Arthrographic and clinical findings in patients with hemiplegic shoulder pain.
OBJECTIVE
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.


METHODS
Case series.


METHODS
Medical center of a 1582-bed teaching institution in Taiwan.


METHODS
Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited.


METHODS
Not applicable.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Lo
Sui-Foon
SF
Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 91 Shiuesh Road, Taichung 404, Taiwan, ROC.
Chen
Shu-Ya
SY
Lin
Hsiu-Chen
HC
Jim
Yick-Fung
YF
Meng
Nai-Hsin
NH
Kao
Mu-Jung
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001175:Arthrography; D002062:Bursitis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012019:Reflex Sympathetic Dystrophy / Q000150:complications / Q000000981:diagnostic imaging; D017006:Rotator Cuff / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D012783:Shoulder Dislocation / Q000150:complications / Q000000981:diagnostic imaging; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D020521:Stroke / Q000150:complications*