Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients

Abstract

Background Glenohumeral subluxation (GHS) is common in patients with acute hemiplegia caused by stroke. GHS and upper limb function are closely related. Objective Using musculoskeletal ultrasonography (MSUS) to objectively evaluate the efficacy of functional magnetic stimulation (FMS) in the treatment of GHS in acute hemiplegic patients after stroke. Methods The study used prospective case control study. Stroke patients with GHS were recruited and assigned to control group and FMS group. Control group received electrode stimulation at the supraspinatus and deltoid muscles of the hemiplegic side, while FMS group was stimulated at the same locations. Before and after treatment, the distances of the acromion-greater tuberosity (AGT), acromion-lesser tuberosity (ALT), acromiohumeral distance (AHD), supraspinatus thickness (SST), and deltoid muscle thickness (DMT) in patients' bilateral shoulder joint were measured by MSUS, respectively. Meanwhile, Fugl-Meyer Assessment (FMA) was used to evaluate the improvement of upper limb function. Results 30 patients were recruited. After FMS treatment, there was a significant decrease in the difference value between ipsilateral side and contralateral side of AGT [t = 8.595, P < 0.01], ALT [t = 11.435, P < 0.01], AHD [t = 8.375, P < 0.01], SST [t = 15.394, P < 0.01], and DMT [t = 24.935, P < 0.01], and FMA score increased [t = −13.315, P < 0.01]. Compared with control group, FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT [t = 2.161, P < 0.05], ALT [t = 3.332, P < 0.01], AHD [t = 8.768, P < 0.01], SST [t = 6.244, P < 0.01], and the DMT [t = 3.238, P < 0.01], and FMA score increased more significantly in FMS group [t = 7.194, P < 0.01]. Conclusion The study preliminarily shows that the MSUS can objectively and dynamically evaluate the treatment effect of GHS in hemiplegic patients. Meanwhile, compared with control group, the FMS is more effective and has fewer side effects, and the long-term effect of FMS is worth further study. This trial is registered with ChiCTR1800015352.

Persistence of Glenohumeral Subluxation is Correlated with Prolonged Existence of Crossed Cerebellar Diaschisis in a Hemiplegic Stroke Survivor: A Pilot Study

“…GHS was assessed clinically using a linear measure of fingerbreadths between the acromion and the humeral head [26]. AHD has been studied in patients with rotator cuff disorder using radiograph plain films, magnetic resonance imaging, and musculoskeletal ultrasonography [4,5,27]. With respect to the reliability of radiological methods for measuring AHD in rotator cuff tendinopathy, a systematic review found strong evidence on the reliability of ultrasound, with moderate evidence on MRI and CT measures and conflicting evidence on radiographic methods.…”

“…Although GHS is not typically accompanied by pain initially, as the patient continues in the flaccid stage or with injuries in soft tissues, pain may appear over an area half to two-finger widths at the shoulder joint [3]. Yang et al treated such patients with hemiplegic stroke using magnetic stimulation and found a significant drop in the bilateral differences of acromiohumeral distance (AHD) (t = 8.375, P <0.01) [4]. In a recent study on functional electrical stimulation for treating shoulder pain in stroke patients, Karaahmet et al found a positive correlation between GHS and pain (P= 0.022) [5].…”

The reliability and effectiveness of shoulder joint evaluation by ultrasonography in stroke patients: deltoid muscle thickness, acromion-humeral distance, acromion-lesser tuberosity distance

“…Measurement method of deltoid muscle thickness: When the measuring posture was 0°, 30°, or 60° abduction, the probe was vertically placed at the midpoint of the joint between the lateral acromion edge of the shoulder peak and deltoid tuberosity. The probe was moved in parallel until the thickest cross-section of the deltoid muscle was determined; the image was frozen, the distance of the thickest part of the deltoid muscle was measured twice, and the average value was obtained 8) .…”

“…Park et al 6) confirmed that the increase in the acromion nodule tuberosity (ALT) distance is highly correlated with glenohumeral subluxation (GHS). Previous studies have shown that the acromion tubercle (AGT), acromion-humeral distance (AHD), supraspinatus muscle thickness, and deltoid muscle thickness can be measured using MSUS 2,7,8) . In addition, the reliability of the ultrasound in measuring the thickness of the supraspinatus muscle in the shoulder joints of stroke patients at different abduction angles has been verified 9) .…”

Effect of Electroacupuncture on Shoulder Subluxation in Poststroke Patients with Hemiplegic Shoulder Pain: A Sham-Controlled Study Using Multidimensional Musculoskeletal Ultrasound Assessment

“…Compared to other radiological examinations, it shows advantages including excellent visualization of shoulder structure, lack of ionizing radiation, dynamic assessment, uncomplicated operation, and cost-effectiveness [23]. By measuring the distance between two osseous landmarks, including acromiohumeral distance (AHD) [24], acromiongreater tuberosity (AGT) [22], and acromion-lesser tuberosity (ALT) [24,25], musculoskeletal ultrasonography can accurately compute the degree of subluxation in multidimensions [25].…”