Post-stroke shoulder pain subtypes classifying criteria: towards a more specific assessment and improved physical therapeutic care

Abstract

Background: Post-stroke Shoulder Pain (PSSP) is a common stroke-related syndrome that prolongs hospitalization and diminishes quality of life. PSSP studies were unsuccessful in clarifying pathophysiological mechanisms. Therefore, cohort's studies with greater variety of the sample and larger follow-up period could provide additional clinical data and may improve medical care. Objective: To classify people with PSSP and identify intergroup clinical differences, providing additional data useful for therapeutic care planning. Methods: One thousand individuals with stroke were selected from all levels of one health Area and followed up during one year. Demographic data, stroke clinical characteristics, stroke-related symptoms and rehabilitation parameters were collected. The shoulder muscle impairment was used to group participants into three clinical profiles: severe muscular impairment, moderate muscular impairment and low muscular impairment groups. Results: A total of 119 individuals were diagnosed with PSSP. The suggested classification criteria showed two groups that differed significantly in relation to the onset and duration of PSSP, presence of sensory and speech impairment, and spasticity. The outcomes did not firmly support the existence of a third suggested PSSP subtype.

Efficacy of acupuncture versus rehabilitation therapy on post-stroke shoulder pain: A systematic review and meta-analysis of randomized controlled trials

“…PSSP may result from several pathological, such as soft tissue disorders, impaired motor control, and changes in peripheral and central nervous system activities. [11,[73][74][75] When the soft tissue of the shoulder is injured after a stroke, the improper pulling of gravity and external force may lead to joint subluxation, thereby causing shoulder pain. [11] The decrease of muscle tension can also slow down the local blood circulation and increase inflammatory cytokine release, thereby causing the adhesion of joint capsule and soft tissue, which may lead to shoulder pain as well.…”

Early multidisciplinary prevention program of post-stroke shoulder pain: A randomized clinical trial

“…In addition, some authors argued against a unique entity and suggesting the need to develop more individualized multidisciplinary management approaches have emphasized the different clinical profiles and risk factors to the development of post-stroke shoulder pain. 29 Particularly it will be necessary to address central pain mechanisms that might underlie a significant part of the residual pain observed in the stroke population. 30 Interestingly we observed a better early functional independence in the intervention group that might be related to a better ability to cope with the motor disability as no difference was observed in terms of spasticity, motor function or articular amplitudes.…”

“…In addition, some authors argued against a unique entity and suggesting the need to develop more individualized multidisciplinary management approaches have emphasized the different clinical profiles and risk factors to the development of post-stroke shoulder pain. 29 Particularly it will be necessary to address central pain mechanisms that might underlie a significant part of the residual pain observed in the stroke population. 30…”

Research Hotspots and Frontiers in Post Stroke Pain: A Bibliometric Analysis Study

“…Pain is often missed clinically due to a low disclosure rate. The main subtypes of pain after stroke include central post-stroke pain (CPSP), complex regional pain syndrome (CRPS), shoulder pain, and spasticity-related pain (Delpont et al, 2018;Torres-Parada et al, 2020;Yang and Chang, 2021). Many patients persistently experience at least one subtype.…”