Innovation in advanced management of the post stroke spastic hemiplegic shoulder, from early intervention to contracture.

Session outline

Introduction: Hemiplegic shoulder pain (HSP) is the most common pain disorder after stroke with incidence estimates of 30–70% and associated with reductions in function, interference with rehabilitation, and a reduced quality of life. Onset may occur as soon as a week after stroke in 17% of patients. Management of HSP represents a complex treatment pathway with a lack of evidence to support one treatment. The pain has heterogeneous causes. In the acute setting, decreased range of motion in the shoulder can be due to early-onset spasticity, capsular pattern stiffness, glenohumeral pathology, or complex regional pain syndrome (CRPS). As contracture can form in up to 50% of patients after stroke, effective management of the painful shoulder and upper limb with decreased range of motion requires assessment of each possible contributor for effective treatment. The anesthetic diagnostic nerve block (DNB) is known to differentiate spasticity from contracture and other disorders of immobility and can be useful in determining

We will offer a comprehensive package, teaching the science, clinical cases, review the evidence and clinical skills demonstartions. We welcome a group from the general public and advocacy groups for the didactic portion and to allow the public to see the potential to regain function, reduce pain and introduce greater patient independence and autonomy.  We have members from several countries.

1. Overview of early spasticity to late- Dr. Eve Boissonnault, Canada
2. Relevant anatomy of the shoulder. Romain David France.
3. The Victoria-Verona ViVe Algorithm, a published guideline – Paul Winston, Canada Eve Boissonnault
4. Percutaneus contracture management. Romain David France.

Learning outcomes

1. The urgency of treating hemiplegic pain immediately after stroke.
2. To recognize that complex regional pain syndrome, or shoulder hand syndrome must be recognized and treated.
3. Outline the indications for botulinum toxin acutely.
4. Introduce cryoneurolysis for the management of hemiplegic shoulder pain.
5. Case examples to illustrate the ViVe algorithm and late management.

Target audience

We encourage all backgrounds to attend.

• Allied health
• Medical practitioners
• Students
• Trainees
• Nursing staff
• General public