MRI Findings in the Painful Poststroke Shoulder

Abstract

Background and Purpose-We describe the structural abnormalities in the painful shoulder of stroke survivors and their relationships to clinical characteristics. Method-Eighty-nine chronic stroke survivors with poststroke shoulder pain underwent T1-and T2-weighted multiplanar, multisequence MRI of the painful paretic shoulder. All scans were reviewed by one radiologist for the following abnormalities: rotator cuff, biceps and deltoid tears, tendinopathies and atrophy, subacromial bursa fluid, labral ligamentous complex abnormalities, and acromioclavicular capsular hypertrophy. Clinical variables included subject demographics, stroke characteristics, and the Brief Pain Inventory Questions 12. The relationship between MRI findings and clinical characteristics was assessed through logistic regression. Results-Thirty-five percent of subjects exhibited a tear of at least one rotator cuff, biceps or deltoid muscle. Fifty-three percent of subjects exhibited tendinopathy of at least one rotator cuff, bicep or deltoid muscle. The prevalence of rotator cuff tears increased with age. However, rotator cuff tears and rotator cuff and deltoid tendinopathies were not related to severity of poststroke shoulder pain. In approximately 20% of cases, rotator cuff and deltoid muscles exhibited evidence of atrophy. Atrophy was associated with reduced motor strength and reduced severity of shoulder pain. Conclusions-Rotator cuff tears and rotator cuff and deltoid tendinopathies are highly prevalent in poststroke shoulder pain. However, their relationship to shoulder pain is uncertain. Atrophy is less common but is associated with less severe shoulder pain. (Stroke. 2008;39:1808-1813.)

Guidelines for Adult Stroke Rehabilitation and Recovery

“…Among patients with acute and chronic stroke with hemiplegic shoulder pain, the presence of shoulder tissue injury on imaging is not associated with the severity of pain. 108,109 Patients with stroke-related hemiplegia demonstrate altered movement patterns at certain stages of recovery. In the acute phase of stroke, shoulder subluxation is associated with pain.…”

“…103,110 Compared with those without voluntary movement, patients with some movement in the painful hemiparetic shoulder have a higher rate of shoulder joint tissue injury on magnetic resonance imaging, suggesting that more physical activity promotes injury. 109 However, the relationship between altered kinematics and pain in the hemiparetic shoulder has not been established. For example, shoulder joint kinematics are altered with spasticity, yet there are no clear correlations between reductions in Ashworth and pain scores or reductions in subluxation and pain.…”

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient

“…Shoulder pain has been associated with poor glenohumeral joint alignment, decreased shoulder passive range of motion (PROM), and reduced muscular, ligamentous, and tendinous function around the shoulder. 191,192 Traditional behavioral treatments for shoulder pain and contracture include support for the arm against gravity, PROM, and facilitation of the muscles around the shoulder. There is, however, conflicting evidence for positioning, strapping, or PROM as interventions for shoulder contracture and pain prevention.…”

Back Pain and Musculoskeletal Disorders in Multiple Sclerosis

“…In addition, motor impairment of the upper limb was not evaluated in our study. Severe muscle weakness could improve lesions of the rotator cuff, as in stroke patients [22]. 50% of patients were painful at the moment of the clinical exam.…”