Abstract WP314: Frequency and Characteristics of Hemiplegic Shoulder Pain - A Population-Based Assessment

Abstract

Background: Shoulder pain is common complication of stroke with multiple aetiological mechanisms but there are few population-based studies of the clinical profile, frequency and impact of the disorder. Objectives: To determine the frequency and characteristics of hemiplegic shoulder pain in the first year after stroke. Methods: Data on any shoulder pain were obtained in patients registered in a population-based stroke incidence study undertaken in a defined area of the western suburbs of Adelaide, South Australia, over a 12-month period to July 2010. Subjective (any, onset, severity [visual analogue scale] and aggravating factors) and three objective (modified Neer test, passive hand-behind-neck, and passive external rotation) measures of pain were undertaken at baseline, and 4 and 12 months post-stroke. Results: Among 301 stroke patients, shoulder pain data were available for 198 (66%), as 62 had died prior to the 4 month assessment and 41 either refused or were unavailable for assessment. Information on shoulder pain was available from 198 stroke survivors at baseline, 156 at 4 months and 148 at 12 months. Overall, 10% reported shoulder pain at baseline, whilst 21% reported pain at both follow-up assessments, so that overall approximately one third (27%) of patients reported some shoulder pain during 12 months post-stroke. The median pain score (visual analogue scale = 40) was highest at 4 months, and the characteristics varied from mild and prominent at rest (including night) in the early weeks, to being more associated with limited range of movement and aggravated by active movement towards 12 months, suggesting increasing musculoskeletal contributions to pain over time. Objective passive range of motion tests were associated with higher frequencies of pain than were elicited by self-reports. Conclusions: The frequency of post-stroke shoulder pain was similar to other population-based studies, suggesting limited progress in prevention and management of this complication. As the disorder is most common and severe after hospital-discharge, targeted protocols may facilitate identification and management.