Search

This study aimed to identify very early incidence of hemiplegic shoulder pain within 72hours (HSP), how clinical assessment was related to pain at 8-10 week follow-up and explore current standard therapy/management.Observational, prospective.Teaching hospital hyper-acute and follow-up stroke services.121 consecutive patients with confirmed cerebral infarct/haemorrhage recruited within 72hours of stroke onset.N/A.Subjective report of pain severity and aggravating factors: using numerical rating scales and pain questionnaire (ShoulderQ), shoulder abductor and flexor muscle strength (Oxford MRC Scale), Neer's Test of sub-acromial pain, shoulder subluxation and soft tissue shoulder palpation.At initial assessment (72hours), 35% (42/121) reported HSP. At follow-up (8-10 weeks), 44% (53/121) had pain: pain persisted in 32 of the original 42, resolved in 10 and had developed since initial assessment in 21. Pain at follow-up was associated with a statistically significant higher frequency of severe shoulder muscle weakness (MRC grade ≤2) and gleno-humeral subluxation at initial assessment. Soft tissue palpation and Neer's Test detected pain but did not predict development of HSP. 50/121 patients had 140 therapy interventions, particularly targeted to those with a higher HSP risk.This study reports HSP at an earlier time point after stroke than previous publications. Patients with severe arm weakness and/or shoulder subluxation within 72hours are at significantly higher risk of HSP at 8-10 weeks. These data highlight the high incidence of HSP, the non-standardized therapy approach, and can inform sample size calculations for future intervention studies.NCT02574000 (clinicaltrials.gov).

Magnetic resonance imaging (MRI) is as good as, if not better than, X-ray Computed Tomography (CT) for providing useful information about cerebral infarction [1±3]. In particular, newer techniques such as diffusion weighted imaging are very sensitive to the earliest changes of cerebral ischaemia but are not widely available because of hardware limitations [4]. Most centres, therefore, continue to rely on T2-weighted images to recognize the early ischaemic lesion. Most MRI studies emphasize changes that occur acutely; much less is known about the sub-acute changes that occur. Previous observations have established that changes in T2-weighted imaging occur within the ®rst 24 h after the onset of infarction and it has been assumed that these changes persist inde®nitely in permanent infarcts. Here, we report on two patients in whom we found the surprising and intriguing observation that the T2 of the region of infarction returned to normal, or near normal, about 12 days after the onset of stroke but then became abnormal again a few days later.