A clinical, electrophysiological, and imaging study on the different causes of poststroke shoulder pain

Abstract

Background: Poststroke shoulder pain (PSSP) is a complex phenomenon. Defining the exact etiology would facilitate proper management. Aim: The aim of the study is to identify the different causes of PSSP. Settings and Design: Observational cross-sectional study at institution, university hospital, tertiary level of clinical care. Methods: A total of 30 stroke survivors with PSSP were enrolled in this study. Patients were subjected to neuromuscular clinical examination of the shoulder, and evaluation (spasticity assessment using Modified Ashworth scale and Fugl-Meyer upper extremity scale to assess impairment). The shoulder pain was evaluated using the numerical rating scale and the neuropathic pain diagnostic questionnaire (DN4). Electrophysiological studies (nerve conduction and electromyography) and imaging (plain radiograph and magnetic resonance imaging [MRI]) were done to reveal neuromusculoskeletal causes for PSSP. Results: One or more musculoskeletal cause occurred in all patients. These were rotator cuff tear/tendinopathy (90%), impingement syndrome (90%), bursitis (66.7%), and adhesive capsulitis (50%). Concomitant proximal neuropathies including (upper trunk brachial plexopathy, axillary neuropathy, and suprascapular neuropathy) were found in 40% of PSSP patients. The DN4 questionnaire was positive in only two patients. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS version 20 Chicago, IL, USA). Conclusion: The most common causes of PSSP were the musculoskeletal causes. MRI studies were helpful in revealing the common causes of shoulder pain such as rotator cuff tear and bursitis in those disabled population in whom clinical assessment could be difficult.

Keywords

• magnetic resonance imaging
• shoulder pain
• stroke
• survivors