Sonography and physical findings in stroke patients with hemiplegic shoulders: a longitudinal study

Objective: To investigate the correlation between hemiplegic shoulder pain factors during the acute and chronic stages of stroke recovery. Design: A prospective longitudinal study. Subjects: Seventy-six stroke patients with hemiplegic shoulders. Methods: Hemiplegic shoulder pain and clinical, physical, and sonography results were recorded at admission and during both acute (before discharge) and chronic stages (6 months after discharge). Results: During the acute stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level and range of motion limitations. During the chronic stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level, range of motion limitations, spasticity and abnormal sonographic findings. Higher incidence (p = 0.014) of hemiplegic shoulder pain and pain scores (p < 0.01) were noted and abnormal sonographic findings of the biceps tendon long head (p = 0.01) and subscapularis tendon (p = 0.01) were higher during the chronic stage. Effusion, tenosynovitis or tendinopathy of the biceps tendon long head, and supraspinatus tendinopathy were notable during both stages. Conclusion: Hemiplegic shoulder pain was correlated with lower motor function level and shoulder range of motion limitation in both stages. Shoulder spasticity and abnormal sonographic findings were correlated with hemiplegic shoulder pain during the chronic stage.