Prevalence of and risk factors for shoulder pain in poststroke hemiplegic patients

Abstract EN

Objective : to measure out the prevalence of shoulder pain in post stroke hemiplegic patients and to determine risk factors for this complication in heterogeneous sample of stroke patients.

Subjects Methods : Nested case control study included 107 patients with post stroke hemiplegia satisfied the criteria for this study were taken over a period of two years.

All patients were underwent full history taking, full rheumatologic and neurological examination of the affected upper limb .examination of shoulder on the hemiplegic side by plain x- ray film in anteroposterior view.

Results : of 107 patients with post stroke hemiplegia, 89 patients (83 %) developed shoulder pain on the same side of hemiplegia.

The risk of shoulder pain was higher in post stroke hemiplegic patients with older age (risk of age was divided by 2.4 for every 10 years growth), ischemic stroke (odds ratio (OR) = 1.5 ; 95 % confidence interval (CI) = 1.2-2.6), stroke at cortical level (OR = 1.7 ; 95 % CI = 1.3-2.8) and stroke in the left hemisphere (OR = 2.2 ; 95 % CI = 1.8-3.1).

Also, in patients with long time since onset of stroke (OR = 1.5 ; 95 % CI = 1.3-2.9).

Risk of developing of shoulder pain increased with increasing of severity of neurological deficit (The odds of shoulder pain was divided by 3.7 for every increasing level of severity of neurological deficit), motor deficit (OR = 6.4 ; 95 % CI = 2.3-61), sensory impairment (OR=3.3; 95% CI=2.7-4.1),occurrence of shoulder subluxation (OR = 2.4 ; 95 % CI = 1.7-3.6),occurrence of reflex sympathetic dystrophy (OR = 1.7 ; 95 % CI = 1.3-2.5), diabetes mellitus (DM) (OR = 6.5 ; 95 % CI = 2.9-7.3).

Depression (OR = 5.6 % ; 95 % CI = 4.3-7.1).each of sex, spasticity and Using of supportive measures were neither risky nor protective factors for developing of shoulder pain.

Staying in rehabilitation ward was protective factor against developing of shoulder pain in post stroke hemiplegic patients (OR = 0.2 ; 95 % CI = 0.08-0.9).

Conclusions : shoulder pain is a common complication in post stroke patient.

There are many different risk factors responsible for shoulder pain in these patients.

So, preventive strategies to reduce shoulder pain in post stroke hemiplegic patients should be considered.

Also, early and proper management of shoulder pain in these patients should be followed.