Association between ultrasound assessment of glenohumeral subluxation and shoulder pain, muscle strength, active range of movement and upper limb function in people with stroke

Abstract

Association between ultrasound assessment of glenohumeral subluxation and shoulder pain, muscle strength, active range of movement and upper limb function in people with Stroke 2 ABSTRACT Background: Glenohumeral subluxation (GHS) is a commonly reported poststroke complication which has a negative effect on rehabilitation. Objective: To explore the association between GHS and other clinical outcomes in people with post-stroke hemiplegia. Methods: Patients with post-stroke hemiplegia (n=105, 71±11 years, median time since stroke 5.6 weeks), who gave informed consent, were recruited. GHS was assessed by the ultrasound method. Assessment of shoulder pain (visual analogue scale), active range of movement (AROM), muscle strength (Medical Research Council Scale), muscle tone (Modified Ashworth Scale) and the upper limb section of the Motor Assessment Scale (MAS) was undertaken.Results: GHS was present in 65 (62%) patients. There was a moderate negative correlation between GHS and muscle strength (r=-0.54, p<0.01); MAS score (r=-0.58, p<0.01); flexion (r=-0.54 p<0.01), abduction (r=-0.53 p<0.01), and external rotation (r=-0.52 p<0.01) but not between GHS and muscle tone (r =-0.18, p>0.05) and pain (r=0.06, p>0.05). Stepwise linear regression analysis showed that muscle strength, external rotation of the shoulder and GHS were associated with upper limb function (adjusted R 2 = 0.83, p<0.01). Conclusion:The relationship between GHS, shoulder AROM, muscle strength and upper limb function suggests that patients with GHS are more like to have poor motor recovery.

Sensori-Motor Recovery in Post-Stroke Shoulder Subluxation: A Non Invasive Correlation Study

“…Although Zorowitz et al1995 [14] found no correlation between Fugl-Meyer scores and vertical subluxation , but 6 years later, in their study-"Recovery patterns of shoulder subluxation after stroke" Zorowitz et al2001 [15] found that motor recovery can influence the reduction of GHS. Kumar P et al,2019 [16] concluded-as presence of GHS is related to reduction in shoulder ROM, muscle strength and upper limb function, proper preventive measures should be taken to prevent and or manage GHS, and here lies the clinical implication of our study. With the negative correlation derived from our study it can be strongly recommended that the measures like proper positioning-handling of the affected limb for prevention , along with functional electrical stimulations for managing GHS should be applied to hasten the upper limb recovery, also supported by the studies of Türkkan C et al2017 [3], Jung KM et al2019 [17], and meta-analysis by Nadler M, Pauls MM in 2017 [18] and also by Arya KN et al2018 [19].…”