Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke.
OBJECTIVE
Shoulder pain is known to retard rehabilitation after stroke. Its causes and prognosis are uncertain. This study describes the incidence of poststroke shoulder pain prospectively, in an unselected stroke population in the first 6 months after stroke and identifies risk factors for developing pain.


METHODS
297 patients with possible stroke were screened and stroke diagnosed in 205 cases. The 152 patients entered the study of which 123 patients were assessed up to 6 months. This cohort, with a mean age of 70.6 years, was examined at 2 weeks, 2, 4, and 6 months. A history of shoulder pain, Barthel score, anxiety and depression score were recorded. Full neurological and rheumatological examination was undertaken, using the contralateral side as a control. Pain outcome and stroke outcome was recorded at subsequent visits.


RESULTS
52 (40%) patients developed shoulder pain on the same side of their stroke. There was a strong association between pain and abnormal shoulder joint examination, ipsilateral sensory abnormalities and arm weakness. Shoulder pain had resolved or improved at 6 months in 41 (80%) of the patients with standard current treatment.


CONCLUSIONS
Shoulder pain after stroke occurred in 40% of 123 patients surviving, consenting and not too unwell to participate. This included 52 patients of an original cohort of 205 patients presenting with stroke. Eighty percent of patients made a good recovery with standard treatment Patients with sensory and or motor deficits represent at risk sub-groups.
Gamble
Giles E
GE
Elderly Care Department, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK. fellhound@doctors.org.uk
Barberan
Elisa
E
Laasch
Hans-Ulrich
HU
Bowsher
David
D
Tyrrell
Pippa J
PJ
Jones
Anthony K P
AK
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D012737:Sex Factors; D020069:Shoulder Pain / Q000209:etiology* / Q000523:psychology; D020521:Stroke / Q000150:complications*; D013697:Thermosensing / Q000502:physiology