Mazlum Serdar AKALTUN, Burhan Fatih KOCYİGİT

Evaluation of glenohumeral subluxation and related factors in patients with post-stroke shoulder pain

Aim: Glenohumeral subluxation (GHS) is a frequent complication of post-stroke patients which can be considered as a major predisposing factor for other disorders. We aimed to assess the frequency of GHS in patients with post-stroke shoulder pain and to determine the relationships of GHS with motor recovery, pain, functional status and depression.Material and Methods: This study has a descriptive design. A total of 73 stroke patients with shoulder pain were enrolled in this study. Patients’ demographic characteristics, disease duration, Brunnstrom motor recovery levels for upper extremities, functional ambulation scales (FAS), spasticity stages, pain levels, Barthel Index (BI) and depression scores were recorded. The presence of GHSwas evaluated clinically and radiologically. Considering patients with and without GHS, clinical variables were compared.Results: Of the 73 patients, 21 (28.7%) of them had GHS. The ratio of patients in Brunnstrom Category I (Brunstrom 1-3) and nonfunctional ambulation level were significantly higher in patients with GHS (p < 0.05). Shoulder flexion, abduction, internal rotation and external rotation ROMs were found to be significantly lower in patients with GHS (p < 0.05). No significant difference was found in terms of spasticity and shoulder extension (p > 0.05). Pain levels and BDI scores were significantly higher, BI scores were significantly lower in patients with GHS, though (p < 0.05).Conclusion: GHS is a frequent problem in stroke patients which is closely related to the motor recovery and ambulation level. Patients with GHS have a more restricted shoulder ROM, higher pain and depression scores and poor level functional independence.

PDF

___

1. Joynt RL. The source of shoulder pain in hemiplegia. Arch Phys Med Rehabil 1992;73:409-13.
2. Stolzenberg D, Siu G, Cruz E. Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke. Top Stroke Rehabil 2012;19:444-56.
3. Barlak A, Unsal S, Kaya K, et al. Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes. Int J Rehabil Res 2009;32:309-15.
4. Paci M, Nannetti L, Rinaldi LA. Glenohumeral subluxation in hemiplegia: An overview. J Rehabil Res Dev 2005;42:557-68.
5. Veeger H, van der Helm F. Shoulder function; the perfect compromise between mobility and stability. Journal of Biomechanics 2007;40:2119-29.
6. Suethanapornkul S, Kuptniratsaikul PS, Kuptniratsaikul V, et al. Post stroke shoulder subluxation and shoulder pain: a cohort multicenter study. J Med Assoc Thai 2008;91:1885-92.
7. Pompa A, Clemenzi A, Troisi E, et al. Enhanced-MRI and ultrasound evaluation of painful shoulder in patients after stroke: a pilot study. Eur Neurol 2011;66:175-81.
8. Kumar R, Metter EJ, Mehta AJ, et al. Shoulder pain in hemiplegia. The role of exercise. Am J Phys Med Rehabil 1990;69:205-8.
9. Ikai T, Tei K, Yoshida K, et al. Evaluation and treatment of shoulder subluxation in hemiplegia: relationship between subluxation and pain. Am J Phys Med Rehabil 1998;77:421-6.
10. Kumar P, Mardon M, Bradley M, et al. Assessment of glenohumeral subluxation in poststroke hemiplegia: comparison between ultrasound and fingerbreadth palpation methods. Phys Ther 2014;94:1622-31.
11. Pop T. Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability. Ortop Traumatol Rehabil 2013;15:259-67.
12. Yücel Y, Senocak M, Kocasoy-Orhan E, et al. Results of Leeds assessment of neuropathic symptoms and signs pain scale in Turkey: A validation study. The J Pain 2004;5:427-32.
13. Van Deusen J, Harlowe D. Continued construct validation of the St. Marys CVA evaluation: Brunnstrom arm and hand stage ratings. Am J Occup Ther 1986;40:561-3
14. Gregson J, Leathley M, Moore A, et al. Reliability of tone assessment scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil 1999;80:1013-6.
15. Holden MK, Kathleen MG. Clinical gait assesment in the neurologically impaired. Rehability and meaningfulness. Phys Ther 1986;66:1530-9.
16. Mahoney FJ, Barthel DW. Functional evaluation: the Barthel index. Md State Med J 1965;14:61-5.
17. Küçükdeveci AA, Yavuzer G, Tennant A, et al. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med 2000;32:87-92.
18. Beck AT, Steer RA, Garbin MG. Psychometric properties of the beck depression inventory: 25 years of evaluation. Clin Psychol Rev 1988;8:77-100.
19. Hisli N. Beck depresyon envanterinin üniversite öğrencileri için geçerliği ve güvenirliği. Türk Psikoloji Dergisi 1989;7:3-13.
20. Ikai T, Tei K. Interval change of the shoulder subluxation in hemiplegic patients. Japan J Rehabil Med 1992;29:56.
21. Van Langenberghe HV, Hogan BM. Degree of pain and grade of subluxation in the painful hemiplegic shoulder. Scand J Rehab Med 1988;20:161-6.
22. Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil 2002;16:276-98.
23. Huang YC, Liang PJ, Pong YP, et al. Physical findings and sonography of hemiplegic shoulder in patients after acute stroke during rehabilitation. J Rehabil Med 2010;42:21-6.
24. Faghri PD, Rodgers MM, Glaser RM, et al. The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil 1994;75:73-9.
25. Zorowitz RD, Hughes MB, Idank D, et al. Shoulder pain and subluxation after stroke: correlation or coincidence? Am J Occup Ther 1996;50:194-201.
26. Kim NY, Lee SC, Kim YW. Effect of Duloxetine for the Treatment of Chronic Central Poststroke Pain. Clin Neuropharmacol 2019;42:73-6.
27. Walsh K. Management of shoulder pain in patients with stroke. Postgrad Med J 2001;77:645-9.
28. Lo SF, Chen SY. Artrographic and Clinical Findings in patients with hemiplegic shoulder pain.Arch Phys Med Rehabil 2003;84:1786-91.
29. De Courval LP, Barsauscas A, Berenbaum B. Painful shoulder in the hemiplegic and unilateral neglect. Arch Phys Med Rehabil 1990;71:673-6.