Treatment of shoulder and upper limb pain after stroke: an obstacle course for evidence-based practice

The upper limb (UL) is a common site for poststroke pain, which is often regarded as a direct consequence of proximal motor impairment. Although the subacromial region is the commonest site, pain can also occur lower down the UL and some causes are not directly related to hemiplegia. As distal clinical features unrelated to motor consequences of stroke can be useful for making a management plan for pain, this review will generally refer to poststroke upper limb pain (PULP) rather than use traditional terms such as hemiplegic shoulder pain (which may erroneously imply a proximal, purely motor related aetiology).