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Management of Hemiplegic Shoulder Pain (HSP)

Hemiplegic shoulder pain (HSP) is a common complication of stroke but also occurs in other forms of neurological injury, that result in weakness or spasticity around the shoulder girdle.

It can result from a number of different clinical problems and may impact negatively on rehabilitation.

Established in 2002, the integrated care pathway (ICP) for hemiplegic shoulder pain, is an evidence-based practical tool to support coordinated multidisciplinary reasoning and decision-making across the range of different clinical presentations, to support targeted intervention depending on the root cause of the symptoms.

The toolkit supports systematic recording of symptoms, signs and outcome within a standardised database, to improve our understanding of what approaches work best for which patients.

This integrated care pathway was developed by members of the multidisciplinary team from the Regional Hyperacute Rehabilitation (RHRU) at Northwick Park Hospital, and has been refined through an iterative process of research, audit and development.

The resources below are freely available to clinicians and researchers interested in the management of hemiplegic shoulder pain. 


  • The integrated care pathway for hemiplegic shoulder pain has been established in routine clinical practice at Northwick Park Hospital for over 20 years.
  • The pathway has resulted in a number of publications and the novel development of adapted tools to capture pain experience in patients with cognitive/communicative problems.
  • A recent evaluation has demonstrated the effectiveness of the integrated care pathway’s stratified approach to themanagement of hemiplegic shoulder pain.