Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation

Abstract

Objective: To clarify the pathophysiology of hemiplegic shoulder pain by determining the frequency of abnormal shoulder physical diagnosis signs and the accuracy of self-report.

Design: Prospective inception cohort.

Setting: Academic inpatient stroke rehabilitation service.

Participants: Consecutive admissions (N=46) to stroke rehabilitation service.

Interventions: Not applicable.

Main outcome measures: The Neer test, Speed test, acromioclavicular shear test, Rowe test, and palpation for point tenderness.

Results: Participants were enrolled at a mean time to evaluation of 18.9+/-14.1 days after stroke. Weakness of shoulder flexion, extension, or abduction was present in 94% of subjects, and neglect was found in 29%. Pain was present by self-report in 37%. The most common finding, which was found in nearly all persons with abnormalities in the study physical examination maneuvers, was bicipital tendon tenderness (54%), followed by supraspinatus tenderness (48%). The Neer sign was positive in 30%; 28% had the triad of bicipital tenderness, supraspinatus tenderness, and the Neer sign. Self-reported pain was a poor predictor of abnormalities elicited on the examination maneuvers, even in those without neglect.

Conclusions: Our data implicate 2 vertical stabilizers of the humerus in early onset hemiplegic shoulder pain, the long head of the biceps and the supraspinatus. Our results also suggest that simple questioning of stroke rehabilitation inpatients about shoulder pain may not be adequate for clinical care or research purposes, even in the absence of neglect.