Post stroke shoulder subluxation and shoulder pain: a cohort multicenter study.
OBJECTIVE
To study the occurrence of shoulder subluxation, shoulder pain in stroke patients and identify factors associated to these conditions during rehabilitation period.


METHODS
Stroke patients from 9 rehabilitation centers from March to December 2006 were enrolled in the present study. All subjects were registered for demographic data including risk factors and type of stroke. They were assessed for motor recovery, cognitive ability, functional ability, psychological reaction and quality of life by using Brunnstrom stage, Thai Mental State Examination (TMSE), Barthel ADL Index (BI), Hospital Anxiety and Depression Scale (HADS) and WHOQOL-BREF questionnaires respectively at the beginning and the end of the present study. The occurence of shoulder subluxation and shoulder pain were recorded and then were analyzed for the associated factors. All subjects received the conventional rehabilitation program until they reached their rehabilitation goals or discharge criteria.


RESULTS
Of 376 stroke patients, 327 met the inclusion criteria, 62 patients (19%) were found to have shoulder pain and 122 (37%) patients had shoulder subluxation. Shoulder pain was significantly more frequent in subjects with shoulder subluxation (odds ratio (OR) 2.48, 95% confidence interval (CI) 1.38-4.46) and at 2-6 months after stroke onset (OR 4.0, 95% CI 2.06-7.79). Shoulder subluxation was significantly associated with hemorrhagic type of stroke (OR 2.06, 95% CI 1.08-3.93), loss of proprioceptive sensation (OR 3.03, 95% CI 1.26-7.29) and negatively associated with Brunnstrom's stage of arm recovery (OR 0.44, 95% CI 0.34-0.56). No significant functional and quality of life impact was found from these conditions.


CONCLUSIONS
Post stroke shoulder pain and subluxation were common during the rehabilitation period. Shoulder pain significantly occurred within 6 months after stroke onset and increased risk in patients with shoulder subluxation. Shoulder subluxation was correlated with Brunnstrom's stage, proprioceptive loss and hemorrhagic type of stroke.
Suethanapornkul
Sumalee
S
Rehabilitation Medicine Department, Phramongkutklao Hospital, Bangkok, Thailand. ssumalee@hotmail.com
Kuptniratsaikul
Patcharawimol Srisa-an
PS
Kuptniratsaikul
Vilai
V
Uthensut
Pimwipa
P
Dajpratha
Piyapat
P
Wongwisethkarn
Jongkolporn
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011581:Psychological Tests; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D012042:Registries; D012307:Risk Factors; D012782:Shoulder / Q000473:pathology*; D012783:Shoulder Dislocation / Q000150:complications* / Q000503:physiopathology; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000473:pathology; D020069:Shoulder Pain / Q000209:etiology* / Q000473:pathology; D020521:Stroke / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D055815:Young Adult