Hemiplegic shoulder pain (HSP) after stroke has negative effects on functional use of hemiplegic arm.
OBJECTIVE:
This study aimed to investigate the effects of HSP on upper extremity motor function and proprioception.
METHODS:
Hundred and twenty-two patients with hemiplegia were included in this study. The patients’ shoulder pain was evaluated by Visual Analog Scale. According to pain scores, patients were divided into two groups as group with HSP (Group 1, n = 76) and group without HSP (Group 2, n = 46). Upper extremity motor function level and proprioception were assessed by using Fugl Meyer Motor Function Scale and the Laser-pointer Assisted Angle Reproduction Test for the 45°, 60° and 90° of shoulder flexion.
RESULTS:
Upper extremity motor function and shoulder’s proprioceptive sense at each angles of group 1 were found significantly worse than group 2’s (p≤0.005). Correlation analysis revealed a significant positive correlation between HSP severity, and upper extremity motor dysfunction and proprioceptive impairment (p < 0.005).
CONCLUSIONS:
Presence of HSP is one of the main determinators of upper extremity motor function level and proprioceptive ability at different angles. Management of HSP can make a significant contribution to sensorimotor integration by leading to recovery in the motor function and proprioceptive acuity.
Adey-Wakeling,Z., Arima,H., Crotty,M., Leyden,J., Kleinig,T., Anderson,C. S., ... Collaborative,S. S. (2015). Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study. Archives of Physical Medicine and Rehabilitation96, 241–247.
2.
Ager,A. L., Borms,D., Deschepper,L., Dhooghe,R., Dijkhuis,J., Roy,J. S., & Cools,A. (2019). Proprioception: How is it affected by shoulder pain? A systematic review. Journal of Hand Therapy, 1-9.
3.
Baek,J. H., Kim,J. W., Kim,S. Y., Oh,D. W., & Yoo,E. Y. (2009). Acute effect of repeated passive motion exercise on shoulder position sense in patients with hemiplegia: A pilot study. NeuroRehabilitation25, 101–106.
4.
Balke,M., Liem,D., Dedy,N., Thorwesten,L., Balke,M., Poetzl,W., & Marquardt,B. (2011). The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability. Archives of Orthopaedic and Trauma Surgery131, 1077–1084.
5.
Blennerhassett,J. M., Gyngell,K., & Crean,R. (2010). Reduced active control and passive range at the shoulder increase risk of shoulder pain during inpatient rehabilitation post-stroke: an observational study. Journal of Physiotherapy56, 195–199.
6.
Carey,L. M., Matyas,T. A., & Oke,L. E. (1993). Sensory loss in stroke patients: effective training of tactile and proprioceptive discrimination. Archives of Physical Medicine and Rehabilitation74, 602–611.
7.
Chae,J., Mascarenhas,D., David,T. Y., Kirsteins,A., Elovic,E. P., Flanagan,S. R., ... Fang,Z. P. (2007). Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life. Archives of Physical Medicine and Rehabilitation88, 298–301.
8.
Dos Santos,G. L., Salazar,L. F. G., Lazarin,A. C., & de Russo,T. L. (2015). Joint position sense is bilaterally reduced for shoulder abduction and flexion in chronic hemiparetic individuals. Topics in Stroke Rehabilitation22, 271–280.
9.
Findlater,S. E., & Dukelow,S. P. (2017). Upper extremity proprioception after stroke: bridging the gap between neuroscience and rehabilitation. Journal of Motor Behavior49, 27–34.
10.
Karaahmet,O. Z., Eksioglu,E., Gurcay,E., Bora Karsli,P., Tamkan,U., Bal,A., & Cakcı,A. (2014). Hemiplegic shoulder pain: associated factors and rehabilitation outcomes of hemiplegic patients with and without shoulder pain. Topics in Stroke Rehabilitation21, 237–245.
11.
Lindgren,I., & Brogårdh,C. (2014). Poststroke shoulder pain and its association with upper extremity sensorimotor function, daily hand activities, perceived participation, and life satisfaction. PM&R, 6, 781–789.
12.
Lindgren,I., Brogårdh,C., & Gard,G. (2019). Pain management strategies among persons with long-term shoulder pain after stroke–a qualitative study. Clinical Rehabilitation33, 357–364.
13.
Lindgren,I., Jonsson,A. C., Norrving,B., & Lindgren,A. (2007). Shoulder pain after stroke: a prospective population-based study. Stroke, 38, 343-348.
14.
Manara,J. R., Taylor,J., & Nixon,M. (2015). Management of shoulder pain after a cerebrovascular accident or traumatic brain injury. Journal of Shoulder and Elbow Surgery24, 823–829.
15.
Namdari,S., Yagnik,G., Ebaugh,D. D., Nagda,S., Ramsey,M. L., WilliamsJr, G. R., & Mehta,S. (2012). Defining functional shoulder range of motion for activities of daily living. Journal of Shoulder and Elbow Surgery21, 1177–1183.
16.
Niessen,M., Janssen,T., Meskers,C., Koppe,P., Konijnenbelt,M., & Veeger,D. (2008). Kinematics of the contralateral and ipsilateral shoulder: a possible relationship with post-stroke shoulder pain. Journal of Rehabilitation Medicine40, 482–486.
17.
Niessen,M. H., Veeger,D. H., Meskers,C. G., Koppe,P. A., Konijnenbelt,M. H., & Janssen,T. W. (2009). Relationship among shoulder proprioception, kinematics, and pain after stroke. Archives of Physical Medicine and Rehabilitation90, 1557–1564.
18.
Paci,M., Nannetti,L., Taiti,P., Baccini,M., Pasquini,J., & Rinaldi,L. (2007). Shoulder subluxation after stroke: relationships with pain and motor recovery. Physiotherapy Research International12, 95–104.
19.
Rand,D., & Eng,J. J. (2012). Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation. NeuroRehabilitation and Neural Repair26, 76–84.
20.
Ribeiro,F., & Oliveira,J. (2007). Aging effects on joint proprioception: the role of physical activity in proprioception preservation. European Review of Aging and Physical Activity4, 71–76.
21.
Röijezon,U., Clark,N. C., & Treleaven,J. (2015). Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions. Manual Therapy20, 368–377.
22.
Roosink,M., Renzenbrink,G. J., Buitenweg,J. R., Van Dongen,R. T., Geurts,A. C., & IJzerman,M. J. (2011). Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study. Archives of Physical Medicine and Rehabilitation92, 1139–1145.
23.
Suprak,D. N., Sahlberg,J. D., Chalmers,G. R., & Cunningham,W. (2016). Shoulder elevation affects joint position sense and muscle activation differently in upright and supine body orientations. Human Movement Science46, 148–158.
24.
Teasell,R., Foley,N., Salter,K., Bhogal,S., Jutai,J., & Speechley,M. (2009). Evidence-based review of stroke rehabilitation: executive summary. Topics in Stroke Rehabilitation16, 463–488.
25.
Turner-Stokes,L., & Jackson,D. (2002). Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clinical Rehabilitation16, 276–298.
26.
Weerakkody,N. S., Blouin,J. S., Taylor,J. L., & Gandevia,S. C. (2008). Local subcutaneous and muscle pain impairs detection of passive movements at the human thumb. The Journal of Physiology586, 3183–3193.
27.
Yi,Y., Lee,K. J., Kim,W., Oh,B. M., & Chung,S. G. (2013). Biomechanical properties of the glenohumeral joint capsule in hemiplegic shoulder pain. Clinical Biomechanics28, 873–878.
