title: Enhanced-MRI and ultrasound evaluation of painful shoulder in patients after stroke: a pilot study.
abstract: BACKGROUND
  Epidemiological and radiological studies have previously been performed to identify the possible causes of hemiplegic shoulder pain (HSP). Many different etiologies have been postulated, though no clear correlations have emerged, and a multifactorial pathogenesis of HSP has been proposed. Recently, two MRI-based studies have described different shoulder findings as possible causes of pain in chronic stroke survivors.
  
  
  OBJECTIVE
  The aim of this study was to describe the structural abnormalities of the painful shoulder in the first months after stroke by ultrasound and enhanced MRI. The secondary aims were to identify possible predisposing factors for HSP and to evaluate its impact on motor recovery.
  
  
  METHODS
  One hundred and fifty-three first-time stroke patients, admitted to the Santa Lucia Foundation for rehabilitation, were investigated for HSP. Twenty-five stroke patients with HSP and 16 stroke patients without shoulder pain were included. An ultrasound evaluation and enhanced shoulder MRI were performed for all the patients.
  
  
  RESULTS
  Among the shoulder abnormalities detected by both imaging studies, only capsulitis, which was detected by enhanced shoulder MRI in 88% of the HSP patients, was independently associated with pain (p < 0.001) and proven to be predictive of pain intensity as expressed by the VAS score (p < 0.003). HSP correlated with a worse global recovery (p < 0.05) as well as with male sex (p = 0.006), neglect (p = 0.02) and subluxation (p = 0.03), although none of these features were found to be independent predictors of pain.
  
  
  CONCLUSIONS
  Adhesive capsulitis was found to be a possible cause of HSP. However, MRI, which is more expensive than other diagnostic tools, may be considered the gold standard tool for understanding the etiology of HSP.
authors: Santa Lucia Foundation, IRCCS, Rome, Italy. a.pompa@hsantalucia.it
authors: Alessandra
authors: A
authors: Pompa
authors: Alessandro
authors: A
authors: Clemenzi
authors: Elio
authors: E
authors: Troisi
authors: Marco
authors: M
authors: Di Mario
authors: Angelo
authors: A
authors: Tonini
authors: Luca
authors: L
authors: Pace
authors: Paolo
authors: P
authors: Casillo
authors: Alessandro
authors: A
authors: Cuccaro
authors: Maria Grazia
authors: MG
authors: Grasso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology; D009483:Neuropsychological Tests; D010147:Pain Measurement; D010865:Pilot Projects; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D018608:Ultrasonography, Doppler