How a stroke can cause arm problems

Stroke often causes paralysis (hemiplegia) or weakness (hemiparesis) of 1 or more of the muscles in your arm or shoulder. The muscles might feel tight instead of weak (spasticity). In general, stroke might increase or decrease the normal muscle tone in these muscles. You may also have numbness or limited feeling in your arm.

The shoulder is often a problem area after a stroke. The shoulder blade (scapula) and the upper arm bone (humerus) come together to form the shoulder joint. This joint is shaped like a ball and socket. Problems with the shoulder muscles can cause this joint to partly dislocate because of the weight of your arm. This partial separation (subluxation) makes your shoulder droop down.

Subluxation can cause pain when you move your arm. You may also feel like your shoulder is out of joint. Muscles, tendons, and ligaments can become overstretched. These muscle problems can lead to other problems with your shoulder. For example, you may not be able to move your shoulder as much as you used to. Some of the muscles may also be permanently shortened. This is called contracture.

How arm care helps

Arm care after a stroke helps prevent and treat problems. If you have had a stroke, it's very likely that you will need some sort of arm care treatment while you recover function. Most people who have a stroke need treatment for trouble with the muscles of their arm or shoulder, and shoulder pain is common. This treatment often starts right after a stroke. Even if you only have minor harm from your stroke, correct arm care can help keep future problems from occurring.

Your treatment plan

Learn everything you can about your treatment plan. Your healthcare team will work with you to design a treatment plan to fit your needs. You may work with a physiatrist. This is a healthcare provider who specializes in rehabilitative medicine. You will likely work with a physical therapist. This is a therapist who can teach you safe exercises to improve the strength, endurance, and range of motion in your arm, shoulder, and hand. An occupational therapist can help you learn to regain skills needed for everyday living using your arm. This may include using devices to aid you, such as braces or arm rails.

Expect your treatment plan to change as you recover. Talk with the members of your medical team about how things are going. If an exercise causes pain, stop the exercise, and let someone know right away.

Some people regain full use of their arm in the weeks after a stroke. Many others still have some weakness, pain, or other problems with their arm. You may continue to benefit from arm therapy. Your medical team can tailor your treatment plan to your needs.

Protecting your shoulder joint

Preventing subluxation is one of the most important goals of arm care after a stroke. To prevent this problem, you must protect your arm at the shoulder joint. You will need to control the shoulder joint when you move around. Make sure all of your caregivers know about the correct ways to help you.

• Don't let anyone pull on your arm.

• Don't let anyone help you stand or move by lifting under your armpits.

• Don't lean your body weight on anything in your armpit while standing or walking.

• Keep your affected arm supported and immobile when you stand up. Use your strong arm to help pull yourself up.

• Keep your arm in a sling or harness after your stroke, if advised.

• Support your affected arm while sitting. If you’re in a wheelchair, rest it on one of the chair’s arms. You can also rest your arm on things, such as a lap tray or pillow.

Other types of correct positioning

• When lying on your unaffected side, use 1 or 2 pillows for your head. Your affected shoulder should be forward, with your arm resting on a pillow.

• When lying on your affected side, use 1 or 2 pillows for your head. Your affected shoulder should be positioned comfortably.

• When sitting up, sit fully back into the chair. Place your arms forward onto 2 pillows on a table. Your feet should be flat on the floor.

• When lying on your back, place 3 pillows supporting both your shoulders and your head. Place your affected arm on a pillow.

• When sitting in bed, sit upright, well supported by pillows. Place both arms on pillows. This is usually only recommended for limited periods.

Your physical therapist may advise other positions that are safe for you. You may also do physical therapy exercises. These are to help you regain strength and flexibility in your muscles.

Additional treatments

If you continue to have arm problems, your healthcare team might try other treatments, such as:

• Constraint-induced movement therapy. This involves using your affected arm a lot and not using your unaffected arm. A therapist might help you with this. Or it could be robot-assisted.

• Botulinum toxin injections. This can help to reduce tightness in the arm muscles.

• Electrical stimulation of muscles. The weakened muscles in your arm or shoulder may be treated with electricity. This can help strengthen your weakened arm.

• Electrical stimulation of the brain. This may be done during rehabilitation exercises and may help you be able to move your arm better.

• Motor imagery. This method may help you be able to use your arm more easily.

• Biofeedback exercises. These may help you be able to move your arm better and reduce pain.

• Pain medicine. These may be needed to ease shoulder pain if subluxation has occurred.

Depending on your situation, these treatments might be used early or late in your therapy. Ongoing physical therapy may also help you reduce chronic pain as you regain your strength and flexibility.