Objective: To build on existing publications and give guidance for healthcare providers managing shoulder conditions following central lesions, including how to identify, diagnose, and treat for different patient presentations.

Background: Published guidance for the assessment and management of shoulder conditions following central lesions is currently lacking, and less experienced practitioners may therefore be reluctant or unaware of how to assess and globally treat shoulder involvement in patients with upper-limb spasticity.

Method: A meeting was held in 2023 with the intention of reaching consensus on best treatment practice and expert recommendations to deliver guidance on diagnosis and treatment of complications of the hemiplegic shoulder following central lesions. Eleven experts with extensive experience in spasticity and dystonia gave presentations on shoulder spasticity diagnosis and management, followed by discussion. The experts were divided into groups to discuss i) Evaluation with clinical examination and investigations based on anatomical approach and presence of pain, and ii) Management strategies, including surgery. The discussion was conducted in such a way as to identify consensus on assessment and treatment practices and provide recommendations based on this consensus.

Results: Recommended assessments were grouped as follows: patient history, symptoms, observation, clinical signs and tests that should be conducted, other diagnostic tests that can be considered, assessment of upper limb impairment, and assessment of upper limb capacity with functional tests. The assessment groups were intended to cover all relevant tools and approaches that can be used to evaluate a patient presenting with upper limb spasticity, identify shoulder involvement and guide tailored treatment. Treatment recommendations take into account musculoskeletal involvement (apart from muscle overactivity) as well as time from central lesion (acute, post-acute and chronic phases).

Conclusion: Recommendations add to previously published guidance for this undertreated patient population and provide additional details for specific patient groups, based on the experience and consensus opinion of the expert panel. These recommendations can enhance clinical practice, especially for clinicians who may not be experienced in evaluating and treating hemiplegic shoulder following central lesions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pathways-for-diagnosis-and-multimodal-management-including-botulinum-neurotoxin-therapy-in-shoulder-conditions-following-central-lesions/