Rengin GÜZEL, Selen ÖZGÖZEN, İlke COŞKUN BENLİDAYI

İnme Sonrası Hemiplejik Omuz Ağrılı Hastalarda Kantitatif Yöntemle Belirlenen Glenohumeral Subluksasyonun Klinik Değişkenlerle İlişkisi

Amaç: Bu çalışmanın amacı, inme sonrası hemipleji hastalarında glenohumeralsubluksasyonun klinik değişkenlerle ilişkisinin değerlendirilmesidir.“Hemiplejik hastalardaki omuz subluksasyonu; spastisite, motor iyileşme veambulatuvar durum ile ilişkilidir” hipotezinin değerlendirilmesiamaçlanmaktadır.Yöntemler: İnme sonrası hemipleji tanılı hastalardan, omuz ağrısı nedeniyleanteroposterior omuz radyografisi çekilmiş olanlar çalışmaya dahil edildi.Retrospektif olarak dizayn edilen bu çalışmada, hastaların elektronik veritabanındaki ve dosyalarındaki verilerinden demografik özellikleri (yaş,cinsiyet), hastalık süreleri, fonksiyonel ambulasyon skalaları (FAS), üstekstremite için Brunnstrom motor iyileşme seviyeleri ve Modifiye AshworthSkalası'na (MAS) göre spastisite evreleri kaydedildi. Muayene verilerindenklinik GHS tanısı alıp almadıkları not edildi. GHS saptanan hastalarda,muayeneleri ile eş zamanlı çekilmiş olan anteroposterior omuzradyografilerinde vertikal ve horizontal mesafeler ölçüldü. Klinik değişkenlerile GHS arasındaki ilişki değerlendirildi.Bulgular: Omuz ağrısı nedeniyle anteroposterior omuz grafisi çekilmiş olan,toplam 47 hemipleji hastasının sistem verisine ulaşıldı. Dışlama kriterlerindensonra, yaş ortalaması 66,2±12,1 yıl olan 41 hasta istatistiksel analize dahiledildi. Hastaların 22’sinde (%53,7) GHS mevcuttu. Subluksasyon oranıBrunnstrom kategori I’de (Brunnstrom 1-3), kategori II’deki (Brunnstrom 4-6)hastalara göre anlamlı olarak daha fazlaydı (p0,05). Non-fonksiyonel (FAS 0-2) ve fonksiyonel (FAS 3-5) ambulasyonasahip hastalarda subluksasyon oranları benzerdi (p>0,05). GHS'li hastalarda,vertikal ve horizontal mesafeler, FAS ve MAS kategorisine göre değişimgöstermezken (p>0,05), Brunnstrom kategori II’de, istatistiksel analiz içinyeterli hasta sayısına ulaşılamadığından karşılaştırmalı analiz yapılamadı.Sonuç: İnme sonrası hemipleji hastalarında, GHS varlığı, motor iyileşmeseviyesiyle ilişkili olmakla birlikte, ambulasyon ve spastisite düzeyindenbağımsızdır. Subluksasyon olan hastalarda, ambulasyon ve spastisite düzeyininsubluksasyonun kantitatif ölçümleri üzerine etkisi olduğu gösterilememiştir.

Relation of Quantitative Glenohumeral Subluxation with Clinical Variables in Patients with Post-Stroke Hemiplegic Shoulder Pain

Objective: The objective of the present study was to evaluate the relationship between glenohumeral subluxation (GHS) and the clinical variables in patients with post-stroke hemiplegia. The hypothesis, “Spasticity, motor recovery and ambulatory status are associated with GHS in hemiplegic patients” was tested. Methods: Post-stroke hemiplegic patients who had undergone anteroposterior shoulder radiography with a complaint of shoulder pain were included in the study. In this retrospectively designed study, demographic features (age, sex), disease duration, Functional Ambulation Scale (FAC) score, upper extremity Brunnstrom’s motor recovery stage, spasticity grade of the affected upper limb according to the Modified Ashworth Scale (MAS) were recorded from the electronic medical database. It was also noted whether the patients were diagnosed with GHS or not. In patients with GHS, vertical and horizontal distances were measured on anteroposterior shoulder radiographs, which were taken at the time of physical examination. Results: Data of 47 hemiplegic patients underwent anteroposterior shoulder radiographs due to shoulder pain was obtained. Following the application of exclusion criteria, 41 patients with a mean age of 66.2±12.1 were analysed. Of them, 22 (53.7%) had GHS. Subluxation rate was significantly higher among patients in Brunnstrom category I (Brunnstrom 1-3) than those in category II (Brunnstrom 4-6) (p0.05). Subluxation frequency was also similar between patients with non-functional (FAC 0-2) and functional ambulation (FAC 3-5) (p>0.05). In patients with GHS, vertical and horizontal distances did not differ by FAC and MAS category (p>0.05). Since Brunnstrom category II did not have enough number of patients for statistical tests, comparative analysis could not be applied. Conclusion: Among patients with post-stroke hemiplegia, presence of GHS is related to the motor recovery stage, but is regardless of ambulation and spasticity level. In patients with GHS, level of ambulation and spasticity had no impact on the quantitative measures of subluxation.

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