shoulder and hand pain after stroke

[TORTONI]

MY HUSBAND HAD A COROTID DISSECTION 3/7/06 HE IS WALKING AND MOVING HIS HAND BUT STARTED TO HAVE SEVERE PAIN IN SHOULDER/HAND. HE FEELS A POPPING IN HIS SHOULDER ALSO. HE HAS HAD XRAYS OF BOTH AND THEY SHOW NOTHING. HIS PHYSIATRIST SEEMS STUMPED AND TOLD HIM TO GO TO AN OTHOPEDIC DOCTOR FOR AN MRI.HE CAN'T SLEEP AND IS ON CONSTANT PAIN MED AND IS NOT WANTING TO DO THERAPY BECAUSE IT HURTS SO MUCH. DO YOU HAVE ANY IDEAS?

[Rajool]

I am not surprised that your husband does not want to do therapy as his shoulder hurts & has pain in hand as well.



BUT the problem is, he got passive therapy (may be) Passive movements to the shoulder, assisted movements on shoulder wheel & pulley if at all done, guarantees the pain in shoulder.





The only treatment for such pain is active shoulder exercises. pain killers do not resolve root cause of shoulder pain.



Mild heat with steam pack helps to some extent.

avoid to sleep on the affected shoulder for long hours.



You may find more information on

www.brainstrokes.com



good luck.

rajul

[caregiver222]

You need to have axial traction applied and see if the pain immediately disappears. If so the treatment is simple. An anti- inflammatory for a few days and a $35 dollar axial traction harness you hang over the door and use three times a day for about four minutes per session. The pain should disappear in about 90 days. A reasonable protocol is prednisone for four days to dampen the infmmation, then ibuprufin for a week. If you don;t go for the prednisone an anti-inflammatory such as Ibuprufin (Motrin) should work fine. You have to dampen the inflammation. The axial traction devices are available at drug stores without prescription. Check with your physician to see if he thinks this is reasonable.

[caregiver222]

The x-rays won't show anything. They are pointless. There are several possible causes. The most likely cause is cervical compression of a nerve, which can be definitively diagnosed by applying cervical traction and observing if the symptoms disappear.

[cotagrl]

The popping in the shoulder could possibly - and i emphasize heavily "possibly" due to such a small ammount of info!!! - indicate muscle weakness/deficit in the "rotator cuff" muscles or other muscles around the shoulder and neck.  The "rotator cuff" muscles (there are 4) hold your arm in the socket. So if there is any weakness in any one of these muscles, the balance of how they all work together changes, resulting in movement and pain issues (poping & clicking, pain, reduced range of motion). But the poping and pain could also be nerve related.  Either one should becom apparent on an MRI.......

I would be wary of heat because heat can cause inflamation if applied too long or too often or too hot! If this is a nerve issue, inflamation can cause swelling in muscles around nerves resulting in an increase problems. But heat has it's benefits because it increases circulation which can promote healing. You could try heat and ice and see what results are the best for reducing symptoms.  With heat or ice never apply for longer than 20 min - i learned in my treatment modalities class there is no therapeutic value for heat or ice applied longer than 20 min.

I hope that he has had an MRI and has been getting treatment with BOTH a Physical Therapist AND Occupational Therapist!!

[caregiver222]

You have symptoms that are characteristic of a "pain dermatome".



It is not likely that this is "phantom" or neurogenic pain. It is more likely that you have a nerve that pressure is being put on. There are a variety of reasons for this.



The big problem is that people "self-splint" to avoid the pain, and eventually the movement of the arm and hand become more and more limited until they become frozen. The answer is to exercise through the limits of pain, use anti-inflammatories, and practice range-pf-motion exercises. Including rotating the head.