in a certain position.
Contractures usually occur due to brain damage and
irreversible contraction and fibrosis of the muscles.
 INFECTIONS: Swallowing impairment can sometimes result
entering the lungs, leading to pneumonia. Poor hygiene care
cause urinary tract infection.

7.  PRESSURE SORES: The constant pressure over certain body parts from reduced
mobility may cause the skin over that area to break down.
 DVT:Formation ofblood clots in veins of the legs may occurbecauseof reduced mobility
after stroke.
 MUSCLE SPASTICITY: Formation of blood clots in veins of the legs may occur
because ofreduced mobility after stroke.
 SEIZURES:Damagedbrain cells from stroke may lead to abnormal electrical activity in
the brain causing convulsions.

8.  SHOULDER SUBLUXATION: Subluxation is the partial dislocation of a joint.
It may occurwhen there is a lack of support in an armdue to weakness. Thehanging of
the affected arm pulls the arm from the shoulder at the joint.
 Complex regional pain syndrome (CRPS): It is a form of
chronic pain that usually affects an arm or a leg. CRPS
typically develops after an injury, a surgery, a stroke or a
heart attack. The pain is out of proportion to the severity of
the initial injury.

9. POST- STROKE SHOULDER PAIN

10.  Muscle tone, the amount of resistance or tension in a muscle, is
controlled by signals from the brain.
 When the brain areas responsible for sending out these signals
become damaged from a stroke, changes in muscle tone occur
from either overactivity or underactivity of electrical signals to the
muscles.
 This results in spasticity, where the muscles become overly stiff and
tight, or flaccidity, where the muscles become weak and floppy.
 During stroke rehabilitation, many patients often encounter
shoulder complications as a result of these changes in muscle tone.

11. 4 Common causes:
• Shoulder Subluxation
• Shoulder Impingement
• Spasticity
• Frozen Shoulder

13.  With muscle flaccidity, the rotator cuff muscles that support
and stabilize the shoulder joint become weak and
underactive.
 The continual pull of gravity on the weight of the arm causes
further subluxation of the shoulder joint when the shoulder
muscles are weak, resulting in pain over time.

14. SYMPTOMS:
• Shoulder pain
• Swelling
• Weakness and difficulty moving the arm
• Shoulder instability
• Numbness or tingling
• Visible malalignment of the shoulder joint

16.  Increased friction and compression in the shoulder joint also occur from
muscle flaccidity when the muscles of the back and shoulder do not
work together in synchronicity.
 When the muscles of the shoulder and back become flaccid and weak
following a stroke, the scapula, or shoulder blade, cannot properly
rotate upward when the arm is lifted, causing compression and pinching
of the tendons that run through the narrow passageway of the shoulder.
 This is referred to as shoulder impingement and can make movements
of the arm up overhead, out to the side, and behind the back painful,
thereby limiting ease and independence with performing everyday
activities.

17. SYMPTOMS:
• Shoulder pain, particularly with movement of the arm
• Pinching sensation at the top of the shoulder
• Increased pain with movements of the arm overhead, out to the side,
or behind the back
• Decreased shoulder strength and range of motion
• Difficulty performing activities of daily living

19.  Alternatively, with muscle spasticity, increased muscle tone can tighten the
shoulder muscles, causing muscle contractures that are stiff and painful.
 Spasticity of the shoulder significantly limits mobility and range of
motion, making movements that involve the hand and arm challenging
and pain-provoking.

20. SYMPTOMS:
• Pain in spastic muscles
• Tightness and stiffness
• Presence of contractures
• Significantly limited shoulder and arm range of motion

22.  Due to decreased movement of the arm and shoulder joint
from spasticity, the ligaments and joint capsule of the
shoulder can also stiffen.
 This can develop into adhesive capsulitis, commonly
referred to as “frozen shoulder,” where the connective tissue
in the shoulder joint thickens and tightens, limiting range of
motion and causing pain with arm movements.

23. STAGES OF FROZEN SHOULDER:
1. Freezing stage: The shoulder joint begins to lose range of
motion and movements of the arm become painful.
2. Frozen stage: The shoulder becomes stiffer with a
significant loss of range of motion and pain may continue
or begin to decrease.
3. Thawing stage: Range of motion begins to improve as the
pain continues to decrease.

24. SYMPTOMS:
• Shoulder pain
• Stiffness and difficulty moving the arm
• Difficulty sleeping
• Significant limitations in shoulder range of motion,
especially shoulder flexion, abduction, and external
rotation

25. THANK YOU