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Hemiplegic shoulder pain
  1. Anthony B Ward
  1. Correspondence to:
 Dr Anthony B Ward
 North Staffordshire Rehabil Centre, The Hywood, High Lane, Burslem, Stoke on Trent ST6 7AG, UK; anthony.ward{at}uhns.nhs.uk

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Reducing muscle tone in the subscapularis muscle with botulinum toxin can help in the treatment of shoulder pain in patients with spastic hemiplegia

Shoulder pain is a common problem after stroke. Its incidence is variable in up to 70% of patients1 and it often appears in the first few days. It is a marker of stroke severity, and 75% of patients complain of pain at some time in the first 12 months following a stroke. The mechanisms for the development of pain are sometimes unclear but, since the attachment of the upper limb to the trunk is muscular rather than directly skeletal, any disruption of muscular action is likely to give biomechanical problems around the shoulder, which …

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