Alec Titan
Experiencing muscle pain is common after a stroke. The pain can occur soon after a stroke or develop later. It can be caused by a decrease in muscle mass, a decrease in fibre length, and a smaller pennation angle. Shoulder pain is one of the most common issues, and it usually happens on the side of the body affected by the stroke. This is called frozen shoulder or capsulitis. The stroke can also cause muscle weakness down one side, known as hemiparesis, which can lead to spasticity and excruciating pain in muscles and joints. Treatments for muscle pain after a stroke include medication, physiotherapy, injections of botulinum toxin type A, and other exercises to improve strength and flexibility.
| Characteristics | Values |
|---|---|
| Muscle pain occurrence | Pain is a frequent problem after a stroke |
| Time of occurrence | Can occur soon after a stroke or develop later |
| Types | Muscle and joint pain, spasticity, shoulder pain, headaches, central post-stroke pain (CPSP) |
| Muscle weakness | Can occur on one side of the body, causing weakness in arms and hands, as well as legs |
| Treatment | Physical therapy, medications (antispasticity drugs, botulinum toxin type A, baclofen, etc.), stretching, strengthening exercises, range-of-motion exercises |
| Shoulder pain | Frozen shoulder, subluxation, capsulitis, hemiplegic shoulder pain |
| CPSP characteristics | Aching, dull, throbbing, sharp, stabbing, shooting, or burning pain |
| Onset of CPSP | Variable, typically 1-3 months after stroke, with most cases developing within 6 months |
| Other treatments | Constraint-induced movement therapy, robot-assisted therapy, mirror therapy |
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What You'll Learn
Shoulder pain
A stroke can damage the way nerves control muscles, leading to muscle tightness, known as spasticity or hypertonia. Spasticity affects weakened muscles, often in the arms and hands, causing muscle spasms that can hurt mobility and posture. If left untreated, spasticity can lead to contractures, where the joint cannot be fully bent or straightened, and the muscles cannot be stretched to their full length. This can cause pain and stiffness in the shoulder, known as frozen shoulder or capsulitis.
Another common cause of shoulder pain after a stroke is subluxation, which is the partial dislocation of the shoulder joint. This occurs when the muscles that hold the joint in place are weakened due to the stroke, and the weight of the arm pulls and stretches the soft tissues. Shoulder subluxation can cause inflammation, damage, and weakness in the shoulder, leading to pain.
To prevent and treat shoulder pain, proper shoulder support is key. This may include the use of foam supports, shoulder strapping, or slings to keep the arm in a correct and comfortable position. Physiotherapy, including muscle stretches and range-of-motion exercises, can also help to improve strength and flexibility in the affected shoulder.
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Muscle weakness
A stroke can cause muscle weakness in several ways. Firstly, it can lead to hemiplegia or hemiparesis, which are conditions resulting from tissue damage within the brain that interrupts communication with the muscles. Hemiplegia refers to paralysis on one side of the body, while hemiparesis refers to weakness on one side. This occurs because the brain controls muscle activity by sending neural messages, and when a stroke damages the areas of the brain that control muscle movement, the signals between the brain and the muscles can become weakened or lost. As a result, the muscles are not able to respond adequately to the brain's directions, leading to paralysis or weakness.
Secondly, a stroke can cause muscle atrophy, which is a progressive loss of muscle mass and strength. This happens when a stroke survivor's muscles are not regularly used due to weakness or paralysis. Prolonged inactivity contributes significantly to muscle atrophy, and even slight movements can make a difference in preventing it. In addition, muscle atrophy can be exacerbated by difficulties with chewing and swallowing, which may lead to reduced nutrition and less muscle use.
Thirdly, a stroke can cause an increase in stretch reflex excitability, increase in antagonist muscle coactivation, decrease in motor-unit firing rates, and force deficits dependent on muscle length. These factors can further contribute to muscle weakness. Additionally, the mechanical properties of the muscle, such as muscle length and velocity of shortening, play a crucial role in force generation.
Lastly, a stroke can cause hypotonia, which is separate from but often coexists with muscle weakness. Hypotonia is caused directly by tissue damage in the brain, leading to a decrease in muscle tone. In contrast, hypertonia refers to an abnormally high amount of muscle tone and increased tension in the muscles. This occurs when a stroke damages the brain's ability to send inhibitory signals to the muscles, resulting in continuous muscle firing and increased stiffness.
To address muscle weakness after a stroke, rehabilitation and physical therapy are essential. Active exercises that require muscle exertion or body movement are crucial for recovery. Electrical stimulation, such as neuromuscular electrical stimulation devices, can also aid in muscle re-education and strengthening. Additionally, proper arm care after a stroke, including techniques like positioning, stretching, strengthening exercises, and range-of-motion exercises, can help improve muscle weakness and prevent further complications.
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Spasticity
There are various treatment options available for spasticity, including physical therapy, pharmacological treatments, and surgical procedures. Physical therapy can involve muscle stretches, strengthening exercises, and range-of-motion exercises to improve strength and flexibility. Pharmacological treatments include neurolysis with phenol and botulinum toxin injections. In severe cases of spasticity, surgical procedures such as interventions in the posterior root entry zone or dorsal rhizotomy may be considered.
The management of spasticity is crucial to prevent further complications and to improve the patient's quality of life. It is important to work closely with a healthcare team to find the best treatment options and to set realistic goals for recovery.
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Central post-stroke pain (CPSP)
The primary symptoms of CPSP are pain and loss of sensation, typically in the face, arms, and/or legs. Pain may be evoked by mild touch or even in the absence of any stimulus. CPSP can be moderate or severe, and even when the physical pain is moderate, the psychological effects can be severe. Sufferers may experience feelings of hopelessness, lack of motivation, and difficulty in fully recovering. The pain may be intensified by exposure to heat or cold, as well as emotional distress.
The management of CPSP is challenging due to the limited number of approved treatments and their associated side effects. Antidepressants, such as tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and selective serotonin reuptake inhibitors, are frequently used to treat neuropathic pain, although their effectiveness in CPSP has not been extensively studied. Amitriptyline and lamotrigine are considered first-line medications, and non-pharmacological approaches may be explored for cases resistant to pharmacotherapy.
Recently, exogenous epoxyeicosatrienoic acids (EETs) have emerged as potential therapeutic agents for CPSP. EETs have been shown to attenuate mechanical allodynia in CPSP rat models and have demonstrated anti-inflammatory effects. The anti-nociceptive action of EETs is mediated by restoring normal thalamic inhibition through neurosteroid-GABA signaling. EETs also play a role in addressing the comorbid psychological disorders associated with CPSP.
Understanding CPSP is crucial for optimizing the quality of life for stroke survivors and driving further research to develop more effective treatments. Family members and caregivers of individuals with CPSP should be educated about the condition and trained in the administration of analgesics to provide comprehensive support.
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Treatments for pain
Muscle pain is a frequent problem after a stroke. It can occur soon after a stroke or develop later. Treatments for muscle pain after a stroke include:
Physiotherapy
Physiotherapy can help improve the strength, endurance, and range of motion in your arm, shoulder, and hand. This may include muscle stretches, strengthening exercises, and range-of-motion exercises.
Injections
Your doctor may prescribe injections of local anaesthetic, steroids, or botulinum toxin type A (Botox). Botulinum toxin type A works by blocking the action of the nerves on the muscle, reducing its ability to contract. This treatment is mainly used for post-stroke spasticity in the hands, wrists, and ankles.
Medication
Antispasticity medications such as baclofen, tizanidine, dantrolene, and diazepam are commonly prescribed. Anticonvulsants such as gabapentin and pregabalin have also been used with some success in managing post-stroke spasticity and treating associated pain.
Splints and casts
If you develop contractures, your therapist may use a splint or a cast to hold your affected limb in place and stretch out the muscles. This treatment is usually combined with physiotherapy.
External stimulation
External stimulation can help bring range of motion into the hands and drain fluid, helping to relieve pain.
Exercise
Low-intensity prolonged stretches can help to stretch out the affected muscles. SaeboMAS can provide support and facilitation to a weakened shoulder to help complete exercise tasks.
Alternative treatments
Alternative treatments such as cognitive behavioural therapy, hypnotherapy, biofeedback, and stress management and relaxation techniques may also help with pain management.
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Frequently asked questions
Yes, muscle pain is a frequent problem after a stroke. This can be caused by spasticity, which is when muscles contract for long periods or go into spasm. Spasticity can lead to permanently shortened muscles, known as contractures, which can cause pain when joints cannot be fully bent or straightened.
Treatment options for muscle pain after a stroke include medication, physical therapy, and stretching. Medications such as antispasticity drugs and botox injections can help manage pain. Physical therapy exercises can improve strength and flexibility, while stretching can improve and maintain muscle functioning.
Common types of pain after a stroke include shoulder pain, headaches, and central post-stroke pain (CPSP). Shoulder pain can be caused by subluxation, or partial dislocation, due to weakened muscles. CPSP can be moderate or severe and is often described as a dull, throbbing, or sharp pain.
