Why does the shoulder hurt after a stroke?
The shoulder is a shallow joint held in place mostly by muscles. After a stroke, those muscles on the weak side may go slack, so the arm hangs and drags on the joint. Other muscles may turn tight and pull the shoulder inward.
Add a few pulls and tugs during dressing, turning or standing, and the soft tissues around the joint get irritated. The good news is that most of this can be prevented with simple habits.
How can the family protect the shoulder?
Think of the weak arm as something to support, not something to hold on to.
- In bed, rest the arm on a pillow beside the body, with the hand a little higher than the elbow.
- In a chair, put the forearm on a pillow or the table so the arm does not hang.
- When dressing, put the weak arm into the sleeve first and take it out last.
- When turning in bed, roll the whole body and keep the weak arm close, rather than pulling on it.
- When standing up, give support under the strong side and the trunk, never under the weak armpit.
A physiotherapist can show your family these moves in person. The skill is called transfer training and it protects both the survivor and the carer.
What should we avoid?
Never pull on the weak hand or arm to lift, turn or steady someone. Do not use overhead pulleys for the weak arm unless a physiotherapist has set them up, because they can pinch the shoulder. Avoid leaving the arm hanging off the side of a wheelchair or chair.
Be careful with massage. Urut or tuina from a well-meaning relative or masseur can feel good, but strong pressure, stretching or twisting can injure a weak shoulder. Our page on physiotherapy and urut explains how the two differ.
What about a sling?
A sling is not for everyone. Used all day, it can stiffen the shoulder, elbow and hand. Used for short periods, for example when the person is standing or walking, it may help.
Ask the physiotherapist or doctor which supports suit your parent. Pillows and a lap tray are kinder than a sling for most people.
What does the Ipoh home add?
Dining chairs without armrests, plastic stools and a low sofa all let the weak arm drop. Put a cushion on the table or the lap and the arm has somewhere to rest. At the bathroom tap, a family member can stand on the weak side and guide the arm, not pull it.
Heat is part of the picture too. Sweat and a hot room make a person want to move less, which can make the arm tighter. Fan on, loose short sleeves and a cushion for the arm make a real difference.
If you are on the way to a review at Hospital Raja Permaisuri Bainun, make sure the arm is supported in the wheelchair or car.
When should you call the doctor?
Tell the doctor if the pain is getting worse, if sleep is affected or if the hand is swollen. Sudden swelling, heat, colour change or a very painful hand also needs a prompt review. Any new weakness, trouble speaking or severe headache should go straight to the emergency department.
How does home physiotherapy help?
We look at how your parent moves at home, then show you and the helper how to position, dress and transfer safely. We check which movements the shoulder can do without pain and plan gentle exercise. The plan fits into stroke rehabilitation at home, and you can read about the hand recovery too.
Our Canning Garden centre, near Fatimah Hospital, is opening soon. Home and centre prices differ, and we quote on WhatsApp after a short description.