Aras Meltem Dalyan, Gokkaya Nilufer Kutay Ordu, Comert Didem, Kaya Ayse, Cakci Aytul
Department of Physical Medicine, Ankara Physical Medicine and Rehabilitation, Education, and Research Hospital, Turkey.
Am J Phys Med Rehabil. 2004 Sep;83(9):713-9. doi: 10.1097/01.phm.0000138739.18844.88.
Shoulder pain is a common complication after stroke that can limit the patients' ability to reach their maximum functional potential and impede rehabilitation. The aim of our study was to examine the occurrence of hemiplegic shoulder pain in a group of Turkish patients and clarify contributing factors such as glenohumeral subluxation, reflex sympathetic dystrophy, tonus changes, motor functional level, limitation in shoulder range of motion, thalamic pain, neglect, and time since onset of hemiplegia. The effect of shoulder pain on the duration of rehabilitation stay was also identified.
A total of 85 consecutive patients with hemiplegia admitted to a national rehabilitation center were evaluated for the presence of shoulder pain. A brief history of pain was taken for each patient, and each patient was evaluated by radiographic and ultrasonographic examination. The subjects with shoulder pain were compared with those without pain in regard to certain of the above variables.
Of the 85 patients with stroke, 54 patients (54/85, 63.5%) were found to have shoulder pain. Shoulder pain was significantly more frequent in subjects with reflex sympathetic dystrophy, lower motor functional level of shoulder and hand (P < 0001), subluxation, and limitation of external rotation and flexion of shoulder (P < 0,05). Age was also a significant factor in the development of shoulder pain. We were unable to demonstrate a significant relationship between shoulder pain and sex, time since onset of disease, hemiplegic side, pathogenesis, spasticity, neglect, and thalamic pain. There was no prolongation of rehabilitation stay in patients with shoulder pain.
These results indicate that shoulder pain is a frequent complication after stroke and that it may develop from a variety of factors. To prevent and alleviate shoulder pain, efforts should be directed toward proper positioning of the shoulder, range of motion activities, and the avoidance of immobilization.
肩痛是中风后常见的并发症，会限制患者发挥其最大功能潜力的能力，并阻碍康复进程。我们研究的目的是调查一组土耳其患者中偏瘫肩痛的发生率，并阐明相关因素，如肩肱关节半脱位、反射性交感神经营养不良、肌张力变化、运动功能水平、肩关节活动范围受限、丘脑痛、忽视以及偏瘫发病后的时间。还确定了肩痛对康复住院时间的影响。
对一家国家康复中心收治的85例连续偏瘫患者进行肩痛评估。为每位患者采集简要的疼痛病史，并通过影像学和超声检查对每位患者进行评估。将有肩痛的受试者与无肩痛的受试者在上述某些变量方面进行比较。
在85例中风患者中，发现54例（54/85，63.5%）有肩痛。反射性交感神经营养不良、肩和手的运动功能水平较低（P<0.001）、半脱位以及肩关节外旋和屈曲受限（P<0.05）的受试者中，肩痛明显更常见。年龄也是肩痛发生的一个重要因素。我们未能证明肩痛与性别、发病后的时间、偏瘫侧、发病机制、痉挛、忽视和丘脑痛之间存在显著关系。有肩痛的患者康复住院时间没有延长。
这些结果表明，肩痛是中风后常见的并发症，可能由多种因素引起。为预防和减轻肩痛，应致力于正确摆放肩部位置、进行活动范围锻炼以及避免固定不动。
