The objective of this study was to determine the frequency of shoulder pain in the first 12 weeks after acute stroke, and its relationship to functional outcome. The study was prospective observational in design, carried out weekly over 12 weeks from consecutive admissions. Acute medical and geriatric wards in three district hospitals provided the setting, and the 76 included patients admitted to hospital with a first documented episode of stroke resulting in neurological deficit lasting more than seven days.The main outcomes measured were frequency and severity of pain using visual analogue scores; arm function (by Frenchay Arm Test and Motricity Index) and length of stay in hospital. Fifty-five patients (72%) experienced shoulder pain at some stage, most commonly on movement. Length of stay in those with pain was 82 days and those without pain 39 days (p < 0.001). All patients requiring continuing care, or dying after inclusion in the study, suffered shoulder pain. Patients with pain showed greater weakness and poorer arm function at study entry and at study termination, the rate of recovery of arm function being slower in those with pain than those without.The results concluded that shoulder pain is a common phenomenon in acute hemiplegia and is strongly associated with prolonged hospital stay, and poor recovery of arm function in the first 12 weeks of illness.

The aim of this study was to decide whether shoulder pain in stroke is a marker of severity, or an independent predictor of poor outcome. The study was prospective observational in design from consecutive admissions. Acute medical and geriatric wards in three district hospitals provided the setting, and the subjects were 76 patients acutely admitted to hospital with a first stroke. The main outcomes measured were length of stay in hospital, Barthel Index, Frenchay Arm Test, Motricity Index and discharge placement. After controlling for other indicators of stroke severity, shoulder pain on movement was the most important predictor of poor recovery of arm power and function, and an important contributor to length of stay in hospital. Urinary incontinence was the strongest indicator of length of stay and Barthel Index scores. Patients with subluxation and malalignment of the shoulder fared much more poorly than those with normal shoulder alignment. The results concluded that shoulder pain appears to influence outcome of stroke independent of severity. We recommend that this symptom receive careful attention.