Risk Factors of Hemiplegic Shoulder Pain in Stroke Patients

Cheng, Pao-Tsai; Lee, Chia-En; Liaw, Mei-Yun; Wong, May‐Kuen; Hsueh, Tse-Chieh

doi:10.1300/j094v03n03_05

Cited by 20 publications

(25 citation statements)

References 9 publications

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“…Of these, 49 studies were obtained as full text and 14 of these met the selection criteria. [27][28][29][30][31][32][33][34][35][36][37][38][39][40] Figure 1 summarises the results of the search strategy, including the reasons for exclusion of studies from the review.…”

Section: Resultsmentioning

confidence: 99%

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Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke

Kumar

Saunders

Ellis

et al. 2013

Physical Therapy Reviews

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Background: Glenohumeral subluxation (GHS) and hemiplegic shoulder pain (HSP) are the most common musculoskeletal complications reported in patients with stroke. These secondary problems present considerable challenges to the rehabilitation of the upper limb. Objective: The aim of this review was to evaluate the evidence on the association between shoulder subluxation and pain in patients with stroke. Method: A systematic online search was conducted of MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and the Cochrane Library. The search was supplemented by hand searching of relevant journals and citation tracking of the retrieved papers. All primary studies published in English language fulfilling the review's inclusion criteria were included. Five reviewers independently appraised the methodological quality of the selected studies. Any discrepancies were resolved following discussions. Results: Of the 148 articles that were identified by the search, 14 studies met the criteria to be included in the review. Seven studies found an association and seven studies did not find an association between subluxation and pain. The methodological quality of the studies varied considerably and studies used a wide range of outcome measures to assess both subluxation and pain. Conclusions: Irrespective of any association, both subluxation and pain can independently have an impact on functional rehabilitation. Management of these clinical outcomes is critical in clinical practice and clinicians should continue to prevent and reduce these post-stroke secondary complications to enhance upper limb function.

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Section: Resultsmentioning

confidence: 99%

“…Eight studies used cross-sectional design, [27][28][29][30][31][32]34,40 and the designs used by the other studies included case series study, 33 case-controlled, 35 retrospective, 36 cohort, 37,38 and correlation 39 study.…”

Section: Description Of Studiesmentioning

confidence: 99%

Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke

Kumar

Saunders

Ellis

et al. 2013

Physical Therapy Reviews

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“…Although many risk factors for HSP have been identified, such as age, sex [37,38], side of stroke [39], neglect [38,39], severity of paresis [27,37,38,39,40,41], time since stroke [40] and shoulder subluxation [42], strong evidence-supported predisposing clinical or epidemiological factors have yet to emerge [42,43]. …”

Section: Discussionmentioning

confidence: 99%

Enhanced-MRI and Ultrasound Evaluation of Painful Shoulder in Patients after Stroke: A Pilot Study

et al. 2011

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Background: Epidemiological and radiological studies have previously been performed to identify the possible causes of hemiplegic shoulder pain (HSP). Many different etiologies have been postulated, though no clear correlations have emerged, and a multifactorial pathogenesis of HSP has been proposed. Recently, two MRI-based studies have described different shoulder findings as possible causes of pain in chronic stroke survivors. Purpose: The aim of this study was to describe the structural abnormalities of the painful shoulder in the first months after stroke by ultrasound and enhanced MRI. The secondary aims were to identify possible predisposing factors for HSP and to evaluate its impact on motor recovery. Methods: One hundred and fifty-three first-time stroke patients, admitted to the Santa Lucia Foundation for rehabilitation, were investigated for HSP. Twenty-five stroke patients with HSP and 16 stroke patients without shoulder pain were included. An ultrasound evaluation and enhanced shoulder MRI were performed for all the patients. Results: Among the shoulder abnormalities detected by both imaging studies, only capsulitis, which was detected by enhanced shoulder MRI in 88% of the HSP patients, was independently associated with pain (p < 0.001) and proven to be predictive of pain intensity as expressed by the VAS score (p < 0.003). HSP correlated with a worse global recovery (p < 0.05) as well as with male sex (p = 0.006), neglect (p = 0.02) and subluxation (p = 0.03), although none of these features were found to be independent predictors of pain. Conclusion: Adhesive capsulitis was found to be a possible cause of HSP. However, MRI, which is more expensive than other diagnostic tools, may be considered the gold standard tool for understanding the etiology of HSP.

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“…Despite this limitation, the findings support those of several other cross-sectional studies which found an association between shoulder subluxation and pain. 32,33,35,37 In contrast, other clinical studies have reported no association between shoulder subluxation and pain. 28,[39][40][41][42][43][44] One study of 10 patients with stroke found that the pain scores did not correlate with shoulder subluxation scores at initial evaluations and there was no association between pain and shoulder subluxation change scores at subsequent evaluations.…”

Section: Shoulder Painmentioning

confidence: 97%

“…30 Several studies have identified a link between shoulder subluxation and shoulder pain; 12,29,[31][32][33][34][35][36][37][38] these are summarised in Table 1. In the largest of these, 219 patients were followed up for 11 months and it was found that 157 patients had shoulder pain at least once during the course of their treatment.…”

Section: Shoulder Painmentioning

confidence: 99%

A critical review of shoulder subluxation and its association with other post-stroke complications

Kumar¹,

Swinkels²

2009

Physical Therapy Reviews

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Objectives: Shoulder subluxation affects up to 81% of patients with stroke and has been the subject of clinical research studies for decades. Despite this, its role in upper limb recovery is poorly understood. Subluxation has been linked to other post-stroke complications such as pain, restricted range of motion, poor motor recovery and reflex sympathetic dystrophy. The aim of the present study is to synthesise research findings on the association between subluxation and other post-stroke complications. Methods: A critical review of the relevant literature was undertaken. Results: The association between shoulder subluxation and post-stroke complications is equivocal. The majority of studies were found to have methodological limitations such as heterogeneous patient recruitment criteria, small sample sizes, lack of a standardised definition of subluxation and the use of varied and insensitive clinical measures of assessment. Discussion: Although the association between subluxation and post-stroke complications is uncertain, when present in combination, these complications could have a significant impact on upper limb function. Early rehabilitation programmes which target shoulder muscle function may be the best approach to the prevention of secondary complications and the facilitation of motor recovery in the upper limb. Future longitudinal studies with more homogenous samples are needed. These should consider assessing patients at multiple times and follow them up for at least 1 year. The use of prediction models would allow understanding of a causal association between subluxation and other post-stroke complications. This would inform the effective rehabilitation of upper limb dysfunction in patients with stroke.

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Risk Factors of Hemiplegic Shoulder Pain in Stroke Patients

Cited by 20 publications

References 9 publications

Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke

Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke

Enhanced-MRI and Ultrasound Evaluation of Painful Shoulder in Patients after Stroke: A Pilot Study

A critical review of shoulder subluxation and its association with other post-stroke complications

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