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Chatterjee S, Goyal M. Development and content validation of an ADL questionnaire for hemiplegic shoulder. J Neurosci Rural Pract 2023; 14:235-238. [PMID: 37181177 PMCID: PMC10174179 DOI: 10.25259/jnrp_67_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/27/2022] [Indexed: 02/12/2023] Open
Abstract
Objective Shoulder problems can be a common secondary musculoskeletal complication after stroke. Common post-stroke shoulder problems include altered muscle tone, pain, and a frozen shoulder. The study was aimed at formulating an activities of daily living (ADL) questionnaire for stroke patients with shoulder problems. Materials and Methods The study was a cross-sectional content validation study conducted in a tertiary care hospital from August 2020 to March 2021. A literature review and direct patient interview were used to identify items for the scale. Before the construction of the scale, two physiotherapists with relevant field experience were interviewed to identify the items. Then, ten stroke patients were interviewed to generate new items depending on the challenges that they experienced. The scale was subsequently sent to a panel of eight experts for content evaluation. Results After the first round of Delphi, we excluded the items that failed to achieve at least a 0.8 item-level content validity index (I-CVI). In the first round, 9 items fail to achieve 0.8 I-CVI hence removed from the actual draft of the scale. Total 10 items were included in the second draft and it was sent to the 2nd round of Delphi survey. In this phase, all items got more than 0.8 I-CVI. The average value and universal acceptance of the scale level content validity index have been obtained at 0.96 and 0.8, respectively. It denotes that our proposed questioner got excellent level of content validity. Conclusion As the ADL questioner got excellent content validity, this scale can be used to assess the ADL functions of hemiplegic shoulder.
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Affiliation(s)
- Subhasish Chatterjee
- Department of Neurological Physiotherapy, Maharishi Markandeshwar (Deemed to be University), Ambala, Haryana, India
| | - Manu Goyal
- Department of Musculoskeletal Physiotherapy, MMIPR, Maharishi Markandeshwar (Deemed to be University), Ambala, Haryana, India
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Struyf P, Triccas LT, Schillebeeckx F, Struyf F. The Place of Botulinum Toxin in Spastic Hemiplegic Shoulder Pain after Stroke: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2797. [PMID: 36833493 PMCID: PMC9957016 DOI: 10.3390/ijerph20042797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/19/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Stroke is a common pathology worldwide, with an age-standardized global rate of new strokes of 150.5 per 100,000 population in 2017. Stroke causes upper motor neuron impairment leading to a spectrum of muscle weakness around the shoulder joint, changes in muscle tone, and subsequent soft tissue changes. Hemiplegic shoulder pain (HSP) is the most common pain condition in stroke patients and one of the four most common medical complications after stroke. The importance of the appropriate positioning and handling of the hemiplegic shoulder for prevention of HSP is therefore of high clinical relevance. Nevertheless, HSP remains a frequent and disabling problem after stroke, with a 1-year prevalence rate up to 39%. Furthermore, the severity of the motor impairment is one of the most important identified risk factors for HSP in literature. Spasticity is one of these motor impairments that is likely to be modifiable. After ruling out or treating other shoulder pathologies, spasticity must be assessed and treated because it could lead to a cascade of unwanted complications, including spastic HSP. In clinical practice, Botulinum toxin A (BTA) is regarded as the first-choice treatment of focal spasticity in the upper limb, as it gives the opportunity to target specifically selected muscles. It thereby provides the possibility of a unique patient tailored focal and reversible treatment for post stroke spasticity. This scoping review aims to summarize the current evidence of BTA treatment for spastic HSP. First, the clinical manifestation and outcome measures of spastic HSP will be addressed, and second the current evidence of BTA treatment of spastic HSP will be reviewed. We also go in-depth into the elements of BTA application that may optimize the therapeutic effect of BTA. Finally, future considerations for the use of BTA for spastic HSP in clinical practice and research settings will be discussed.
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Affiliation(s)
- Pieter Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, B-2610 Wilrijk, Belgium
- Department of Rehabilitation Medicine, Research School Caphri, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
- Adelante Zorggroep, 6229 HX Maastricht, The Netherlands
| | - Lisa Tedesco Triccas
- REVAL, Faculty of Rehabilitation Sciences, Universiteit Hasselt, B-3590 Diepenbeek, Belgium
- Department of Clinical and Movement Neuroscience, Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Fabienne Schillebeeckx
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven, B-3000 Leuven, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, B-2610 Wilrijk, Belgium
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3
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Haslam BS, Butler DS, Kim AS, Carey LM. Somatosensory Impairment and Chronic Pain Following Stroke: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:906. [PMID: 36673661 PMCID: PMC9859194 DOI: 10.3390/ijerph20020906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Chronic pain and somatosensory impairment are common following a stroke. It is possible that an interaction exists between pain and somatosensory impairment and that a change in one may influence the other. We therefore investigated the presence of chronic pain and self-reported altered somatosensory ability in individuals with stroke, aiming to determine if chronic pain is more common in stroke survivors with somatosensory impairment than in those without. METHODS Stroke survivors were invited to complete an online survey that included demographics, details of the stroke, presence of chronic pain, and any perceived changes in body sensations post-stroke. RESULTS Survivors of stroke (n = 489) completed the survey with 308 indicating that they experienced chronic pain and 368 reporting perceived changes in somatosensory function. Individuals with strokes who reported altered somatosensory ability were more likely to experience chronic pain than those who did not (OR = 1.697; 95% CI 1.585, 2.446). Further, this difference was observed for all categories of sensory function that were surveyed (detection of light touch, body position, discrimination of surfaces and temperature, and haptic object recognition). CONCLUSIONS The results point to a new characteristic of chronic pain in strokes, regardless of nature or region of the pain experienced, and raises the potential of somatosensory impairment being a rehabilitation target to improve pain-related outcomes for stroke survivors.
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Affiliation(s)
- Brendon S. Haslam
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3010, Australia
| | - David S. Butler
- IMPACT in Health, University of South Australia, Kaurna Country, Adelaide 5001, Australia
- Neuro-Orthopaedic Institute, Adelaide 5000, Australia
| | - Anthony S. Kim
- Weil Institute of Neurosciences, Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3010, Australia
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4
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Analysis of Muscular Electrical Activity and Blood Perfusion of Upper Extremity in Patients with Hemiplegic Shoulder Pain: A Pilot Study. Neural Plast 2022; 2022:5253527. [PMID: 36203950 PMCID: PMC9532142 DOI: 10.1155/2022/5253527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/01/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hemiplegic shoulder pain (HSP) is a common symptom for post-stroke patients, which has a severely adverse impact on their rehabilitation outcomes. However, the cause of HSP has not been clearly identified due to its complicated multifactorial etiologies. As possible causes of HSP, the abnormality of both muscular electrical activity and blood perfusion remains lack of investigations. Objective This study aimed to analyze the alteration of muscular electrical activity and blood perfusion of upper extremity in patients with HSP by using surface electromyography (sEMG) and laser speckle contrast imaging (LSCI) measurement techniques, which may provide some insight into the etiology of HSP. Methods In this observational and cross-sectional study, three groups of participants were recruited. They were hemiplegic patients with shoulder pain (HSP group), hemiplegic patients without shoulder pain (HNSP group), and healthy participants (Healthy group). The sEMG data and blood perfusion data were collected from all the subjects and used to compute three different physiological measures, the root-mean-square (RMS) and median-frequency (MDF) parameters of sEMG recordings, and the perfusion unit (PU) parameter of blood perfusion imaging. Results The RMS parameter of sEMG showed significant difference (p < 0.05) in the affected side between HSP, HNSP, and Healthy groups. The MDF parameter of sEMG and PU parameter of blood perfusion showed no significant difference in both sides among the three groups (p > 0.05). The RMS parameter of sEMG showed a statistically significant correlation with the pain intensity (r = -0.691, p =0.012). Conclusion This study indicated that the muscular electrical activity of upper extremity had a correlation with the presence of HSP, and the blood perfusion seemed to be no such correlation. The findings of the study suggested an alternative way to explore the mechanism and treatment of HSP.
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5
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Glize B, Cook A, Benard A, Sagnier S, Olindo S, Poli M, Debruxelles S, Renou P, Rouanet F, Bader C, Dehail P, Sibon I. Early multidisciplinary prevention program of post-stroke shoulder pain: A randomized clinical trial. Clin Rehabil 2022; 36:1042-1051. [PMID: 35505589 DOI: 10.1177/02692155221098733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate if positioning the upper-limb promoting abduction, external rotation and flexion of the shoulder reduces the intensity of post-stroke shoulder pain at day-7 compared to usual clinical practice. DESIGN & SETTING Prospective single-center randomized clinical trial using a superiority design comparing two preventive strategies of post-stroke shoulder pain in a stroke unit. SUBJECTS Patients were included within 2 days from a first symptomatic ischemic stroke affecting shoulder motor function. INTERVENTIONS Intervention group included specific positioning of the shoulder in abduction, external rotation and flexion in bed, chair and during mobilization. Control group referred to usual practice i.e. positioning using a standard support scarf. MAIN MEASURES Primary outcome was the intensity of shoulder pain assessed by the visual analog scale (VAS) (0-100) at day-7 post-stroke. Other outcomes measured at day-7 and 2 months post-stroke were the VAS, motor function, spasticity, depression, functional independence and rates of complex regional Pain syndrome (CRPS). RESULTS 76 patients (49 males; mean age = 68.3) were randomized. The shoulder pain at day-7 was not different between the control group (16.1, SD = 27.4) and the intervention group (10.3, SD = 21.5, p = 0.18) as well as at 2 months (p = 0.12). A lower rate of depression was observed in the intervention group at 2 months 36.7% (CI95% 19.9;56.1) vs 52.9% (CI95% 35.1;70.2). No between-group difference in other outcomes was observed at 2 months. CONCLUSIONS This study failed to demonstrate the benefit of a specific positioning tool in reducing the intensity of post-stroke shoulder pain which was lower than previously reported in the literature.
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Affiliation(s)
- Bertrand Glize
- Service de MPR, 36836CHU Bordeaux, Bordeaux, France.,HACS team, BPH INSERM 1219, 158435Univ. Bordeaux, Bordeaux, France
| | - Amandine Cook
- Centre de rééducation de la Tour de Gassies, Bruges, France.,Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France
| | - Antoine Benard
- Clinical Epidemiology Unit (USMR), 36836CHU Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Sharmila Sagnier
- Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France.,Clinical Epidemiology Unit (USMR), 36836CHU Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Stéphane Olindo
- Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France
| | - Mathilde Poli
- Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France
| | | | - Pauline Renou
- Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France
| | - François Rouanet
- Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France
| | - Clément Bader
- Clinical Epidemiology Unit (USMR), 36836CHU Bordeaux, Pôle de Santé Publique, Bordeaux, France
| | - Patrick Dehail
- Service de MPR, 36836CHU Bordeaux, Bordeaux, France.,HACS team, BPH INSERM 1219, 158435Univ. Bordeaux, Bordeaux, France
| | - Igor Sibon
- Stroke Unit, Department of Neurology, 36836CHU Bordeaux, Bordeaux, France.,Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France
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6
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Clinical and radiological assessment of hemiplegic shoulder pain in stroke patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hemiplegic shoulder pain (HSP) is one of the most common complications of stroke. This work aimed to evaluate and analyze the clinical and radiological features of painful shoulder in hemiplegic stroke patients with evaluating the diagnostic role of shoulder ultrasound and shoulder MR imaging in assessment of the causes of shoulder pain.
Methods
210 stroke patients with shoulder affection within 3 years of stroke development were enrolled. Clinical assessment including Medical Research Council scoring, The Brunnström motor recovery and Ashworth Scale. Shoulder ultrasound and MR imaging were done for 74 patients with painful hemiplegic shoulder.
Results
The prevalence of HSP was 35.2% with statistically significantly higher proportion of shorter disease duration, lower muscle power, lower BMR stage with higher proportion of bicipital tendinitis and complex regional pain syndrome in major versus moderate dependence (P < 0.001, P < 0.001, P < 0.001, P = 0.011 and P = 0.001 respectively). On multivariate analysis only short disease duration was statistically significant independent predictor. Participants with disease duration ≤ 2 months have 21.9 times higher odds to exhibit major rather than moderate dependence. By imaging there was high prevalence of joint effusion (47.3%), bicipital tendinitis (44.6%), bursitis (31%) and adhesive capsulitis (29.7%) in painful hemiplegic shoulder with a very good agreement between MRI and US in diagnosis.
Conclusion
HSP has a high prevalence in stroke patient with increased morbidity due to various factors and US can be used as an alternative or a complementary to MRI for diagnosis of hemiplegic shoulder pain.
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7
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Kumar P, Fernando C, Mendoza D, Shah R. Risk and associated factors for hemiplegic shoulder pain in people with stroke: a systematic literature review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2019369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Praveen Kumar
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Chiara Fernando
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Deanna Mendoza
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Riya Shah
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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8
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Dyer S, Mordaunt DA, Adey-Wakeling Z. Interventions for Post-Stroke Shoulder Pain: An Overview of Systematic Reviews. Int J Gen Med 2020; 13:1411-1426. [PMID: 33324087 PMCID: PMC7732168 DOI: 10.2147/ijgm.s200929] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background Shoulder pain following stroke leads to poorer quality of life and daily functioning. Whilst many treatment approaches exist, there is currently no systematic overview of the evidence base for these. This review addressed the question “What is the evidence for interventions for treating hemiplegic shoulder pain?” Methods An overview of systematic reviews was performed according to PROSPERO protocol (CRD42020140521). Five electronic databases including Cochrane, MEDLINE, Embase and EmCare were searched to June 2019. Included systematic reviews were those of comparative trials of interventions for hemiplegic shoulder pain in adults, reporting pain outcomes using a validated pain scale. Review quality was assessed with AMSTAR2 and those considered at high risk of bias for four or more items were excluded. The most recent, comprehensive review for each intervention category was included. Outcomes of function and quality of life were also extracted. Results Seven systematic reviews of 11 interventions were included, with varied quality. Reviews showed significant benefits in terms of pain reduction for many interventions including acupuncture (conventional 19 trials, electroacupuncture 5 trials, fire needle 2 trials, warm needle 1 trial and bee venom 3 trials), orthoses (1 trial), botulinum toxin injection (4 trials), electrical stimulation (6 trials) and aromatherapy (1 trial). However, the majority of trials were small, leading to imprecise estimates of effect. Findings were often inconsistent across outcome measures or follow-up times. Outcomes from trials of acupuncture were heterogenous with likely publication bias. Conclusion A number of systematic reviews indicate significant reductions in pain, with a wide range of treatments appearing promising. However, significant limitations mean the clinical importance of these findings are uncertain. Due to complex etiology, practitioners and health systems must consider the range of potential interventions and tailor their approach to individual presentation, guided by their local circumstances, expert opinion and the growing literature base.
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Affiliation(s)
- Suzanne Dyer
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Dylan A Mordaunt
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Department of Rehabilitation Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Zoe Adey-Wakeling
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Department of Rehabilitation Medicine, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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9
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Aprile I, Germanotta M, Cruciani A, Pecchioli C, Loreti S, Papadopoulou D, Montesano A, Galeri S, Diverio M, Falsini C, Speranza G, Langone E, Carrozza MC, Cecchi F. Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial. Int J Stroke 2020; 16:396-405. [PMID: 32640881 DOI: 10.1177/1747493020937192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Poststroke shoulder pain is a common complication. We aimed to investigate the prevalence of poststroke shoulder pain, with attention to the neuropathic component, and the relationship between poststroke shoulder pain and upper limb improvement in motor function, strength, disability, and quality of life after upper limb rehabilitation. METHODS This is a secondary analysis of a multicenter randomized controlled trial to compare upper limb conventional or robotic rehabilitation on 224 patients enrolled in eight rehabilitation centers. We assessed poststroke shoulder pain (using the Numerical Rating Scale and the Douleur Neuropathique 4), and upper limb motor function, strength, disability, and quality of life at baseline (T0), after 30 rehabilitation sessions (T1), and three months after the end of rehabilitation (T2). RESULTS A moderate/severe poststroke shoulder pain was reported by 28.9% of patients, while 19.6% of them showed a neuropathic component. At T0, the intensity of pain was higher in women and in patients with neglect syndrome, positively correlated with the time since stroke and disability and negatively correlated with motor function, strength, and the physical aspects of the quality of life.Moderate/severe pain and neuropathic component significantly reduced after both treatments and this reduction was maintained at T2. Finally, the intensity of pain at baseline was negatively correlated with the improvement of upper limb motor function. CONCLUSIONS Poststroke shoulder pain negatively impact on motor performance, strength, disability, and physical aspects of the quality of life as well as on upper limb motor recovery; however, it can be reduced after a robotic or a conventional rehabilitation. Therefore, we suggest considering poststroke shoulder pain when planning the rehabilitation intervention.
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Affiliation(s)
- I Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - A Cruciani
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C Pecchioli
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S Loreti
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - A Montesano
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - S Galeri
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Diverio
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Speranza
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - E Langone
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M C Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - F Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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10
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Anwer S, Alghadir A. Incidence, Prevalence, and Risk Factors of Hemiplegic Shoulder Pain: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144962. [PMID: 32660109 PMCID: PMC7400080 DOI: 10.3390/ijerph17144962] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/11/2023]
Abstract
The current systematic review aimed to investigate the incidence, prevalence, and risk factors causing hemiplegic shoulder pain (HSP) after stroke. Two independent authors screened titles and abstracts for the eligibility of the included studies in the electronic databases PubMed and Web of Science. Studies which reported the incidence, prevalence, and risk factors of HSP following stroke were included. The included studies were assessed using the Newcastle–Ottawa Scale for evaluating the quality of nonrandomized studies in meta-analyses. Eighteen studies were included in the final synthesis. In all studies, the number of patients ranged between 58 and 608, with the mean age ranging from 58.7 to 76 years. Seven included studies were rated as “good “quality, while one study rated “fair” and 10 studies rated “poor” quality. Eight studies reported incidence rate while 11 studies reported the prevalence of HSP following a stroke. The incidence of HSP was ranging from 10 to 22% in the metanalysis of the included studies. The prevalence of HSP was ranging from 22 to 47% in the metanalysis of the included studies. The most significant predictors of HSP were age, female gender, increased tone, sensory impairment, left-sided hemiparesis, hemorrhagic stroke, hemispatial neglect, positive past medical history, and poor National Institutes of Health Stroke Scale score. The incidence and prevalence of HSP after stroke vary considerably due to various factors. Knowledge of predictors is important to minimize the risk of developing HSP following a stroke.
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Affiliation(s)
- Shahnawaz Anwer
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
- Department of Building and Real Estate, Hong Kong Polytechnic University, Kowloon, Hong Kong
- Correspondence:
| | - Ahmad Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
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11
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Serrezuela RR, Quezada MT, Zayas MH, Pedrón AM, Hermosilla DM, Zamora RS. Robotic therapy for the hemiplegic shoulder pain: a pilot study. J Neuroeng Rehabil 2020; 17:54. [PMID: 32321536 PMCID: PMC7178610 DOI: 10.1186/s12984-020-00674-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/01/2020] [Indexed: 11/28/2022] Open
Abstract
Backgrounds Exoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree. Methods An experimental study was conducted in 16 patients with painful shoulder post- ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital “Dr. Juan Bruno Zayas Alfonso” in Santiago de Cuba, from September 2016 - March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher’s Exact Tests were used as comparison criteria. Results Robotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone.
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12
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Chohan SA, Venkatesh PK, How CH. Long-term complications of stroke and secondary prevention: an overview for primary care physicians. Singapore Med J 2020; 60:616-620. [PMID: 31889205 DOI: 10.11622/smedj.2019158] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite a decline in mortality from stroke, the annual incidence in the general population is increasing. For many stroke survivors and their families, the acute stroke is the beginning of an ongoing struggle with physical impairment and subsequent disability. Over time, the immediate clinical consequences of the stroke are complicated by a variety of lesser-known medical, musculoskeletal and psychosocial difficulties. The primary care physician is best positioned to optimise chronic disease control, reduce risk and manage complications of stroke. Early screening and appropriate management is key. Instituting secondary prevention and attention to bowel and bladder problems can help reduce medical complications and re-admissions, while adequate analgesia, positioning/splinting of limbs and physiotherapy can lessen discomfort and preventable suffering. Primary care physicians can identify and treat post-stroke mood issues and involve psychological counselling for patients and caregivers. Adequate education and support may restore the independence of patients with stroke or minimise any resultant dependency.
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Affiliation(s)
| | | | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore.,Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
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13
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Ratanapinunchai J, Mathiyakom W, Sungkarat S. Scapular Upward Rotation During Passive Humeral Abduction in Individuals With Hemiplegia Post-stroke. Ann Rehabil Med 2019; 43:178-186. [PMID: 31072084 PMCID: PMC6509579 DOI: 10.5535/arm.2019.43.2.178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To describe scapular upward rotation during passive humeral abduction in individuals with hemiplegia post-stroke compared to normal subjects. Methods Twenty-five individuals with hemiplegia post-stroke and 25 age- and gender-matched normal subjects voluntarily participated in this study. Scapular upward rotation during resting and passive humeral abduction at 30°, 60°, 90°, 120°, and 150° were measured using a digital inclinometer. Results In both groups, scapular upward rotation significantly increased as humeral abduction increased (p<0.001). Scapular upward rotation was significantly less in the hemiplegic group compared to that in the control at 90° (p=0.002), 120° (p<0.001), and 150° of humeral abduction (p<0.001). The mean difference in scapular upward rotation between these two groups ranged from 6.3° to 11.38°. Conclusion Passive humeral abductions ranging from 90° to 150° can significantly alter scapular upward rotation in individuals with hemiplegia post-stroke compared to those of matched normal subjects. The magnitude of reduction of the scapular upward rotation may potentially lead to the development of hemiplegic shoulder pain after prolonged repetitive passive movement. Scapular upward rotation should be incorporated during passive humeral abduction in individuals with hemiplegia post-stroke, especially when the humeral is moved beyond 90° of humeral abduction. Combined movements of scapular and humeral will help maintain the relative movement between the scapula and humerus. However, further longitudinal study in patients with shoulder pain post-stroke is needed to confirm these findings.
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Affiliation(s)
- Jonjin Ratanapinunchai
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Witaya Mathiyakom
- Department of Physical Therapy, California State University, Northridge, CA, USA
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Gaitan M, Bainbridge L, Parkinson S, Cormack L, Cleary S, Harrold M. Characteristics of the shoulder in patients following acute stroke: a case series. Top Stroke Rehabil 2019; 26:318-325. [PMID: 30893022 DOI: 10.1080/10749357.2019.1590973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stroke can result in pain and loss of motor control in the hemiplegic shoulder, and while prevention of secondary changes is likely to be the most effective management, there is limited evidence directing clinicians towards the most at-risk patients. OBJECTIVES The aim of this case series was to investigate the presentation of shoulder pain, motor impairment, shoulder passive range of motion (PROM) and alignment of the hemiplegic shoulder following acute stroke. METHODS This study reported data that was collected as part of a pilot randomized controlled trial investigating kinesiology taping of the hemiplegic shoulder. Participants with a diagnosis of acute stroke and severe upper limb motor impairment were included. From 24-h post stroke and continuing every three days until discharge, measurements of shoulder pain (visual analogue scale, Ritchie Articular Index), motor impairment (Chedoke McMaster Stroke Assessment), PROM and alignment (both clinical measures) were collected. Clinical trial registry number - ACTRN12615000502538. RESULTS Of 156 patients screened over six months, 10 of 15 eligible participants were recruited. On initial assessment, three participants reported pain and all had severe upper limb motor impairment. All participants initially demonstrated close to full shoulder PROM. Six participants had shoulder subluxation and five demonstrated scapula malalignment. CONCLUSIONS Given the severity of upper limb motor impairment, pain and reduced PROM were seen in a small number of participants. The clinical course of shoulder pain and PROM following stroke remains unclear. Large observational studies tracking shoulder characteristics from acute through to rehabilitation settings are needed.
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Affiliation(s)
- Melissa Gaitan
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
| | - Liz Bainbridge
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
| | - Stephanie Parkinson
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
| | - Leanne Cormack
- b Department of Physiotherapy, Sir Charles Gairdner Hospital , Perth , Australia
| | - Sarah Cleary
- b Department of Physiotherapy, Sir Charles Gairdner Hospital , Perth , Australia
| | - Meg Harrold
- a School of Physiotherapy, Faculty of Health Sciences , Curtin University , Perth , Australia
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Torres-Parada M, Vivas J, Balboa-Barreiro V, Marey-López J. Post-stroke shoulder pain subtypes classifying criteria: towards a more specific assessment and improved physical therapeutic care. Braz J Phys Ther 2019; 24:124-134. [PMID: 30853351 DOI: 10.1016/j.bjpt.2019.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 12/05/2018] [Accepted: 02/18/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Post-stroke Shoulder Pain (PSSP) is a common stroke-related syndrome that prolongs hospitalization and diminishes quality of life. PSSP studies were unsuccessful in clarifying pathophysiological mechanisms. Therefore, cohort's studies with greater variety of the sample and larger follow-up period could provide additional clinical data and may improve medical care. OBJECTIVE To classify people with PSSP and identify intergroup clinical differences, providing additional data useful for therapeutic care planning. METHODS One thousand individuals with stroke were selected from all levels of one health Area and followed up during one year. Demographic data, stroke clinical characteristics, stroke-related symptoms and rehabilitation parameters were collected. The shoulder muscle impairment was used to group participants into three clinical profiles: severe muscular impairment, moderate muscular impairment and low muscular impairment groups. RESULTS A total of 119 individuals were diagnosed with PSSP. The suggested classification criteria showed two groups that differed significantly in relation to the onset and duration of PSSP, presence of sensory and speech impairment, and spasticity. The outcomes did not firmly support the existence of a third suggested PSSP subtype. CONCLUSIONS PSSP may vary in onset, clinical manifestations, severity and syndrome duration. These results highlight the course of different clinical profiles and require multidisciplinary management approaches.
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Affiliation(s)
- Manuel Torres-Parada
- Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physical Therapy, Universidade da Coruña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain.
| | - Jamile Vivas
- Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physical Therapy, Universidade da Coruña, A Coruña, Spain
| | - Vanesa Balboa-Barreiro
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - José Marey-López
- Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Department of Neurology, A Coruña, Spain
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Kashi Y, Ratmansky M, Defrin R. Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain. Pain Pract 2018; 18:716-728. [DOI: 10.1111/papr.12658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/14/2017] [Accepted: 11/08/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Yafit Kashi
- Department of Physical Therapy; Loewenstein Rehabilitation Hospital; Raanana Israel
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Motti Ratmansky
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Pain Rehabilitation Unit; Loewenstein Rehabilitation Hospital; Raanana Israel
| | - Ruth Defrin
- Department of Physical Therapy; Sackler Faculty of Medicine; Tel-Aviv University; Tel-Aviv Israel
- Sagol School of Neuroscience; Tel-Aviv University; Tel-Aviv Israel
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17
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Park D, Yu KJ, Cho JY, Woo SB, Park J, Lee Z, Kim JM. The effectiveness of 2 consecutive intra-articular polydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain: A STROBE-complaint retrospective study. Medicine (Baltimore) 2017; 96:e8741. [PMID: 29145323 PMCID: PMC5704868 DOI: 10.1097/md.0000000000008741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to investigate the effects of intra-articular injection of polydeoxyribonucleotide (PDRN), compared with intraarticular triamcinolone (TA) injection, in subacute stroke patients with hemiplegic shoulder pain (HSP).Participants were subacute stroke patients with HSP who had undergone 2 consecutive intra-articular injections of TA or PDRN.Numeric rating scale (NRS) and passive range of motion (PROM) of hemiplegic shoulder were evaluated until 4 weeks after 2nd injection.In the results, there were significant improvements in all PROM measures 2 weeks after the second injection, compared with pre-injection results, in both groups (P < .05). In the PDRN group, however, none of the PROM measures were significantly improved at 3 and 4 weeks after the second injection, compared with pre-injection results (P ≥ .05). When comparing pre-injection results with those at 4 weeks after the second injection, all PROM and NRS measures in the TA group were more improved than in the PDRN group, but this was not statistically significant (P ≥ .05).In conclusion, considering the systemic side effects of steroids, especially among patients with diabetes or metabolic syndrome, PDRN seems to be a worthwhile treatment option for HSP, although PDRN does not seem to have an equivalent persistence effects when compared with TA.
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Affiliation(s)
- Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
- Deparment of Phamacology, Kyungpook National Univeresity School of Medicine, Daegu, South Korea
| | - Kwang Jae Yu
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Ju Young Cho
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Seung Beom Woo
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Junu Park
- Master of Science in Management, University of Liverpool, Liverpool, UK
| | - Zeeihn Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Jong Min Kim
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
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Pan R, Zhou M, Cai H, Guo Y, Zhan L, Li M, Yang Z, Zhu L, Zhan J, Chen H. A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients. Clin Rehabil 2017. [PMID: 28629270 PMCID: PMC5751850 DOI: 10.1177/0269215517714830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective: To evaluate the effect of modified wheelchair arm-support to mitigate hemiplegic shoulder pain and reduce pain frequency in stroke patients. Design: A single-blind randomized controlled trial using computer-generated simple randomization. Setting: Participants recruited from inpatients at the Guangdong Provincial Hospital of Chinese Medicine. Subjects: A total of 120 patients with stroke were divided into two groups. Interventions: All subjects underwent basic rehabilitation training and wheelchair assistance with eight weeks follow-up period. Patients in the treatment group additionally received modified wheelchair arm-support for at least 60 minutes a day, six days a week, for four weeks. Outcome measures: Primary outcome was measured by the Visual Analogue Pain Scale or Numeric Pain Rating Scale. Secondary outcome was measured using the Upper Extremity Fugl-Meyer Assessment scale, Modified Barthel Index and Quality of Life Index. Measurements were made at 4 weeks and 12 weeks, following the intervention. Results: Patients age from 21 to 83 years (mean ± SD = 62.41 ± 12.26). The average duration of disease was 1.9 ± 1.3 months. At four weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.75 vs. 2, 3.75; P = 0.059). At 12 weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.00 vs. 0, 1.00; P < 0.001). At 12 weeks, patients with shoulder pain were higher in the control group (6 vs. 1; P < 0.05). Conclusion: Using the modified wheelchair arm-support could lead to the mitigation of hemiplegic shoulder pain and reduction in pain incidence in stroke patients. It may also improve the patients’ quality of life.
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Affiliation(s)
- Ruihuan Pan
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingchao Zhou
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hao Cai
- 2 Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Youhua Guo
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lechang Zhan
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mei Li
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhijing Yang
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Leying Zhu
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Zhan
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongxia Chen
- 1 Department of Rehabilitation, The 2nd Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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19
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Liang CM, Peng W, Ma XJ. Acupuncture for post-stroke upper limb pain. Hippokratia 2017. [DOI: 10.1002/14651858.cd009087.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Cui-mei Liang
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Acupuncture and Moxibustion; No. 5, Bei Xian Ge Street, Xuanwu district Beijing China 100053
| | - Weina Peng
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Acupuncture and Moxibustion; No. 5, Bei Xian Ge Street, Xuanwu district Beijing China 100053
| | - Xiao Jing Ma
- Guang An Men Hospital, China Academy of Chinese Medical Sciences; Department of Acupuncture and Moxibustion; No. 5, Bei Xian Ge Street, Xuanwu district Beijing China 100053
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20
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Jang MH, Lee CH, Shin YI, Kim SY, Huh SC. Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke. Ann Rehabil Med 2016; 40:835-844. [PMID: 27847713 PMCID: PMC5108710 DOI: 10.5535/arm.2016.40.5.835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/10/2016] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke. Methods Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician. Results There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively. Conclusion IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.
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Affiliation(s)
- Myung Hun Jang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Chul Huh
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Gustafsson L, McKenna K. A programme of static positional stretches does not reduce hemiplegic shoulder pain or maintain shoulder range of motion -a randomized controlled trial. Clin Rehabil 2016; 20:277-86. [PMID: 16719026 DOI: 10.1191/0269215506cr944oa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effectiveness of a programme of static positional stretches and positioning of the stroke-affected shoulder for maintaining shoulder external rotation and decreasing hemiplegic shoulder pain. Design: Randomized controlled trial with pretest and posttest design. Setting: Inpatient rehabilitation unit. Subjects: Thirty-two participants (17 treatment, 15 comparison) with a first time stroke who were admitted for rehabilitation. Interventions: Treatment participants completed a programme of static positional stretches of the stroke-affected shoulder twice daily and positioned the stroke affected upper limb in an armrest support at all other times when seated. Main measures: The main outcome measures were pain-free range of motion into external rotation, pain in the stroke-affected shoulder at rest and with movement, motor recovery and functional independence. Results: All participants demonstrated a significant loss of external rotation (P=0.005) with no significant group differences. All participants demonstrated a significant improvement in motor recovery (P<0.01) and functional independence (P<0.01) with no significant group differences. There were no significant effects for pain. The comparison group recorded a decrease in mean pain reported with movement from admission to discharge, and the treatment group recorded an increase. Conclusions: Participation in the management programme did not result in improved outcomes. The results of this study do not support the application of the programme of static positional stretches to maintain range of motion in the shoulder. The effect of increasing pain for the treatment group requires further investigation.
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Affiliation(s)
- Louise Gustafsson
- Division of Occupational Therapy, University of Queensland, 4072 Brisbane, QLD, Australia.
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22
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Renzenbrink GJ, IJzerman MJ. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin Rehabil 2016; 18:359-65. [PMID: 15180118 DOI: 10.1191/0269215504cr759oa] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Design: Prospective, open label design. Setting: The outpatient services of a large teaching rehabilitation hospital in the Netherlands. Subjects: Fifteen stroke survivors with chronic (> six months) hemiplegia and a therapy-resistant painful shoulder with subluxation. All patients suffered from clinically relevant shoulder pain, as assessed by a score of at least 4 out of 10 on a numerical rating scale. Shoulder subluxation was indicated by at least 1/2 fingerbreadth of glenohumeral separation on palpation. Intervention: Six hours of P-NMES per day for a total of six weeks. Main outcome measures: Shoulder pain (Brief Pain Inventory), shoulder subluxation (clinical and radiographic), shoulder pain-free external rotation (hand-held goniometer), motor impairment (Fugl-Meyer Motor test) and quality of life (SF-36) were assessed before treatment, after six weeks of intramuscular stimulation, at three months and six months follow-up. Results: A significant reduction in pain was found on the Brief Pain Inventory. Pain reduction was still present at six months follow-up. All domains, in particular bodily pain, of the SF-36 showed improvement in the short term. After six months of follow-up, bodily pain was still strongly and significantly reduced, whereas social functioning and role physical demonstrated a nonsignificant improvement of more than 10% compared with baseline. Conclusion: This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed.
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Affiliation(s)
- Gerbert J Renzenbrink
- Roessingh Research and Development and Rehabilitation centre Het Roessingh, Enschede, The Netherlands.
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23
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Heo MY, Kim CY, Nam CW. Influence of the application of inelastic taping on shoulder subluxation and pain changes in acute stroke patients. J Phys Ther Sci 2015; 27:3393-5. [PMID: 26696705 PMCID: PMC4681912 DOI: 10.1589/jpts.27.3393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the impact on the shoulder joints
of performing inelastic taping and bed physical therapy for acute stroke. [Subjects and
Methods] The intervention was conducted for eight weeks with an experimental group of 18
stroke patients who received bed physical therapy and inelastic taping and a control group
of 18 stroke patients who received only bed physical therapy. [Results] After the
intervention, the subluxation degree of the experimental group, which received bed
physical therapy and inelastic taping, was found to be significantly different from that
of the control group, which received only bed physical therapy. [Conclusion] In
conclusion, the application of inelastic taping for acute stroke patients was confirmed to
be effective at reducing shoulder subluxation and pain, and was confirmed to be a good
physical therapy intervention, based on its efficacy.
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Affiliation(s)
- Min-Yeong Heo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Cheol-Yong Kim
- Department of Physical Therapy, Ulsan College, Republic of Korea
| | - Chan-Woo Nam
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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25
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Aoyagi Y, Tsubahara A. Therapeutic Orthosis and Electrical Stimulation for Upper Extremity Hemiplegia After Stroke: A Review of Effectiveness Based on Evidence. Top Stroke Rehabil 2015; 11:9-15. [PMID: 15480949 DOI: 10.1310/6q5q-69pu-nlq9-avmr] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.
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Affiliation(s)
- Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
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26
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Marciniak C. Poststroke Hypertonicity: Upper Limb Assessment and Treatment. Top Stroke Rehabil 2015; 18:179-94. [DOI: 10.1310/tsr1803-179] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kwon YH, Kwon JW, Lee NK, Kang KW, Son SM. Prevalence and determinants of pain in the ipsilateral upper limb of stroke patients. Percept Mot Skills 2014; 119:799-810. [PMID: 25387036 DOI: 10.2466/26.29.pms.119c28z2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study investigated the prevalence of pain in the ipsilateral upper-limb in stroke patients. 229 stroke patients (133 men, 96 women; M age = 59.0 yr., SD = 12.4) were assessed with the Pain Behaviors Scales and their motor weakness was measured with the Motricity Index. Results indicated that over 27% of patients experienced pain in at least one joint of the ipsilateral upper limb. Shoulder pain was the most common. Further analysis indicated that the occurrence of pain in the ipsilateral upper limb was higher among women, among patients who used a cane, and among patients with a greater weakness of the affected lower limb.
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Affiliation(s)
- Yong Hyun Kwon
- 1 Department of Physical Therapy, Yeungnam University College, Republic of Korea
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28
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Adey-Wakeling Z, Arima H, Crotty M, Leyden J, Kleinig T, Anderson CS, Newbury J. Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study. Arch Phys Med Rehabil 2014; 96:241-247.e1. [PMID: 25264111 DOI: 10.1016/j.apmr.2014.09.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide an epidemiological perspective of the clinical profile, frequency, and determinants of poststroke hemiplegic shoulder pain. DESIGN A prospective population-based study of an inception cohort of participants with a 12-month follow-up period. SETTING General community and hospital within a geographically defined metropolitan region. PARTICIPANTS Multiple ascertainment techniques were used to identify 318 confirmed stroke events in 301 individuals. Among adults with stroke, data on shoulder pain were available for 198 (83% of the survivors) at baseline and for 156 and 148 at 4 and 12 months, respectively. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Subjective reports of onset, severity, and aggravating factors for pain and 3 passive range-of-motion measures were collected at baseline and at 4- and 12-month follow-up. RESULTS A total of 10% of the participants reported shoulder pain at baseline, whereas 21% reported pain at each follow-up assessment. Overall, 29% of all assessed participants reported shoulder pain during 12-month follow-up, with the median pain score (visual analog scale score=40) highest at 4 months and more often associated with movement at later time points. Objective passive range-of-motion tests elicited higher frequencies of pain than did self-report and predicted later subjective shoulder pain (crude relative risk of 3.22 [95% confidence interval, 1.01-10.27]). CONCLUSIONS The frequency of poststroke shoulder pain is almost 30%. Peak onset and severity of hemiplegic shoulder pain in this study was at 4 months, outside of rehabilitation admission time frames. Systematic use of objective assessment tools may aid in early identification and management of stroke survivors at risk of this common complication of stroke.
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Affiliation(s)
- Zoe Adey-Wakeling
- Department of Rehabilitation and Aged Care, Flinders University of South Australia, Adelaide, South Australia, Australia.
| | - Hisatomi Arima
- Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - James Leyden
- Lyell McEwin Health Service and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- Lyell McEwin Health Service and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Craig S Anderson
- Neurological and Mental Health Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Jonathon Newbury
- Faculty of Health Sciences, Discipline of Rural Health, School of Population Health, University of Adelaide, Adelaide, Australia
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Doğun A, Karabay İ, Hatipoğlu C, Özgirgin N. Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain. Top Stroke Rehabil 2014; 21 Suppl 1:S1-7. [PMID: 24722039 DOI: 10.1310/tsr21s1-s1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the ultrasonography (US) and MRI findings in hemiplegic patients with shoulder pain and investigate the correlation between them. It is not possible for these patients to fully perform active range of motion (ROM) and stress tests, so imaging methods take center stage in diagnosis and treatment planning. MATERIALS AND METHODS A total of 68 hemiplegic patients with shoulder pain attending the inpatient rehabilitation program were included in the study. MRI and US results from the patient files were recorded. The frequency of each pathology identified by US and MRI was determined. The distribution of MRI and US findings was investigated to see whether there was a statistical difference between the correlation of MRI and US results. RESULTS The mean (SD) age of the patients was 63.7 (8.3) years and the mean (SD) duration of hemiplegia was 49 (8.9) days. According to the MRI results, glenohumeral and acromioclavicular joint degeneration was found in 77.9% and 79.7% of the patients, respectively; subacromial-subdeltoid bursitis in 80.9%; fluid increase in the joint space in 41.2%; supraspinatus tendinitis in 36.8%; and supraspinatus partial rupture in 33.8%. Shoulder US findings were supraspinatus tendinitis in 54.4%, acromioclavicular joint degeneration in 26.5%, bicipital tendinitis in 20.6%, and subacromial-subdeltoid bursitis in 19.1%. There was a statistically significant difference between MRI and US findings. The results were not compatible with each other (P ≯ .05), and these findings were not consistent with each other since the kappa coefficient was under 0.40 for all these results. CONCLUSION Although US is recommended as the first method in determining shoulder pathologies in hemiplegic patients, we suggest that MRI should be used as the first choice in hemiplegic patients with shoulder pain. MRI and US findings were not consistent, and US is dependent on the experience of the operator. MRI should be the first choice in cases where the diagnosis will affect the treatment choice due to the lack of correlation between US and MRI findings.
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Affiliation(s)
- Asuman Doğun
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - İlkay Karabay
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Cem Hatipoğlu
- Department of Radiology, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Neşe Özgirgin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Kumar P, Saunders A, Ellis E, Whitlam S. Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331913x13608385943254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Yi Y, Lee KJ, Kim W, Oh BM, Chung SG. Biomechanical properties of the glenohumeral joint capsule in hemiplegic shoulder pain. Clin Biomech (Bristol, Avon) 2013; 28:873-8. [PMID: 24067873 DOI: 10.1016/j.clinbiomech.2013.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/21/2013] [Accepted: 09/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although many hemiplegic shoulder patients have been suffering from limited range of motion, it is not fully established whether the pathologic biomechanics are same in hemiplegic shoulder pain and adhesive capsulitis. Therefore we aimed to investigate biomechanical properties of glenohumeral joint capsules of hemiplegic shoulder pain with limited range of motions. METHODS Participants were 14 patients with hemiplegic shoulder pain, 10 controls, and 42 adhesive capsulitis patients matched with the hemiplegic shoulder pain group for sex, age, and range of motion. Demographic data, clinical variables, and sonographic findings were comparable between hemiplegic shoulder pain and adhesive capsulitis groups. We compared capsular capacity, maximal pressure, and capsular stiffness of glenohumeral joint capsule among the 3 groups. FINDINGS Hemiplegic shoulder pain and adhesive capsulitis groups had smaller capsular capacity and higher maximal pressure than controls. The capsular stiffness of hemiplegic shoulder pain group was higher than that of controls (P=0.001) but lower than that of adhesive capsulitis group (P<0.001). INTERPRETATION The stiffness of glenohumeral joint capsules in hemiplegic shoulder pain and adhesive capsulitis patients was substantially higher than that in controls, suggesting that hemiplegic shoulder pain patients had stiffer capsules as adhesive capsulitis patients did although the severities were different. This finding implicates that hemiplegic shoulder pain may share common pathologic properties of tighter capsules with adhesive capsulitis. However, there may be additional mechanisms contributing to range of motion limitation in hemiplegic shoulder pain because capsular stiffness in those patients was not as severe as that in adhesive capsulitis patients with similar range of motion limitation.
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Affiliation(s)
- Youbin Yi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Yi Y, Shim JS, Kim K, Baek SR, Jung SH, Kim W, Han TR. Prevalence of the rotator cuff tear increases with weakness in hemiplegic shoulder. Ann Rehabil Med 2013; 37:471-8. [PMID: 24020027 PMCID: PMC3764341 DOI: 10.5535/arm.2013.37.4.471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/29/2013] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate the relationship between the rotator cuff tear (RCT) and the muscle strength in hemiplegic side, and the effects of paralysis on the affected shoulders in hemiplegic patients. Methods A cross-sectional observational study performed in a university hospital was presented. The study enrolled 55 participants with hemiplegia of diverse degree of motor paresis, excluding those with bilateral lesions, history of major trauma or other co-existing musculoskeletal disorders of the shoulder. The main outcome measurements were muscle strength of the affected upper extremity (based on Medical Research Council scale), RCTs of the bilateral shoulders (by ultrasonography), and presence of shoulder pain, subluxation of the glenohumeral joint, passive range of motions, and subacromial spurs. Results Comparing each side of the shoulders, the prevalence of shoulder pain and supraspinatus muscle tear was higher (p<0.0001, p=0.007), and the range of motion was restricted (p<0.0001, p<0.0001, p<0.0001, p<0.0001) in the affected side. There was a significant trend toward higher prevalence of RCT and shoulder subluxation in the weaker shoulder (p=0.019, p<0.0001). In a multivariate analysis, Manual Muscle Test grade of less than three was an independent risk factor for RCT (p=0.025). Conclusion RCT in hemiplegia had a linear trend with muscle weakness in the affected side and the degree of weakness was an independent risk factor for the occurrence of RCT. In addition, shoulder pain, limitation of range of motions, and RCT were more frequent on the hemiplegic side of the shoulders. It is the first study to reveal a linear trend between RCT and upper extremity weakness and will provide physicians an insight to the management of RCTs in hemiplegic patients.
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Affiliation(s)
- Youbin Yi
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kumar P, Swinkels A. A critical review of shoulder subluxation and its association with other post-stroke complications. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x405883] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Zeilig G, Rivel M, Weingarden H, Gaidoukov E, Defrin R. Hemiplegic shoulder pain: Evidence of a neuropathic origin. Pain 2013; 154:263-271. [DOI: 10.1016/j.pain.2012.10.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 10/15/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022]
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De Baets L, Jaspers E, Desloovere K, Van Deun S. A systematic review of 3D scapular kinematics and muscle activity during elevation in stroke subjects and controls. J Electromyogr Kinesiol 2013; 23:3-13. [DOI: 10.1016/j.jelekin.2012.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 06/05/2012] [Accepted: 06/21/2012] [Indexed: 11/26/2022] Open
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Cho HK, Kim HS, Joo SH. Sonography of affected and unaffected shoulders in hemiplegic patients: analysis of the relationship between sonographic imaging data and clinical variables. Ann Rehabil Med 2013; 36:828-35. [PMID: 23342316 PMCID: PMC3546186 DOI: 10.5535/arm.2012.36.6.828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/23/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the relationship between a number of clinically relevant variables and sonographic imaging data in respect to the level of impairment experienced in the affected and unaffected shoulders of hemiplegic stroke patients. METHOD Fifty-one hemiplegic stroke patients (32 males, 19 females; 29 right-sided hemiplegics, 22 left-sided hemiplegics) participated in this study. A musculoskeletal radiologist conducted a sonographic exam on both the affected and unaffected shoulders of all patients and two physicians classified the severity of the injury on a six-point rating scale. Clinical variables including age, sex, duration of injury, spasticity and muscle power of the hemiplegic side, and level of functional activity of the shoulder were assessed. RESULTS The sonographic rating scores of hemiplegic shoulders were positively correlated with age (p<0.01) and negatively correlated with level of muscle spasticity (p<0.05). The sonographic rating scores of unaffected shoulders were positively correlated with duration of injury (p<0.01). Affected shoulders received sonographic rating scores that reflected significantly more impairment than those of unaffected shoulders (p<0.001), and pre-morbid handedness did not affect the relationship between impairment rating and shoulder injury status. CONCLUSION Hemiplegic stroke influences not only affected shoulders, but also unaffected sides. Proper management of spasticity, enhancement of motor recovery, and avoidance of unaffected shoulder overuse should be considered to prevent shoulder problems following strokes which result in hemiplegia.
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Affiliation(s)
- Hyong Keun Cho
- Department of Physical Medicine and Rehabilitation, National Health Insurance Corporation Ilsan Hospital, Goyang 410-719, Korea
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Maxwell AMW, Nguyen VQC. Management of Hemiplegic Shoulder Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-012-0001-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rah UW, Yoon SH, Moon DJ, Kwack KS, Hong JY, Lim YC, Joen B. Subacromial Corticosteroid Injection on Poststroke Hemiplegic Shoulder Pain: A Randomized, Triple-Blind, Placebo-Controlled Trial. Arch Phys Med Rehabil 2012; 93:949-56. [DOI: 10.1016/j.apmr.2012.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 01/24/2012] [Accepted: 02/03/2012] [Indexed: 11/30/2022]
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Murie-Fernández M, Carmona Iragui M, Gnanakumar V, Meyer M, Foley N, Teasell R. Painful hemiplegic shoulder in stroke patients: Causes and management. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2012.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chae J, Wilson RD, Bennett ME, Lechman TE, Stager KW. Single-lead percutaneous peripheral nerve stimulation for the treatment of hemiplegic shoulder pain: a case series. Pain Pract 2012; 13:59-67. [PMID: 22448759 DOI: 10.1111/j.1533-2500.2012.00541.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Previous studies demonstrated the efficacy of Intramuscular Nerve (IMN) therapy with a 4-lead percutaneous, peripheral nerve stimulation (PNS) system in reducing hemiplegic shoulder pain (HSP). This case series investigates the feasibility of a less complex, single-lead approach in reducing HSP. METHODS Eight participants received one percutaneous intramuscular lead in the hemiparetic deltoid muscle and were then treated 6 hours/day for 3 weeks. The primary outcome measure was the Brief Pain Inventory (Short-Form) Question 3 (BPI3), which queries worst pain in the last week on a 0 to 10 numeric rating scale. Secondary outcomes included pain interference (BPI9) and Medical Outcomes Study Short-Form 36 (SF-36v2). Primary and secondary outcomes were assessed at the end of treatment (EOT) and 1 and 4 weeks after the EOT. RESULTS All participants tolerated the treatment well with 96% compliance. All leads remained infection-free and were removed intact at the EOT. On average, participants exhibited 70% reduction in BPI3 at the EOT and 61% reduction at 4 weeks after the EOT. All participants satisfied the success criterion of at least a 2-point reduction in BPI3 at the EOT. Longitudinal analysis revealed significant treatment effect for BPI3 (F = 14.0, P < 0.001), BPI9 (F = 5.9, P < 0.01), and the bodily pain domain of SF-36v2 (F = 12.8, P < 0.001). CONCLUSION This case series demonstrates the feasibility of a single-lead, 3-week IMN therapy for the treatment of chronic HSP. Additional studies are needed to further demonstrate safety, efficacy, and long-term benefit, define optimal prescriptive parameters and dose, and expand clinical indications.
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Affiliation(s)
- John Chae
- Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, Cleveland, Ohio 44109, USA.
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Abstract
The prevalence of hemiplegic shoulder pain is approximately 22%-23% in the general population of stroke survivors and approximately 54%-55% among stroke patients in rehabilitation settings. Hemiplegic shoulder pain causes a reduced quality-of-life, poor functional recovery, depression, disturbed sleep, and prolonged hospitalization. Herein, we attempted to understand, based on a literature review and experts' opinion, the pathologic processes underlying hemiplegic shoulder pain and the major associated factors contributing to its development. The systematization of underlying pathologies was proposed, which might eventually enable a more constructive clinical approach in evaluating and treating patients with hemiplegic shoulder pain.
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Roosink M, Renzenbrink GJ, Buitenweg JR, Van Dongen RT, Geurts AC, IJzerman MJ. Persistent Shoulder Pain in the First 6 Months After Stroke: Results of a Prospective Cohort Study. Arch Phys Med Rehabil 2011; 92:1139-45. [DOI: 10.1016/j.apmr.2011.02.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 02/15/2011] [Accepted: 02/18/2011] [Indexed: 11/17/2022]
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Murie-Fernández M, Carmona Iragui M, Gnanakumar V, Meyer M, Foley N, Teasell R. [Painful hemiplegic shoulder in stroke patients: causes and management]. Neurologia 2011; 27:234-44. [PMID: 21514698 DOI: 10.1016/j.nrl.2011.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. DEVELOPMENT We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. CONCLUSIONS Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.
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Affiliation(s)
- M Murie-Fernández
- Departamento de Neurología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, España.
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Yasar E, Vural D, Safaz I, Balaban B, Yilmaz B, Goktepe AS, Alaca R. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehabil 2010; 25:60-8. [DOI: 10.1177/0269215510380827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine which injection technique was effective for patients with hemiplegic shoulder pain. Design: Randomized prospective double-blind study. Setting: Brain Injury Rehabilitation Unit. Intervention: Patients with hemiplegic shoulder pain were recruited over a 12-month period and all were hospitalized in our clinic. Intra-articular steroid injection or suprascapular nerve block was performed on all patients. Main measures: Range of motion values at the moment that pain started (range of motion A) and passive maximum range of motion values (range of motion B) were recorded. Pain intensity levels (visual analogue scale) at these two range of motion values (pain A and pain B) were also taken. Evaluations were made before the injection, and 1 hour, one week and one month after the injection. Results: Twenty-six patients were enrolled in the study, the mean age was 61.53 ± 10.30 years. The mean time since injury was 8.69 ± 15.71 months. The aetiology was ischaemic in 16 (61%) patients. Intra-articular steroid injection was performed in 11 (42 %) patients, and suprascapular nerve block in 15 (57%) patients. Range of motion A and range of motion B were changed statistically in repeated measures. There were important differences in repeated measures of pain intensity levels at these two range of motion values ( P < 0.05). However, no significant differences were determined in all measurements between intra-articular steroid injection and suprascapular nerve block groups ( P > 0.05). Conclusions: Our results showed that neither injection technique was superior to the other. Both injection procedures are safe and have a similar effect in stroke patients with hemiplegic shoulder pain.
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Affiliation(s)
- Evren Yasar
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Dilek Vural
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ismail Safaz
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Birol Balaban
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Bilge Yilmaz
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ahmet Salim Goktepe
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
| | - Ridvan Alaca
- Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, TAF Rehabilitation Center, Ankara, Turkey
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Reduced active control and passive range at the shoulder increase risk of shoulder pain during inpatient rehabilitation post-stroke: an observational study. J Physiother 2010; 56:195-9. [PMID: 20795926 DOI: 10.1016/s1836-9553(10)70025-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
QUESTION What factors at admission are associated with shoulder pain during stroke rehabilitation? DESIGN Retrospective audit of medical histories and logistic regression. PARTICIPANTS 94 people with primary diagnosis of stroke attending inpatient rehabilitation. OUTCOME MEASURES Predictors were a battery of impairments, stroke-related factors, and patient characteristics. The outcome of interest was shoulder pain. RESULTS Shoulder pain was present in 23% of patients at admission, and in a total of 35% of patients during inpatient stay. Patients with pain differed significantly (p = 0.04) from those without pain for several factors including age, longer time until rehabilitation admission, impaired movement of the arm (Motor Assessment Scale items), reduced passive range of movement, subluxation, and altered tone and sensation. No differences were found for many factors including neglect, cognitive impairment, side of stroke, and body weight. Logistic regression exploring the association between four predictors (shoulder range, Motor Assessment Scale items, subluxation, and altered sensation) and shoulder pain (outcome of interest) found that shoulder pain was reliably associated with two factors: reduced passive shoulder range (OR 14%, 95% CI 3 to 64), and Motor Assessment Scale Upper Arm item score (OR 64%, 95% CI 43 to 96). The model accurately classified 85% of patients. CONCLUSION Shoulder pain is common and occurs early after stroke. Reduced active control and passive range at the shoulder appear to be risk factors for shoulder pain during inpatient rehabilitation post-stroke.
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Allen ZA, Shanahan EM, Crotty M. Does suprascapular nerve block reduce shoulder pain following stroke: a double-blind randomised controlled trial with masked outcome assessment. BMC Neurol 2010; 10:83. [PMID: 20854696 PMCID: PMC2954969 DOI: 10.1186/1471-2377-10-83] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/21/2010] [Indexed: 11/19/2022] Open
Abstract
Background Shoulder pain is a common complication of a stroke which can impede participation in rehabilitation programs and has been associated with poorer outcomes. The evidence base for current medical and therapeutic management options of hemiplegic shoulder pain is limited. This study will evaluate the use of suprascapular nerve block injection as part of an interdisciplinary approach to the treatment of shoulder pain following stroke. The technique has previously been proven safe and effective in the treatment of shoulder pain associated with rheumatoid arthritis and degenerative shoulder conditions but its usefulness in a stroke population is unclear. Methods/Design A double blind randomised placebo controlled trial will assess the effect of a suprascapular nerve block compared with placebo in a population of 66 stroke patients. The trial will measure effect of injection on the primary outcome of pain, and secondary outcomes of function and quality of life. Measurements will take place at baseline, and 1, 4 and 12 weeks post intervention. Both groups will continue to receive routine physiotherapy and standard ward care. Discussion The results of this study could reduce pain symptoms in persons with mechanical shoulder pain post stroke and provide improvement in upper limb function. Trial Registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000621213.
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Affiliation(s)
- Zoe A Allen
- Division of Rehabilitation, Aged Care and Allied Health, Repatriation General Hospital, Daw Park, South Australia, Australia.
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Roosink M, van Dongen RTM, Renzenbrink GJ, Ijzerman MJ. Classifying post-stroke shoulder pain: can the DN4 be helpful? Eur J Pain 2010; 15:99-102. [PMID: 20547465 DOI: 10.1016/j.ejpain.2010.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 04/23/2010] [Accepted: 05/20/2010] [Indexed: 11/17/2022]
Abstract
The etiology of post-stroke shoulder pain (PSSP) is largely unclear and may involve both nociceptive and neuropathic mechanisms. No gold standard is present for PSSP diagnosis. The neuropathic pain diagnostic questionnaire (DN4), was originally developed to identify neuropathic pain in the clinical context. In this study we used the DN4 to categorize PSSP patients and compared symptoms and signs suggestive of either nociceptive or neuropathic pain. Pain complaints and sensory functions were compared between patients with chronic PSSP scoring at least four (DN4+, n=9) or less than four (DN4-, n=10) on the DN4. Pain was assessed using a numeric rating scale and the McGill pain questionnaire. Sensory functions were assessed using clinical examination and quantitative sensory testing combined with a cold pressor test. Patients classified as DN4+ reported constant pain, higher pain intensity, a higher impact of pain on daily living, more frequent loss of cold sensation, reduced QST thresholds at the unaffected side and increased QST thresholds at the affected side. Notably, several symptoms and signs suggestive of either neuropathic or nociceptive pain corresponded to the subgroups DN4+ and DN4- respectively. However, since the pathophysiological mechanisms remain unclear and none of the sensory signs could be exclusively related to either DN4+ or DN4-, PSSP prognosis and treatment should not be solely based on the DN4. Nonetheless, a thorough assessment of neuropathic and nociceptive pain complaints and somatosensory functions should be included in the diagnostic work-up of PSSP.
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Affiliation(s)
- Meyke Roosink
- Biomedical Signals & Systems, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, The Netherlands.
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Koyuncu E, Nakipoğlu-Yüzer GF, Doğan A, Ozgirgin N. The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial. Disabil Rehabil 2010; 32:560-6. [PMID: 20136474 DOI: 10.3109/09638280903183811] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the effect of functional electrical stimulation (FES) for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients. METHOD A total of 50 hemiplegic patients with shoulder subluxation and shoulder pain were included in the study. The patients were randomly divided into the study and control groups. All patients were put on a rehabilitation program using conventional methods while the study group patients were additionally applied FES to supraspinatus and posterior deltoid muscles. The shoulder pain of all patients during resting, passive range of motion (PROM) and active range of motion (AROM) was measured with the visual analog scale (VAS) while the shoulder subluxation levels were evaluated with the classification developed by Van Langenberghe and by using the millimetric measurements on anteroposterior shoulder X-ray before and after the physical treatment and rehabilitation program and compared. RESULTS Comparison of the resting AROM vs. PROM VAS value changes showed no significant difference between the groups. There was a significant difference between the two groups for the amount of change in shoulder subluxation in favor of the study group. CONCLUSIONS The results of our study have shown that applying FES treatment to the supraspinatus and posterior deltoid muscles in addition to conventional treatment when treating the subluxation in hemiplegic patients is more beneficial than conventional treatment by itself.
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Affiliation(s)
- Engin Koyuncu
- 5th Physical Medicine and Rehabilitation Clinic, Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
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Hemiparetic Shoulder Pain Syndrome Treated with Deep Dry Needling During Early Rehabilitation: A Prospective, Open-Label, Randomized Investigation. ACTA ACUST UNITED AC 2010. [DOI: 10.1300/j094v12n02_04] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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