Hemiplegic shoulder pain (HSP): Natural history and investigation of associated features

Abstract

The prevalence of hemiplegic shoulder pain (HSP) and associated factors was studied in patients with a stroke followed for 6 months after discharge from hospital. A questionnaire was used to evaluate shoulder symptoms and an examination of the shoulder and arm was carried out three times over 6 months. A total of 108 patients were studied with a mean age of 71 years. Sixty-nine patients (63.8%) developed HSP at some time during the study period. The number with HSP was 39 at discharge from hospital, 59 at 8 weeks post-discharge and 36 at 6 months. Nine carers reported lifting the patient by pulling on the hemiplegic arm, even though six of them had received advice about correct lifting techniques. Reduced shoulder shrug was associated with HSP at all times and reduced pinch grip was also associated with HSP at discharge from hospital. Patients who required help with transfers were more likely to suffer with HSP. There was no difference in the prevalence of HSP in patients treated at the day hospital compared to those who received domiciliary physiotherapy. It is concluded that HSP is common after a stroke and the prevalence increases in the first weeks after discharge from hospital. Stroke patients and their carers need advice about correct handling of the hemiplegic arm, and more work is required to ensure that correct handling occurs after discharge in patients at high risk of this unpleasant complication.

Cinesioterapia previne ombro doloroso em pacientes hemiplégicos/paréticos na fase sub-aguda do acidente vascular encefálico

“…Além disso, resulta em grande impacto negativo sobre a recuperação funcional de pacientes que sobrevivem a um AVE [4][5][6][7] . Devido à importância e à necessidade de medidas profiláticas precoces, apontadas por vários autores 1,15,16 , o tratamento fisioterapêutico proposto para esse estudo foi iniciado nas primeiras 48 horas pois, em cerca de 20% dos pacientes, a dor no ombro H/ P pode surgir já na 1 a e 2 a semana pós ictal [8][9][10] .…”

“…Com a musculatura flácida, decorrente da perda do controle motor na fase inicial do AVE, o ombro torna-se muito suscetível a graus variados de lesões, principalmente ao estiramento e ao posicionamento inadequado do membro superior. Observou-se, no entanto, que apesar de todos os pacientes terem evoluído sem dor no ombro H/P, em alguns deles houve dificuldade em manter o posicionamento orientado pelo terapeuta, fato já observado anteriormente por alguns autores 10 .…”

“…Outro aspecto que favoreceu os resultados foi a manutenção da ADM do ombro H/P livre para os movimentos, visto que estudos mostram que o ombro doloroso, geralmente vem acompanhado com a perda progressiva de sua amplitude de movimento articular 3,[8][9][10] .…”

“…A recuperação de um paciente com hemiplegia/ hemiparesia (H/P), considerada a principal causa de incapacidade grave na sociedade atual, constitui-se em um grande desafio, tanto pela complexidade das funções perdidas, quanto pela alta incidência de dor no ombro H/P 1-3 , resultando em sofrimento e impacto negativo na sua recuperação global 4-7. Cerca de três quartos dos pacientes sofrem de dor no ombro durante o primeiro ano após o acidente vascular encefálico (AVE) e, em aproximadamente 20% deles, a dor pode surgir na 1 a e 2 a semana pós ictal, prolongando o tempo de internação [8][9][10] . …”

A Study of the Clinical Utility of the BPI-12 and 23 in Predicting Shoulder Pain in Stroke Patients

“…The pain severity is different depending on the causes of the pain, and patients suffer various senses of pain 1,2) . About 17% of stroke patients suffer shoulder pain within one week after stroke 2) ; 55% of them suffer it within two weeks 3) ; 87% of them suffer it within two months 3) ; and 75% of them suffer it within one year 4) . The initial attack of shoulder pain in stroke patents prevents is patients from recovering their upper extremity function because the non-paralyzed upper extremity is overused in performing functional exercises; therefore, the patients' upper extremity function is reported to improve within five weeks after the attack 5) .…”