Prevalence of the Shoulder-Hand Pain Syndrome in an Inpatient Stroke Rehabilitation Population: A Quantitative Cross-Sectional Study

Abstract

Of 41 patients with hemiparesis and associated functional deficits requiring inpatient rehabilitation a mean of 8 weeks post unilateral hemispheric stroke, 17 (41%) had evidence of pain, edema, and vasomotor changes in the affected upper extremity. These 17 patients met criteria for stage I of the shoulder-hand syndrome (SHS). The prevalence of SHS in patients with hemiplegia without proprioceptive deficit or visual neglect was 7%, whereas it was present in 61% of patients with hemiplegia plus impaired proprioception and visual neglect. The prevalence of SHS in our population is considerably higher than that reported from previous retrospective studies. Such studies have not used quantitative assessment of pain, edema, and vasomotor dysfunction to establish the diagnosis. We conclude that SHS is a common rehabilitation problem during the subacute phase post stroke. It occurs despite currently available techniques for supporting and exercising the affected limb. From our data it is apparent that weakness is a necessary but not sufficient cause of SHS post stroke. Impaired hemispatial awareness or cognitive impairment must also be present affecting the patient's ability to position, protect, and exercise the affected limb. Reproducible measures of pain, edema and vasomotor dysfunction exist and should be used to develop more effective techniques for SHS prophylaxis and treatment.