Risk Factors for Poststroke Shoulder Pain: A Systematic Review and Meta-Analysis

Abstract

Objective: To identify the risk factors identified within one month post-stroke that predict the onset of post-stroke shoulder pain (PSSP) within the first year after stroke. Methods: Five databases, (AMED, CINAHL, EMBASE, Medline, PubMed) were searched from inception to April 2019. Prospective cohort studies that measured a potential risk factor for post-stroke shoulder pain within the first month after stroke were included. Two authors independently reviewed and selected articles for inclusion. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data extracted included raw data for odds ratio (OR) calculations, definition and measurement of pain, study limitations and baseline characteristics of participants. The review was conducted following PRISMA guidelines. Results: Nine articles were retrieved that met the inclusion criteria, and six presented data to use in meta-analysis. Fifty-four different factors were identified as potential risk factors. Meta-analysis was possible for four factors; sex (OR 0.93, CI 0.75-1.15), laterality (OR 0.78, CI 0.59-1.05), diabetes (OR 2.09, CI 1.16-3.78), and history of shoulder pain (OR 2.78, CI 1.29-5.97). Reduced motor function in the upper limb was also identified as a significant risk factor through qualitative synthesis. Conclusions: Reduced motor function in the upper limb, diabetes, and a history of shoulder pain were identified as significant risk factors for the development of PSSP within the first year after stroke. Recommendations to standardise future studies in this area have been made and it is suggested that defining subtypes of PSSP may aid future interventional studies.

Sensori-motor recovery in post-stroke shoulder pain: a correlation study

“…7,9,10 Among the recent publications, Holmes et al concluded that reduced motor function in upper limb is significantly related with post stroke shoulder pain, which is also clearly evident from our study. 13 Lindgren et al concluded that PSSP is an important predictor of affected upper limb recovery and requires multidisciplinary approach to manage PSSP for faster limb recovery-which is also the clinical implication of our study. 14…”

Treatment effect and mechanism of Fu's subcutaneous needling among patients with shoulder pain: A retrospective pilot study

“…The physiological basis of shoulder pain is very complicated. It can be caused by various reasons, poststroke (Holmes et al, 2020), rotator cuff injury (Sir & Eksert, 2019), subacromial bursitis (Chen et al, 2019), and heart disease (Mizokami et al, 2016). However, it is often seen that many patients with shoulder pain may not be categorized based on various clinical examinations including ultrasound, MRI or X ray examination.…”

“…There are many conditions that may induce shoulder pain, such as cerebrovascular accidents (Holmes, McManus, Koulouglioti, & Hale, 2020), rotator cuff injury (Sir & Eksert, 2019), subacromial bursitis (Chen, Jiang, & Huang, 2019), and heart disease (Mizokami et al, 2016). The pathogenesis of shoulder pain can be difficult to identify based on consensus or diagnostic criteria and can be a confounding problem for many practitioners.…”

Risk factors for shoulder pain after stroke: A clinical study

“…In a meta-analysis, Shahnawaz and colleagues 4 concluded that the significant predictors of shoulder pain after stroke were age, female gender, increased tone, sensory impairment, left-sided hemiparesis, hemorrhagic stroke, hemispatial neglect, and poor NIHSS score. However, in another meta-analysis by Holmes 7 , diabetes, a history of shoulder pain, and reduced motor function in the upper limb were identified as significant risk factors for the development of shoulder pain after stroke. Obviously, a wide variation is available in meta-analysis studies.…”

“…Obviously, a wide variation is available in meta-analysis studies. At the same time, both meta-analyses have referred to their limitations, in terms of outcome measures, cause and definition of shoulder pain, and selective reporting 4 , 7 , which may affect the validation of the conclusions inevitably. Up to now, the issue seems still controversial.…”