Evaluation and assessment of shoulder pain in hemiplegic patients and its exact causes

Abstract EN

Hypothesis: Shoulder pain is a common complication after stroke, occurring in 60 to 84% of hemiplegic patients.

Shoulder subluxation in these patients has been recognized as a difficult problem to manage and as a cause of shoulder pain.

In fact the exact causes of shoulder pain in hemiplegic patients are not known.

Previous studies have used plain radiography and shoulder arthrography to detect the cause of pain.

Aim of Study: (1) To detect the incidence of shoulder pain and subluxation in the hemiplegic shoulder.

(2) To clarify the exact causes of shoulder pain, using MRI.

(3) To evaluate shoulder subluxation and to show if shoulder subluxation causes pain.

Methodology: The study included 50 hemiplegic patients.

Each patient was evaluated as for: (1) The degree of shoulder pain.

(2) Shoulder range of motion.

(3) Upper limb motor function.

(4) Spastic activity.

(5) Shoulder subluxation.

(6) MRI and plain radiography were performed for both shoulders in each patient.

Results: (1) shoulder pain was found in 80% of our patients.

(2) Shoulder subluxation was detected in 46% of the patients.

(3) Spasticity was found to interfere with shoulder range of motion, and may have a role in shoulder pain.

(4) There were correlations between shoulder pain and shoulder range of motion particularly external rotation.

(5) MRI provided us excellent details of soft tissue, tendons, capsule around the joint and abnormalities within the joint.

In addition joint effusions were detected and recorded for the first time in those patients.

Conclusion: Our study has demonstrated a variety of causes and clinical situations that can be diagnostically misleading.

MRI may provide a solution to explain the exact etiology of shoulder pain in hemiplegic patients.