Shoulder pain in people with a stroke: a population-based study

Ratnasabapathy, Yogini; Broad, Joanna; Baskett, J. J.; Pledger, Megan; Marshall, J; Bonita, Ruth

doi:10.1191/0269215503cr612oa

Cited by 117 publications

(119 citation statements)

References 12 publications

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“…Headache in the acute phase of stroke has been reported in 27-31% of patients, depending on the type of stroke (Vestergaard et al, 1993;Tentschert et al, 2005;Verdelho et al, 2008), whereas headache with late onset has shown prevalence rates of 3.5-11% within the first 2 years (Ferro et al, 1998;Widar et al, 2002;Jonsson et al, 2006). Shoulder pain has been reported in 15-40% of patients within 6 months after stroke (Langhorne et al, 2000;Gamble et al, 2002;Ratnasabapathy et al, 2003;Lindgren et al, 2007), and CPSP is seen in 5-11% of stroke patients (Andersen et al, 1995;Bowsher, 2001;Weimar et al, 2002;Widar et al, 2002).…”

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confidence: 99%

Pain following stroke: A prospective study

Hansen

Marcussen

Klit

et al. 2012

European Journal of Pain

150

120

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Background: Post-stroke pain is common and affects the quality of life of stroke survivors, but the incidence and severity of headache, shoulder pain, other joint pain and central post-stroke pain following stroke still remain unclear. The aim of this prospective study was to determine the incidence and intensity of these different types of post-stroke pain. Methods: A total of 299 consecutive stroke patients, admitted to the Department of Neurology at Aarhus University Hospital, underwent a structured interview and a short sensory examination within 4 days of admission. Follow-up was conducted by phone 3 and 6 months after stroke onset, with 275 patients completing the whole study. Pain with onset in relation to stroke onset or following stroke was defined as 'newly developed pain'. Results: At the 6-month follow-up, newly developed pain was reported by 45.8% of the patients; headache by 13.1%, shoulder pain by 16.4%, other joint pain by 11.7%, other pain by 20.0% and evoked pain by light touch or thermal stimuli by 8.0%. More than one pain type was reported by 36.5% of the patients with newly developed pain. According to pre-defined criteria, 10.5% of the patients were classified as having possible central post-stroke pain. There was a moderate to severe impact on daily life in 33.6% of the patients with newly developed pain. Conclusions: Pain following stroke is common, with almost half of the patients reporting newly developed pain 6 months after stroke.

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Section: Introductionmentioning

confidence: 99%

Pain following stroke: A prospective study

Hansen

Marcussen

Klit

et al. 2012

European Journal of Pain

150

120

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“…2 The cause of hemiplegic shoulder pain is multifactorial, 3,4 and contributions have been described from biomechanical changes, 1,5 spasticity, 6,7 and central-pain mechanisms. 8,9 Population based studies suggest that approximately one quarter of stroke survivors develop hemiplegic shoulder pain, 10,11 although higher rates of 52% to 54% have been reported in large studies using retrospective, 12 prospective, 13 and literature review 14 methodologies. Hemiplegic shoulder pain is associated with reduced functional ability, 15 a higher incidence of depression, 15 interference with rehabilitation, and an increased length of hospitalisation.…”

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Suprascapular Nerve Block for Shoulder Pain in the First Year After Stroke

Adey‐Wakeling

Crotty

Shanahan

2013

Stroke

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Background and Purpose-Shoulder pain is a common complication after stroke that can impede participation in rehabilitation and has been associated with poorer outcomes. Evidence-based treatments for hemiplegic shoulder pain are limited. Suprascapular nerve block (SSNB) is a safe and effective treatment of shoulder pain associated with arthritic shoulder conditions, but its usefulness in a stroke population is unclear. Methods-We undertook a randomized controlled trial assessing the effectiveness of SSNB in a population of 64 stroke patients (onset < 1 year) with hemiplegic shoulder pain. The primary outcome was pain measured on a visual analogue scale (VAS). Secondary outcomes were disability (Modified Rankin Scale, Croft Disability Index) and quality of life (EuroQol Health Questionnaire). All participants were assessed before randomization, and at 1, 4, and 12 weeks postintervention. Both groups continued with routine therapy. Results-Although both intervention and control groups demonstrated reduction in pain score, participants who received SSNB consistently demonstrated superior, statistically significant pain reduction compared with placebo. Mean VAS reduction in the SSNB group was >18 mm greater than participants receiving placebo injection. The number needed to treat with SSNB to reduce 1 stroke survivor's pain by 50% at 4 weeks is 4. No significant differences in function or quality of life were observed. No adverse events were reported. Conclusions-Suprascapular

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“…1,2 The incidence varies between 9% and 40% depending on patient group and study design. [1][2][3][4] Different studies have used various terms for shoulder pain, eg, shoulder pain in hemiplegia, [5][6][7][8] hemiplegic shoulder pain, 9 and poststroke shoulder pain. 4 Sometimes, it is unclear whether only proximal pain in the arm was assessed or if also more distal arm pain was included.…”

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confidence: 99%

“…10 Shoulder pain hinders rehabilitation, is an important contributor to length of hospital stay, 11 and has been associated with depression 4 and decreased quality of life. 12 Several factors have been related to shoulder pain after stroke such as paralysis, 3,4,13,14 restricted range of motion in the shoulder, 5,6,13 spasticity, 7,8 right hemispheric cerebrovascular lesion and left hemiplegia, 6,8 sensory abnormalities, 4,8 diabetes mellitus, 3 low Barthel Index score, 11 and inappropriate handling of the patient. 9 Recovery from shoulder pain may occur in 80%.…”

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confidence: 99%

Shoulder Pain After Stroke

Lindgren

Jönsson

Norrving

et al. 2007

Stroke

248

110

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Background and Purpose-Shoulder pain is a well-known complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited. Methods-During a 1-year period, 416 first-ever stroke patients were included in the population-based Lund StrokeRegister. After 4 months, 327 patients were followed up and 1 year later, the surviving 305 patients were followed up again. General status (National Institutes of Health Stroke Scale score) was registered at stroke onset. Shoulder pain intensity (visual analog scale, score 0 to 30ϭno-mild and 40 to 100ϭmoderate-severe pain); arm motor function; restricted dressing and/or ambulating; and functional status (Barthel Index) were registered at both follow ups. Results-Shoulder pain onset within 4 months after stroke was reported by 71 patients (22%). Among the 61 patients able to score the visual analog scale, 79% had moderate-severe pain. One year later, 8 of these 71 patients had died, 17 had no remaining pain, and 28 additional patients had developed shoulder pain since the first follow up. Lost or impaired arm motor function and high National Institutes of Health Stroke Scale score were predictors of shoulder pain. Shoulder pain restricted daily life often or constantly when dressing for 51%/31% and when ambulating for 29%/13% of the patients at 4 and 16 months, respectively. Conclusion-Almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderatesevere pain. Shoulder pain restricts patients' daily life after stroke. The increased risk of shoulder pain for patients with impaired arm motor function and/or low general status needs close attention in poststroke care.

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Shoulder pain in people with a stroke: a population-based study

Abstract: Shoulder pain after stroke is common, especially in patients with severe sensorimotor deficits, diabetics and those living at home. Appropriate management may reduce the rate of occurrence.

Cited by 117 publications

References 12 publications

Pain following stroke: A prospective study

Pain following stroke: A prospective study

Suprascapular Nerve Block for Shoulder Pain in the First Year After Stroke

Shoulder Pain After Stroke

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