Relationship between severity of shoulder subluxation and soft-tissue injury in hemiplegic stroke patients

Huang, Shih Wei; Liu, Sen Yung; Tang, Hao; Wei, Ta Sen; Wang, Wei Te; Yang, Chao

doi:10.2340/16501977-1026

Cited by 24 publications

(25 citation statements)

References 8 publications

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“…This falls within the reported incidence of 17–84% [7,13,14]. Acute hemiplegics with subluxation (75%) were significantly more frequent than chronic hemiplegics with subluxation (15%).…”

Section: Discussionsupporting

confidence: 78%

“…This is close to the 34–38.5% reported by some studies [7,8], lower than 59% reported by Yi et al [35], and higher than the 0–30% reported by other researchers [2,9,3,16,17,23,25]. The different rates of rotator cuff tears could possibly be due to differences in the degree of motor weakness among different study populations.…”

Section: Discussionsupporting

confidence: 76%

“…Subjects’ age, sex, hand dominance, hemiplegic side, time from onset of stroke (stroke symptom duration), and stroke type (ischemic or hemorrhagic) were recorded. Acute hemiplegics were those with stroke symptom duration <3 months, while those hemiplegics with stroke symptom duration of >3 months were classified as chronic [7–9]. …”

Section: Methodsmentioning

confidence: 99%

“…Passive movement was induced as needed with the help of an assistant. Both shoulders were examined in all subjects and controls using a scanning protocol previously described by other authors [11,12] to evaluate the long head of biceps tendon (LHBT), subscapularis (SCT) tendon, supraspinatus (SST) tendon, glenohumeral joint, infraspinatus tendon (IST), shoulder subluxation distance (measured by determining the Acromion-Greater Tuberosity Distance [AGTD]) [7,13,14], presence of adhesive capsulitis (by measuring the thickness of the coracohumeral ligament [CHL] – studies have shown that the coracohumeral ligament (CHL) is thickened in adhesive capsulitis) [15]. All examinations were performed by the first author.…”

Section: Methodsmentioning

confidence: 99%

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Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

et al. 2018

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SummaryBackgroundStroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices.Material/MethodsForty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-subdeltoid bursitis or effusion and adhesive capsulitis.ResultsHemiplegic shoulders exhibited significantly higher number of pathologies compared to the unaffected shoulders and shoulders of controls (p=0.000). One or more structural abnormalities were found in all 45 (100%) hemiplegic shoulders, 25 (55.6%) unaffected shoulders of the stroke subjects, and 39 (43.3%) control shoulders. The most frequent pathologies in the hemiplegic shoulders were the following: tendinosis of the long head of bicep tendon (48.9%), inferior shoulder subluxation (44.4%), co-existing subacromial-subdeltoid bursa/long head of bicep tendon sheath effusion (44.4%), and long head of bicep tendon sheath effusion only (40%). Tendinosis of the long head of bicep tendon was commoner in hemiplegic shoulders with poor motor status than those with good motor status.ConclusionsHemiplegic shoulders have significantly higher number of structural abnormalities than unaffected shoulders and the shoulders of controls. Hemiplegic stroke patients should undergo ultrasonography of the hemiplegic shoulder to define the nature and extent of soft tissue injuries prior to physical therapy.

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“…This falls within the reported incidence of 17–84% [7,13,14]. Acute hemiplegics with subluxation (75%) were significantly more frequent than chronic hemiplegics with subluxation (15%).…”

Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

et al. 2018

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“…According to the literature, subluxation impairs the abduction motion more than the flexion motion, due to anatomical and biomechanical aspects [64, 65]. However, no correlations between the sensorimotor impairment (FMA score) for all the movements and angles were observed, which refutes the second hypothesis of the study.…”

Section: Discussionmentioning

confidence: 53%

Elastic Tape Improved Shoulder Joint Position Sense in Chronic Hemiparetic Subjects: A Randomized Sham-Controlled Crossover Study

et al. 2017

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BackgroundElastic tape has been widely used in clinical practice in order to improve upper limb (UL) sensibility. However, there is little evidence that supports this type of intervention in stroke patients.ObjectiveTo verify the effect of elastic tape, applied to the paretic shoulder, on joint position sense (JPS) during abduction and flexion in subjects with chronic hemiparesis compared to sham tape (non-elastic tape). Furthermore, to verify if this potential effect is correlated to shoulder subluxation measurements and sensorimotor impairment.MethodsA crossover and sham-controlled study was conducted with post-stroke patients who were randomly allocated into two groups: 1) those who received Sham Tape (ST) first and after one month they received Elastic Tape (ET); 2) those who received Elastic Tape (ET) first and after one month they received Sham Tape (ST). The JPS was evaluated using a dynamometer. The absolute error for shoulder abduction and flexion at 30° and 60° was calculated. Sensorimotor impairment was determined by Fugl-Meyer, and shoulder subluxation was measured using a caliper.ResultsThirteen hemiparetic subjects (average time since stroke 75.23 months) participated in the study. At baseline (before interventions), the groups were not different for abduction at 30° (p = 0.805; p = 0.951), and 60° (p = 0.509; p = 0.799), or flexion at 30° (p = 0.872; p = 0.897) and 60° (p = 0.853; p = 0.970). For the ET group, differences between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° p<0.010) and 60° (p<0.010) were observed. For the ST group, differences were also observed between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° (p<0.010,) and 60° (p<0.010). Potential effects were only correlated with shoulder subluxation during abduction at 30° (p = 0.001, r = -0.92) and 60° (p = 0.020, r = -0.75).ConclusionElastic tape improved shoulder JPS of subjects with chronic hemiparesis regardless of the level of UL sensorimotor impairment. However, this improvement was influenced by the subluxation degree at abduction.

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Management of hemiplegic shoulder pain: A UK‐wide online survey of physiotherapy and occupational therapy practice

Kumar

Turton

Cramp

et al. 2020

Physiotherapy Res Intl

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Purpose The purpose of this study was to explore, via an online survey, how therapists assess, diagnose and manage hemiplegic shoulder pain (HSP) in the United Kingdom. The objectives were to explore (1) how therapists assessed HSP, (2) what the aims of therapy were, (3) what interventions therapists used, (4) what outcome measures therapists used, (5) what training of HSP therapists had, and (6) what barriers therapists experienced in the management of HSP. Methods An online survey was distributed to physiotherapists (PTs) and occupational therapists (OTs) working in stroke rehabilitation via professional bodies' interest groups. Results Sixty‐seven responses were received: 40 (60%) were PTs and 27 (40%) were OTs. Therapists routinely screened for HSP (n = 59, 89%). When HSP was assessed, 33 (50%) spent <10 min and 34 (50%) spent >10 min on assessment. Patient‐reported pain was used for assessment of HSP by 66 (99%) of respondents. Frequent interventions included positioning (n = 62, 94%), posture re‐education (n = 57, 86%), and range of motion exercises (n = 55, 83%). Range of movement was used as an outcome measure by 31 (47%). Sixty (91%) respondents reported receiving training in HSP management. Time constraints (n = 41, 62%) and lack of diagnosis of HSP (n = 33, 54%) were identified as barriers to providing appropriate care to people with HSP Conclusion Study findings showed varied practice in the assessment and treatment for HSP and indicate that time constraints are a considerable barrier to the management of these patients. Further research is required to establish best practice which may help improve outcomes and care for people with poststroke shoulder pain.

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Relationship between severity of shoulder subluxation and soft-tissue injury in hemiplegic stroke patients

Abstract: When post-hemiplegic shoulder subluxation measurements exceed the above-mentioned cut-off points in physical or radiographic examinations, further ultrasound evaluation for soft-tissue injury is recommended.

Cited by 24 publications

References 8 publications

Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

Elastic Tape Improved Shoulder Joint Position Sense in Chronic Hemiparetic Subjects: A Randomized Sham-Controlled Crossover Study

Management of hemiplegic shoulder pain: A UK‐wide online survey of physiotherapy and occupational therapy practice

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