Ultrasonographic Finding of Painful Hemiplegic Shoulder Associated with Motor Recovery after Stroke

ABSTRACT

OBJECTIVE: To analyze the relationship between painful hemiplegic shoulder (PHS) and ultrasonographic (US) findings according to the motor recovery stage of the stroke. METHOD: The medical records were reviewed retrospectively in 82 stroke patients from January 2005 to November 2009 who undertook US examination on hemiplegic shoulder. The clinical data collected were age, gender, stroke type, affected side, duration from stroke onset, manual function test (MFT) and the Brunnstrom stage of arm. The presence of spasticity, glenohumeral subluxation and sensory impairment were also investigated. The patients were classified into three groups according to the Brunnstrom recovery stage the first, second and third recovery stages (RS1, RS2 and RS3). Furthermore, the correlations between US findings and the clinical characteristics according to the Brunnstrom recovery stage were analyzed. RESULTS: The presence of spasticity, glenohumeral subluxation, sensory impairment (proprioception) and MFT scores had statistically significant differences in each group. Among the 82 stroke patients, 62 patients (75.6%) had abnormal findings in US examination. The common abnormal structures were supraspinatus tendon (SST), biceps long head tendon (BLH), subacromial-subdeltoid bursa (SA-SD bursa). The frequencies of total US abnormality in each group were not significantly different (p=0.07). However, the SST abnormality was more frequent in the RS1, and the BLH and SA-SD bursa abnormality were more frequent in the RS3 (p<0.05). CONCLUSION: In this study, abnormal findings in US examination are frequent in PHS. The abnormal SST is related to the flaccidity, and the abnormal BLH and SA-SD bursa are related to the overuse.