PREVALENCE OF POST-STROKE SHOULDER PAIN AND ITS ASSOCIATION WITH UPPER-LIMB MOTOR DYSFUNCTION: A NARRATIVE REVIEW OF THE PUBLISHED LITERATURE

Abstract

Background: Post-stroke shoulder pain (PSSP) is a frequent complication of stroke that can limit upper-limb recovery and participation in rehabilitation. Reported prevalence varies widely between studies, and the contribution of upper-limb motor dysfunction to PSSP is still incompletely understood. Objective: To synthesise published evidence on the prevalence of PSSP and on its association with upper-limb motor dysfunction in adult stroke survivors. Methods: A narrative review with structured data extraction was conducted. Published systematic reviews, meta-analyses and observational studies on PSSP were identified, and pooled prevalence and incidence estimates, regional variation, and studies relating shoulder pain to upper-limb motor function (including the Fugl-Meyer Assessment of the Upper Extremity) were extracted and tabulated. No new patient data were collected. Results: One meta-analysis of 10 cross-sectional studies (3,701 patients) reported a pooled PSSP prevalence of 33% (95% CI 22–43%), with very high heterogeneity (I² = 98.8%); pooled incidence from 11 cohort studies (3,496 patients) was 29% (95% CI 21–36%). Regional prevalence estimates ranged from 14% in Europe to 75% in a single African study. A second systematic review reported incidence of 10–22% and prevalence of 22–47%. A meta-analysis of prospective cohorts identified reduced upper-limb motor function, diabetes (OR 2.09) and a history of shoulder pain (OR 2.78) as significant risk factors for PSSP within the first year after stroke, whereas sex and laterality were not significant. In a cross-sectional study of 122 hemiplegic patients, those with shoulder pain (n = 76) had significantly worse Fugl-Meyer upper-extremity motor scores and proprioception than those without (n = 46), and pain severity correlated with motor dysfunction. Conclusion: PSSP affects roughly one in three stroke survivors in pooled estimates, although figures differ markedly by region, setting, definition and timing. The available evidence links upper-limb motor dysfunction with PSSP, but the cross-sectional nature of much of it prevents conclusions about causal direction. Physiotherapy assessment after stroke should record shoulder pain and upper-limb motor function together, and prospective studies with standardised definitions are needed.

Keywords: stroke; shoulder pain; hemiplegic shoulder pain; prevalence; upper extremity; Fugl-Meyer Assessment; physiotherapy