Shoulder Pain In Stroke Patients Research Articles

Comparative effectiveness of high-intensity laser therapy and ultrasound therapy for hemiplegic shoulder pain in stroke patients: a randomized controlled trial“

ABSTRACT Background Hemiplegic shoulder pain (HSP) is a prevalent clinical manifestation following stroke, often causing considerable discomfort and disability. Various therapeutic approaches have been developed to address HSP. Objectives This study aimed to compare the effectiveness of HILT versus US therapy in alleviating HSP in stroke patients. Methods A double-blind randomized controlled trial enrolled stroke patients with HSP within one year post-onset. Participants were randomly assigned to HILT (with sham US) or US therapy (with sham HILT). Both groups received 10-minute sessions of their assigned therapy modality along with daily shoulder range of motion (ROM) exercises 5 times per week over two consecutive weeks. Pain reduction was the primary outcome, with shoulder ROM as secondary outcomes. Results Thirty patients (11 women, 19 men; mean age: 60.80 ± 11.51 years) were included. After the two-week intervention, significant improvements were observed in pain reduction at rest and during motion in the HILT group, and in pain reduction during motion and shoulder internal rotation in the US group compared to pre-treatment values within each group. However, there was no significant difference between the HILT and US therapy groups in any evaluated parameter. Conclusions Comparable efficacy was found between HILT and US therapy in reducing pain and improving shoulder ROM for HSP in stroke patients. Both modalities, when combined with shoulder ROM exercises, offer viable options for managing HSP in this population. Further research with larger sample sizes is needed to validate these findings and explore long-term outcomes.

Nerve and neuromuscular stimulation for hemiplegic shoulder pain in stroke patients – a meta-analysis

Nerve and neuromuscular stimulation for hemiplegic shoulder pain in stroke patients – a meta-analysis

Clinical and radiological assessment of hemiplegic shoulder pain in stroke patients

BackgroundHemiplegic 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.Methods210 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.ResultsThe 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.ConclusionHSP 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.

The use of shoulder orthoses post-stroke: effects on balance and gait. A systematic review.

Since there is no clear conclusion concerning the use of arm slings in the prevention or reduction of shoulder subluxation or shoulder pain in stroke patients, it seems important to explore other potentially beneficial effects. Earlier research already suggested that the upper limb might play a considerable role in efficient balance and gait in stroke patients. Therefore, the aim of this systematic review was to investigate the effects of wearing an arm sling on balance and/or gait in stroke patients. This information could support the decision-making concerning the use of shoulder orthoses after stroke. Four electronic databases (Pubmed/MEDLINE, Embase, Web of Science and CINAHL/EBSCO) were searched until April 8th, 2019. Search alerts were set and followed until January 2020 to assure no new eligible articles were published. Reference lists of included studies were hand searched. All studies examining the effect of wearing an upper limb orthosis on balance and gait in stroke patients were included. Two reviewers independently identified eligible studies and extracted data. The methodological quality of included trials was assessed using the QualSyst assessment tool for quantitative studies. Prospero registration number: CRD42019130282. Ten studies, examining 283 stroke patients with moderate to low level of upper limb impairment, were included in the quantitative synthesis of the results. The pooled mean time since stroke was 21.88±9.03 months. Only minor effects on balance or gait related outcome parameters could be detected in favor of wearing an arm sling. However, these changes did not exceed the minimal clinical important difference (MCID). So far no strong evidence is available regarding a potential benefit of wearing an arm sling on balance and gait for stroke patients. However, further research with longer intervention periods, can be useful to determine if stroke patients in the early phases after stroke or with persistent UL paresis might possibly benefit from wearing an arm sling.

Effects of sling exercise therapy on balance, mobility, activities of daily living, quality of life and shoulder pain in stroke patients: a randomized controlled trial

IntroductionIn recent years, researchers have focused their attention on the application of sling exercise therapy in stroke rehabilitation,but results have been inconsistent.The aim of this trial was to explore the effectiveness of sling exercise therapy on balance, mobility, activities of daily living, quality of life and shoulder pain in stroke patients compared with routine physiotherapy. MethodsA total of 50 stroke inpatients at The First Affiliated Hospital of the University of South China, Hengyang, Hunan,China,were randomly allocated into one of the two groups: the sling exercise therapy(SET) group (n = 25) received this therapy using a suspension device, and the control group (n = 25) participated routine physiotherapy. The interventions in both groups were performed once a day for 30 min, five times per week for four weeks. Measurements were undertaken prior to and after interventions in both groups. The observational indicies included balance function (Berg Balance Scale, BBS), motor function of the upper and lower limbs (Fugl-Meyer Assessment, FMA), daily living ability (Barthel Index, BI), quality of life (Short Form 36, SF-36), and shoulder pain (Visual Analogue Scale, VAS). ResultsAfter therapy, both the SET group and the control group had significant improvements in BBS, FMA, BI and VAS. Sling exercise therapy improved balance ability (△BBS:Z=-2.16, P = 0.031), upper limb motor function (△Fugl- Meyer-upper:Z= -3.88,P = 0.000) and shoulder pain (△VAS:t = 2.64, P = 0.012) more effectively than routine training in stroke patients. Positive changes in quality of life were found in both groups, although the difference between the two groups was not statistically significant. ConclusionsThe sling exercise therapy has been shown to be a safe and effective method to improve balance, mobility, activities of daily living, quality of life and shoulder pain in stroke patients. It could be an important therapeutic strategy to promote comprehensive functional recovery post-stroke.

Modified Biceps Suspension Procedure for Painful Glenohumeral Inferior Subluxation in Hemiplegic Stroke Patients: A Preliminary Study

Shoulder pain is a common cause of pain in hemiplegic stroke patients. Inferior glenohumeral subluxation has been associated with shoulder pain in stroke patients. Various nonsurgical modalities have been tried to alleviate shoulder pain in this patient population but have not been able to provide a long-term symptom relief. In this study, we sought to report the early outcomes of a biceps tendon suspension-rotator interval imbrication procedure performed in 5 hemiplegic stroke patients with intractable shoulder pain. This procedure was a modification of a previously reported technique and involved looping the distal end of the proximal biceps long head tendon through transosseous tunnels in the bicipital groove and imbrication of the rotator interval. The mean pain VAS score was significantly improved from 8 preoperatively to 2 postoperatively. The mean American Shoulder and Elbow Surgeons score was also improved from 12 to 45. Four patients were “very satisfied” and 1 patient was “somewhat satisfied” with the surgical outcome. Our study demonstrates that biceps suspension-rotator interval imbrication procedure can be an effective treatment for hemiplegic patients with painful glenohumeral joint inferior subluxation.

A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients

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.

Prevalence of Post Stroke Shoulder Subluxation and Pain

Objective: To study the occurrence of shoulder subluxation, shoulder pain in stroke patients and to identify its effect on daily life activities of the patient. Material and Method: Stroke patients from Department Of Physiotherapy and Department of Neurology, Christian Medical College and Hospital,Ludhiana from September to March 2012 were enrolled in the present study. All subjects were registered for demographic data including risk factors and type of stroke. They were assessed for functional ability and quality of life by using Barthel ADL Index(BI). The occurence of shoulder subluxation and shoulder pain were recorded and then were analyzed for the associated factors. Results: Of 100 stroke patients, 68 met the inclusion criteria,24/40 male and 19/28 female patients(63.2%) were found to have shoulder pain and 4/40 male and 3/28 female patients(10.2%) had shoulder subluxation. Shoulder pain was significantly more frequent than subjects with shoulder subluxation.35/68 patients(51.4%) were having infarction type of stroke and 33/68 patients(48.5%) were having hemmorhagic type.65 subjects were dependent on their relatives for daily life activities according to Barthel Index(BI). Conclusion: Post stroke shoulder pain and subluxation were common during the rehabilitation period.Shoulder pain significantly occurred within 6 months after stroke onset and increased risk in patients with shoulder subluxation.

Shoulder pain and concomitant hand oedema among stroke patients with pronounced arm paresis

Background: The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. Methods: At stroke onset, 485 patients were initially assessed in 2007–2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Results: Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. Conclusions: One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain.

A Study of the Clinical Utility of the BPI-12 and 23 in Predicting Shoulder Pain in Stroke Patients

A Study of the Clinical Utility of the BPI-12 and 23 in Predicting Shoulder Pain in Stroke Patients

The utility of the Faces Pain Scale in the assessment of shoulder pain in Turkish stroke patients: its relation with quality of life and psychologic status

This study was planned to investigate the utility of the vertical Faces Pain Scale (FPS) in the assessment of pain in stroke patients using the shoulder pain model and to assess its utility in the Turkish patient population. The secondary aim was to analyze the association of FPS with the quality of life and depression in the study population.Thirty stroke patients (group I) and 30 controls (group II),all suffering from shoulder pain were included in the study.The patients with subacute shoulder pain and with no other known diseases and impairments were recruited as a control group. Shoulder pain was evaluated by the commonly used pain scales including the Visual Analogue Scale, Likert Pain Scale and 0–10 Numerical Rating Scale besides FPS. Depression was screened using Beck Depression Inventory (BDI) and quality of life was evaluated using Short Form-36 (SF-36). FPS showed good correlations with the other pain scales in both the groups(r= 0.950–0.972 and 0.674–0.926, respectively). In group I,there were significant correlations between FPS and physical functioning, pain and emotional role subscales of SF-36 (r= – 0.432, 0.707 and – 0.461, respectively).Although there was a low correlation between the FPS and BDI scores, it was not statistically significant. In group II,FPS showed significant correlations with the BDI scores and all subscales of SF-36 except social functioning and vitality (r= – 0.679 to 0.848). FPS had a high degree of convergent validity and can be used in the assessment of shoulder pain in stroke patients. It may be a good alternative for pain assessment especially in patients with speech disorders and illiterate patients.

Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial

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.

Hemiplegische Schulter - Evidenz von Behandlungsmöglichkeiten bei Schulterschmerz

Hintergrund: Das Auftreten von Schulterschmerz nach erlittenem Schlaganfall ist eine häufige Komplikation, die die motorische Erholung, Aktivität und die Lebensqualität der Betroffenen beeinträchtigt.

Effects of bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke

To measure the effects of Bobath-based (BB) therapy on depression, shoulder pain and health-related quality of life (HRQoL) of patients during one year after stroke. In a prospective, non-randomized design, the use of BB therapy was compared with a more task-oriented therapy and no BB therapy. A total of 324 patients in 12 hospitals. Patients in the intervention group received BB therapy, whereas patients in the control group received no BB therapy and a more task-oriented therapy. HRQoL was measured using the SF-36; depression was measured with the Center of Epidemiological Studies Depression Scale and shoulder pain was measured with the Visual Analogue Scale at discharge, 6 and 12 months. Linear and logistic regression analyses were performed. No effects of BB therapy on HRQoL or shoulder pain were found. After one year fewer patients were depressed in the BB group (30%) than in the non-BB group (43%); the adjusted odds ratio was 0.6 (95% confidence interval 0.3-1.0). BB therapy did not have any effect on HRQoL or shoulder pain in stroke patients. Healthcare professionals should reconsider the use of BB therapy in the care of stroke patients.

Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A

Objective: This randomised, double blind, placebo controlled, two parallel group study was conducted to assess the beneficial effect of injection of botulinum toxin A (Dysport) into the subscapularis muscle on...

Risk Factors of Hemiplegic Shoulder Pain in Stroke Patients

Objectives: This study is designed to investigate the degree of correlation of hemiplegic shoulder pain to some clinical parameters including electrodiagnostic testing. Methods: Fifty post-stroke patients were divided into 3 groups: Group A patients had spontaneous hemiplegic shoulder pain, Group B patients had shoulder pain only during movement, and Group C patients had no shoulder pain. The correlational relationships between shoulder pain in the hemiplegic side and some clinical parameters including age, sex, side affected, duration of stroke, motor function, sensory impairment, spasticity, shoulder subluxation, shoulder contracture, peripheral nerve conduction, and the presence of spontaneous electromyographic [EMG] activity was analyzed statistically. Results: Data analysis revealed no significant correlation between the hemiplegic shoulder pain and age, sex, side affected, or duration of stroke. However, the presence of shoulder subluxation or limitation of passive shoulder range of motion [ROM] sho...

The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients

The purpose of this study was to evaluate the effectiveness of a functional electrical stimulation (FES) treatment program designed to prevent glenohumeral joint stretching and subsequent subluxation and shoulder pain in stroke patients. Twenty-six recent hemiplegic stroke patients with shoulder muscle flaccidity were randomly assigned to either a control group (n = 13; 5 female, and 8 male) or experimental group (n = 13; 6 female, and 7 male). Both groups received conventional physical therapy. The experimental group received additional FES therapy where two flaccid/paralyzed shoulder muscles (supraspinatus and posterior deltoid) were induced to contract repetitively up to 6 hours a day for 6 weeks. Duration of both the FES session and muscle contraction/relaxation ratio were progressively increased as performance improved. The experimental group showed significant improvements in arm function, electromyographic activity of the posterior deltoid, range of motion, and reduction in subluxation (as indicated by x-ray) compared with the control group. We concluded that the FES program was effective in reducing the severity of shoulder subluxation and pain, and possibly facilitating recovery of arm function.

Shoulder pain in stroke patients and its effects on rehabilitation

The purpose of this study was to examine whether prompt diagnosis and management of shoulder pain is beneficial in decreasing pain and increasing range of motion and functional recovery. Among 116 stroke patients receiving outpatient rehabilitation, 48 had shoulder pain. Twenty-eight of the patients with shoulder pain received occupational therapy and physiatric management. Five of the 28 patients had specific diagnoses. Etiology of the pain in the remaining 23 patients (Group 1) was not known, and these patients were treated with nonsteroidal antiinflammatory drugs (NSAIDs). The remaining 20 (Group 2) received only occupational therapy and were used as the control group. Pain relief, range of motion (ROM) in flexion, and abduction and functional recovery were compared in the two groups. Results show that a significantly higher percentage of Group 1 was found to have pain relief; 91% versus 15% with p < 0.00001 for the difference. A significant number of patients improved ROM for flexion and abduction in Group 1 versus Group 2 (p < 0.006 and p < 0.055 for the difference for flexion and abduction, respectively). Functional recovery was highly significant for Group 1,100% compared to 55% for Group 2, with p < 0.0001 for the difference. These results emphasize the importance of management of shoulder pain with NSAIDs along with ROM exercises for successful rehabilitation of hemiplegic patients.

Shoulder Subluxation and Pain in Stroke Patients

Twenty-four patients with stroke were studied (a) to determine the interrater reliability of a clinical measurement of shoulder subluxation, (b) to confirm the interrater reliability of the Ritchie Articular Index (Bohannon & LeFort, 1986) for measuring shoulder pain, (c) to establish the relationship between the Ritchie index scores and shoulder lateral rotation range of motion measured at the point of pain (SROMP), and (d) to determine the relationship between shoulder subluxation and shoulder pain. The agreement between the two examiners' (the authors) measurements of subluxation was "almost perfect" (Landis & Koch, 1977, p. 165). The agreement between the two examiners' Ritchie index measurements was "substantial" (Landis & Koch, 1977, p. 165). The Ritchie index and SROMP measurements correlated significantly. Neither the Ritchie index nor the SROMP measurements correlated significantly with subluxation. Although the measurements used in this study were reliable, they did not support the association of shoulder subluxation with shoulder pain in stroke patients. Clinicians wishing to reduce shoulder pain in stroke patients should direct their treatment accordingly.