Jia Fan, Zhu Xin-Rui, Kong Ling-Yu, Fan Jie-Cheng, Zhu Zong-Jing, Lin Li-Zhen, Zhang Shu-Yun, Yuan Xiang-Zhen
Faculty of Rehabilitation Medicine, Weifang Medical University, Weifang, Shandong, China.
Physical Education and Sports School, Soochow University, Suzhou, Jiangsu, China.
Front Neurol. 2023 Jun 2;14:1195915. doi: 10.3389/fneur.2023.1195915. eCollection 2023.
Hemiplegic shoulder pain (HSP) is a common complication in patients with stroke. The pathogenesis of HSP is complex, and muscle hypertonia, especially the hypertonia of internal rotation muscles of the shoulder, may be one of the important causes of shoulder pain. However, the relationship between muscle stiffness and HSP has not been well studied. The purpose of this study is to explore the correlations between the stiffness of internal rotation muscles and clinical symptoms in patients with HSP.
A total of 20 HSP patients and 20 healthy controls were recruited for this study. The stiffness of internal rotation muscles was quantified using shear wave elastography, and Young's modulus (YM) of the pectoralis major (PM), anterior deltoid (AD), teres major ™, and latissimus dorsi (LD) were measured. Muscle hypertonia and pain intensity were evaluated using the Modified Ashworth Scale (MAS) and Visual Analog Scale (VAS), respectively. The mobility of the shoulder was evaluated using the Neer score. The correlations between muscle stiffness and the clinical scales were analyzed.
YM of internal rotation muscles on the paretic side was higher than that of the control group in the resting and passive stretching positions ( < 0.05). YM of internal rotation muscles on the paretic side during passive stretching was significantly higher than that at rest ( < 0.05). YM of PM, TM, and LD during passive stretching were correlated with MAS ( < 0.05). In addition, the YM of TM during passive stretching was positively correlated with VAS and negatively correlated with the Neer score ( < 0.05).
Increased stiffness of PM, TM, and LD was observed in patients with HSP. The stiffness of TM was associated with pain intensity of the shoulder and shoulder mobility.
偏瘫性肩痛（HSP）是中风患者常见的并发症。HSP的发病机制复杂，肌肉张力亢进，尤其是肩部内旋肌的张力亢进，可能是肩痛的重要原因之一。然而，肌肉僵硬与HSP之间的关系尚未得到充分研究。本研究旨在探讨HSP患者内旋肌僵硬与临床症状之间的相关性。
本研究共招募了20例HSP患者和20名健康对照者。采用剪切波弹性成像技术对内旋肌的僵硬程度进行量化，并测量胸大肌（PM）、三角肌前束（AD）、大圆肌（TM）和背阔肌（LD）的杨氏模量（YM）。分别使用改良Ashworth量表（MAS）和视觉模拟量表（VAS）评估肌肉张力亢进和疼痛强度。使用Neer评分评估肩部的活动度。分析肌肉僵硬与临床量表之间的相关性。
患侧内旋肌在静息和被动拉伸位的YM均高于对照组（<0.05）。患侧内旋肌在被动拉伸时的YM显著高于静息时（<0.05）。被动拉伸时PM、TM和LD的YM与MAS相关（<0.05）。此外，被动拉伸时TM的YM与VAS呈正相关，与Neer评分呈负相关（<0.05）。
观察到HSP患者PM、TM和LD的僵硬程度增加。TM的僵硬程度与肩部疼痛强度和肩部活动度相关。
