Arthrographic and clinical findings in patients with hemiplegic shoulder pain.
ABSTRACT To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain.
Medical center of a 1582-bed teaching institution in Taiwan.
Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited.
Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology.
Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM.
After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.
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ABSTRACT: To explore the relationship between a number of clinically relevant variables and sonographic imaging data in respect to the level of impairment experienced in the affected and unaffected shoulders of hemiplegic stroke patients. Fifty-one hemiplegic stroke patients (32 males, 19 females; 29 right-sided hemiplegics, 22 left-sided hemiplegics) participated in this study. A musculoskeletal radiologist conducted a sonographic exam on both the affected and unaffected shoulders of all patients and two physicians classified the severity of the injury on a six-point rating scale. Clinical variables including age, sex, duration of injury, spasticity and muscle power of the hemiplegic side, and level of functional activity of the shoulder were assessed. The sonographic rating scores of hemiplegic shoulders were positively correlated with age (p<0.01) and negatively correlated with level of muscle spasticity (p<0.05). The sonographic rating scores of unaffected shoulders were positively correlated with duration of injury (p<0.01). Affected shoulders received sonographic rating scores that reflected significantly more impairment than those of unaffected shoulders (p<0.001), and pre-morbid handedness did not affect the relationship between impairment rating and shoulder injury status. Hemiplegic stroke influences not only affected shoulders, but also unaffected sides. Proper management of spasticity, enhancement of motor recovery, and avoidance of unaffected shoulder overuse should be considered to prevent shoulder problems following strokes which result in hemiplegia.Annals of rehabilitation medicine. 12/2012; 36(6):828-35.
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ABSTRACT: In people with stroke, range-of-motion (ROM) exercises may contribute to hemiparetic shoulder pain, but the underlying mechanisms are unknown. This study examined scapular and humeral movement patterns in people with poststroke hemiparesis as they performed commonly prescribed ROM exercises. Using kinematic techniques, we studied 13 people with hemiparesis, both with and without pain, as they performed 3 commonly prescribed ROM exercises: person-assisted ROM, self-assisted ROM, and cane-assisted ROM. Their data were compared with those of a group of 12 matched control subjects performing scapular plane shoulder elevation, using mixed-model ANOVAs. Correlation analyses were used to examine the relationship between participants' ratings of pain and kinematic data. The hemiparetic group had mild pain at rest that increased during the performance of the exercises. During shoulder elevation, humeral external rotation in the hemiparetic group was decreased in all 3 ROM exercises compared with that in the control group. Scapular upward rotation in the hemiparetic group was decreased for the person-assisted ROM exercise only. No differences in scapular tilt were found between groups. The extent of movement abnormalities was not related to pain severity. People with hemiparesis had altered scapular and humeral movement patterns and increased shoulder pain when performing the ROM exercises. These data can assist clinicians in making decisions regarding which exercises to prescribe to preserve shoulder motion and prevent contractures in this population.Journal of neurologic physical therapy: JNPT 03/2011; 35(1):18-25. · 1.65 Impact Factor
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ABSTRACT: PURPOSE: Altered movement patterns may contribute to this shoulder pain following stroke. The purpose of this study was to examine scapular and humeral movement patterns in people with hemiparetic shoulder pain (HSP), and to explore the relationships between pain and these movement patterns. METHODS: Kinematic data from nine participants with HSP and twelve matched controls were collected as they performed scapular plane shoulder elevation. Correlation analyses were used to examine relationships between participants' ratings of pain and kinematic data. RESULTS: The HSP group had decreased humeral external rotation compared to the control group. Despite a trend toward decreased scapular upward rotation, there was considerable variation in scapular upward rotation movement patterns across the participants with HSP. Scapular tilt was not different between groups. There was an inverse relationship between pain and scapular upward rotation, indicating that those with more pain had less scapular upward rotation. CONCLUSIONS: People with HSP demonstrated scapular and humeral movement patterns that differed from controls, where some of the altered movement patterns were related to reported pain levels. Rehabilitation management of people with HSP may be improved by careful assessment of scapulohumeral movement patterns and treatments aimed at normalizing these patterns.International journal of therapy and rehabilitation. 04/2011; 18(4):210-220.