Poststroke Shoulder Pain: Inevitable or Preventable?

Cerebral vascular accident or stroke is recognized as the leading cause of disability in the United States; consequently, it is important that all healthcare professionals working with this population develop competency of care to promote functional recovery. One of the most profound effects of stroke is upper‐extremity dysfunction. With correct handling, proper positioning, and ongoing patient‐caregiver education, healthcare professionals can positively influence upper‐extremity recovery and prevention of poststroke shoulder pain. In doing so, they will help patients avoid the mass effect that pain can impart on daily routines. The purposes of this article are to describe poststroke shoulder pain, discuss possible causes of shoulder pain, and detail best practices nurses can use to prevent or minimize poststroke shoulder pain.     

Meningismus Associated with Malpositioned Intraspinal Catheter for Drug Delivery

Background: Implanted delivery systems for intrathecal drug administration have become more common in the management of nonmalignant pain. Many postprocedural complications have been described in the literature including infection and headache provoked by position changes. Determining the etiology of a postimplant headache is important particularly when considering the possibility of a life‐threatening infection. Case Report: We present a patient who underwent placement of an implantable drug delivery system (IDDS) for intractable abdominal pain that developed positional headaches, and significant neck and back pain. Attempted cerebrospinal fluid aspiration reproduced her symptoms and imaging revealed a malpositioned intraspinal catheter tip approximated to the meninges. Revision of the system completely relieved her symptoms. Conclusion: Meningismus from malpositioned catheters is a rare complication that can mimic meningitis but should be considered in the differential for postimplant headaches. Given the increased use of IDDS, it is important to recognize and evaluate postimplant complication and treat it appropriately. We discuss this case report and appropriate work‐up and differential diagnosis for meningismus following implant.