Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

Abstract

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.

A Comparison of Suprascapular Nerve Block vs Intraarticular Steroid Injection in Improvement of Hemiplegic Shoulder Pain

“…22 Comparing our results with this study, all the patients in group A (suprascapular nerve block group) experienced significant pain relief, confirming the efficacy of this procedure in hemiplegic shoulder pain. A number of studies have reported that rotator cuff tendinitis is present in almost 33% of stroke survivors with hemiplegia, 23,24 Hence, it is considered prudent to avoid multiple intraarticular steroid injections in hemiplegic patients, especially as they are known to cause atrophy in tendons and ligaments. A comparison of intraarticular steroid injection versus suprascapular nerve block for non-specific shoulder pain reported that both interventions resulted in improvement in pain scores, with negligible difference in terms of overall efficacy.…”

Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders

“…Ultrasonography is a relatively established tool for assessing post-stroke hemiplegic shoulders ( 19 ) . Furthermore, it has important comparative advantages in evaluating shoulder subluxation ( 6 , 7 ) .…”

Musculoskeletal ultrasound-guided physical therapy in hemiplegic shoulder pain

“…Studies have shown that MU examination is sensitive in detecting SA-SD bursal effusion or inflammation in patients with HSP. [ 24 ] Furthermore, hemiplegic patients primarily suffer from adduction and intorsion of the upper limbs. Under external traction, uncoordinated muscle movements can cause uneven stress on the intertubercular sulcus.…”