Objective: To understand this discrepancy between diagnosis and treatment of spasticity in neurological shoulder dysfunction, we formed an expert panel to establish consensus and provide practical guidance to ensure that people with arm spasticity are assessed for shoulder involvement and that clinicians are confident to treat them.

Background: Shoulder involvement is common in arm spasticity following acquired brain injury.¹ In a real-world study of post-stroke arm spasticity management, 56% of patients had shoulder spasticity and 32% received first-line treatment (botulinum toxin).²

Method: The consensus panel comprised six spasticity experts, with a cumulative experience of >100 years. Experts were interviewed individually to understand how they assess people with arm spasticity for shoulder involvement. Responses were discussed and 100% consensus was reached on recommendations during a face-to-face meeting in March 2023.

Results: Recommendations were grouped into three categories: Posture, Purposeful activity and Pain (PPP; ‘the 3 Ps’). Posture of the arm, shoulder and trunk should be observed, considering published shoulder spasticity patterns. Activity (active and passive use of the arm) should be assessed through asking the patient/carer about limitations confirmed by physical examination. Pain is common in shoulder spasticity and should be discussed and rated by the patient at rest, at night and on movement.

Conclusion: Discussion of the problems identified by the patient, supported by examination, should lead to goal setting prior to intervention. These recommendations will support clinicians in identifying spasticity in shoulder impairment associated with stroke and other neurological conditions.

References: 1. Hefter, et al. Int J Rehabil Res. 2012.
2. Turner-Stokes, et al. BMJ Open. 2013.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/identifying-and-managing-spasticity-in-neurological-shoulder-dysfunction/