Relationship between Shoulder Pain and Selected Variables in Patients with Hemiplegia

Abstract

This investigation was performed to clarify the relationship between six independent variable categories and shoulder pain (SP) in hemiplegia. In this study, 30 hemiplegic patients served as subjects. The Ritchie articular index was used to measure SP. The independent variables were age, body weight, time since onset of stroke, shoulder subluxation, range of shoulder external rotation, and plegic shoulder muscle group strength. Subluxation was judged by palpation. Range of shoulder external rotation was measured goniometrically. Strength of the shoulder internal and external rotator, abductor and extensor muscles was measured with a hand-held dynamometer and normalized against body weight. A strength balance ratio of the shoulder was also determined (external rotators + abductors/internal rotators + extensors). Variables were measured on admission and prior to discharge. Spearman correlations or chi-squares were determined between the initial and final measurements of the independent variables and SP.

More than 80% of the patients had SP. Correlated significantly with SP at both assessments and across time were range of shoulder external rotation (−.574 to −.797), and strength of the shoulder external rotator (−.523 to −.583) and abductor (−.375 to −.519) muscles. Correlated significantly at one or more of the assessments were body weight, time since onset and the strength of the other muscle groups (including the strength ratio). Shoulder subluxation was not correlated with SP. Patients with greater weakness may be more prone to the development of pain because their muscles lack adequate strength to move the joint enough to prevent the development of adhesive capsulitis.