Prevalence of shoulder pain after stroke and associated factors

Background and Purpose: Shoulder pain is a common complication from stroke that may cause some rehabilitation limits to achieve functional goals. The information regarding its prevalence and associated factors is limited. This study was conducted to investigate further details pertaining to its associated factors.Materials and Methods: This study was performed on 191 stroke patients at the Physical Medicine and Rehabilitation Ward at Shiraz-Medical School from 2001 to 2004. Each patient was followed up for one year. A questionnaire was prepared containing information about shoulder pain compliant, thorough history and physical examination, previous history of open heart surgery, scoliosis, limited neck range of motion, type of stroke (based on MRI and brain CT), osteoporosis (based on bone mineral density and X ray), shoulder adductor muscles and biceps spasticity (based on ashworth scale). In follow-up visits bi-monthly for one year, the questionnaire was filled out again and if present, shoulder pain was recorded.Results: Most patients developed shoulder pain between 2 and 6 months following their stroke. Forty-nine patients (32.2%) developed shoulder pain, 39(79.6%) of whom had spastic tone and 8 (16.3%) had flaccid tone. In both groups, with shoulder pain and without shoulder pain respectively, 6.7% and 1.9% had a history of open heart surgery, 6.1% and 1% had scoliosis, 67.3% and 35.1% had Intracranial hemorrhage, 73.5% and 23.3% had limited neck range of motion, and 24.5% and 35% had osteopenia.Conclusion: Spasticity was significantly more common in the shoulder pain group, which can be due to capsulitis, soft tissue inflammation (especially ligament and rotator cuff muscle) and anteroinferior subluxation of the shoulder. There was a significant statistical correlation between intracranial hemorrhage, reduced neck range of motion, and hemiplegic shoulder pain. It appears that treatment and rehabilitation of spasticity and underlying cervical area problems are helpful in preventing hemiplegic shoulder pain.J Mazand Univ Med Sci 2008; 18(65): 28-33(Persian)