Association between glenohumeral subluxation and hemiplegic shoulder pain in patients with stroke

Abstract

Background: Glenohumeral subluxation (GHS) and hemiplegic shoulder pain (HSP) are the most common musculoskeletal complications reported in patients with stroke. These secondary problems present considerable challenges to the rehabilitation of the upper limb. Objective: The aim of this review was to evaluate the evidence on the association between shoulder subluxation and pain in patients with stroke. Method: A systematic online search was conducted of MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and the Cochrane Library. The search was supplemented by hand searching of relevant journals and citation tracking of the retrieved papers. All primary studies published in English language fulfilling the review's inclusion criteria were included. Five reviewers independently appraised the methodological quality of the selected studies. Any discrepancies were resolved following discussions. Results: Of the 148 articles that were identified by the search, 14 studies met the criteria to be included in the review. Seven studies found an association and seven studies did not find an association between subluxation and pain. The methodological quality of the studies varied considerably and studies used a wide range of outcome measures to assess both subluxation and pain. Conclusions: Irrespective of any association, both subluxation and pain can independently have an impact on functional rehabilitation. Management of these clinical outcomes is critical in clinical practice and clinicians should continue to prevent and reduce these post-stroke secondary complications to enhance upper limb function.

Hemiplegic Shoulder Pain in People with Stroke: Present and the Future

“…Association between glenohumeral subluxation (GHS) and HSP has been a controversial issue. Of 14 studies included in a systematic literature review, seven showed an association while another seven showed no association, suggesting that not all patients with GHS necessarily experience shoulder pain [13]. Findings on the association between subluxation and pain are controversial and this may be attributable, in part, to the methodological differences of the studies reviewed.…”

A Multicenter Cross- Sectional Survey on Physiotherapy Treatment Practices in Hemiplegic Shoulder Pain and Subluxation in Stroke Patients

“…did not find association. The writers had an opinion that this area lack high quality clinical research [4]. 100 individuals that formed a 500 subjects for survey.…”

Tracking changes in glenohumeral joint position in acute post-stroke hemiparetic patients: an observational study

“…Spasticity is associated with decreased function due to abnormal patterns of movement, co-contraction of muscles, associated movements and persistent limb posturing, and the development of contractures (Marciniak, 2011). Spasticity has also been associated with HSP (Kumar, Saunders, Ellis, & Whitlam, 2013;Lindgren et al, 2007;Rajaratnam et al, 2008) and glenohumeral joint subluxation (Ada & Foongchomcheay, 2002;Kumar, Kassam, Denton, Taylor, & Chatterley, 2010;Stolzenberg et al, 2012). In summary, evidence points to both flaccidity and spasticity being associated with HSP and subluxation.…”

“…The association between shoulder pain, muscle tonus and subluxation has been investigated within several reviews (Kumar et al, 2013;Murie-Fernández et al, 2012;Paci et al, 2005), though the reviews remain equivocal about these associations. This lack of consensus could be attributable to whether recruitment and data collection occurred in the acute, subacute or chronic phase or a combination of these.…”