Sonography of affected and unaffected shoulders in hemiplegic patients: analysis of the relationship between sonographic imaging data and clinical variables

Abstract

Objective: To explore the relationship between a number of clinically relevant variables and sonographic imaging data in respect to the level of impairment experienced in the affected and unaffected shoulders of hemiplegic stroke patients.

Method: Fifty-one hemiplegic stroke patients (32 males, 19 females; 29 right-sided hemiplegics, 22 left-sided hemiplegics) participated in this study. A musculoskeletal radiologist conducted a sonographic exam on both the affected and unaffected shoulders of all patients and two physicians classified the severity of the injury on a six-point rating scale. Clinical variables including age, sex, duration of injury, spasticity and muscle power of the hemiplegic side, and level of functional activity of the shoulder were assessed.

Results: The sonographic rating scores of hemiplegic shoulders were positively correlated with age (p<0.01) and negatively correlated with level of muscle spasticity (p<0.05). The sonographic rating scores of unaffected shoulders were positively correlated with duration of injury (p<0.01). Affected shoulders received sonographic rating scores that reflected significantly more impairment than those of unaffected shoulders (p<0.001), and pre-morbid handedness did not affect the relationship between impairment rating and shoulder injury status.

Conclusion: Hemiplegic stroke influences not only affected shoulders, but also unaffected sides. Proper management of spasticity, enhancement of motor recovery, and avoidance of unaffected shoulder overuse should be considered to prevent shoulder problems following strokes which result in hemiplegia.

Keywords: Hemiplegia; Shoulder; Ultrasonography.

Fig. 1

The scores of sonographic data. (A) Tendinosis of the supraspinatus tendon (grade 1): The long axis view shows slightly decreased echogenicity of the swollen tendon (arrow). (B) Mild bursitis of the subacromail-subdeltoid bursa (SASD) (grade 2): The long axis view shows small amounts of fluid collection (arrows) in the subacromail-subdeltoid bursa. (C) Severe bursitis of SASD bursa (grade 3): The long axis view shows a large amount of fluid collection (arrow) with internal echogenic spots (arrow heads) in the SASD bursa. (D) Articular side partial tear of the supraspinatus tendon (grade 4): The long axis view shows a focal hypoechogenic area (arrow) of the articular side of the supraspinatus tendon. (E) Complete rupture of the supraspinatus and infraspinatus tendons (grade 5): The short axis view shows absence of tendon (arrows) at the greater tubercle of the humeral head.