Lo Sui-Foon, Chen Shu-Ya, Lin Hsiu-Chen, Jim Yick-Fung, Meng Nai-Hsin, Kao Mu-Jung
Department of Physical Medicine and Rehabilitation, China Medical University Hospital, 91 Shiuesh Road, Taichung 404, Taiwan, ROC.
Arch Phys Med Rehabil. 2003 Dec;84(12):1786-91. doi: 10.1016/s0003-9993(03)00408-8.
To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain.
Case series.
Medical center of a 1582-bed teaching institution in Taiwan.
Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited.
Not applicable.
Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology.
Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM.
After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.
通过关节造影和临床检查确定偏瘫肩痛的病因，并确定偏瘫肩痛患者关节造影测量值与临床发现之间的相关性。
病例系列研究。
台湾一所拥有1582张床位的教学机构的医学中心。
招募了首次中风后1年内连续32例偏瘫肩痛患者。
不适用。
临床检查包括Brunnstrom分期、肌肉痉挛分布、有无半脱位和肩手综合征，以及肩关节的被动活动范围（PROM）。关节造影测量包括肩关节容积和关节囊形态。
大多数患者在中风后不到2个月出现偏瘫肩痛。粘连性关节囊炎是肩痛的主要原因，50%的患者患有粘连性关节囊炎，44%患有肩关节半脱位，22%患有肩袖撕裂，16%患有肩手综合征。粘连性关节囊炎患者的肩关节被动外旋和外展明显受限，肩手综合征的发生率更高（P = 0.017）。关节囊边缘不规则的患者肩痛持续时间明显更长，肩关节被动屈曲（P = 0.017）和外展（P = 0.020）受限更明显。肩关节半脱位患者的PROM明显更大（屈曲，P = 0.007；外旋，P < 0.001；外展，P = 0.001；内旋，P = 0.027），肌张力更低（P = 0.001），上肢近端（P = 0.025）和远端（P = 0.001）的Brunnstrom分期更低。上肢肌肉痉挛与肩关节PROM呈轻度负相关。肩关节容积与肩关节PROM呈中度正相关。
通过临床和关节造影检查对偏瘫肩关节进行研究后，我们发现偏瘫肩痛的病因复杂。粘连性关节囊炎是肩痛的主要原因，其次是肩关节半脱位。肩关节更大的PROM与更大的关节容积相关，可减少粘连性关节囊炎的发生。在早期康复过程中，对中风患者进行适当的物理治疗并谨慎处理以保持肩关节活动度和功能，对取得良好预后很重要。
