Sonography of the shoulder in hemiplegic patients undergoing rehabilitation after a recent stroke

J Clin Ultrasound. 2009 May;37(4):199-205. doi: 10.1002/jcu.20573.


Purpose: To examine the hemiplegic shoulders for soft-tissue injury by musculoskeletal sonography and to determine the relationship between the motor functions of the upper extremity and these injuries, which play an important role in hemiplegic shoulder pain and may impede rehabilitation.

Methods: The following characteristics of 34 acute stroke patients were recorded: age, gender, height, body weight, side of hemiplegia, type and duration of stroke, Brunnstrom stage, subluxation, and degree of spasticity of the upper extremity. On the basis of the Brunnstrom stage, the patients were divided into 2 groups. Patients with stages I, II, or III were categorized under the lower Brunnstrom stage (LBS) group (n = 21), and those with stages IV, V, or VI were allocated to the higher Brunnstrom stage (HBS) group (n = 13). Both shoulders of each patient were examined by musculoskeletal sonography with a 5-10-MHz linear transducer on 2 separate occasions (i.e., at admission and 2 weeks after rehabilitation).

Results: With the exception of age, there were no significant differences in the demographic and clinical characteristics of the patients in the 2 groups. Shoulder musculoskeletal sonography revealed soft-tissue injury in 7 patients (33%) and 15 patients (71%) in the LBS group at admission and 2 weeks after rehabilitation, respectively (p < 0.05), and in 4 patients (31%) in the HBS group both at admission and 2 weeks after rehabilitation.

Conclusions: Acute stroke patients with poor upper limb motor functions are more prone to soft-tissue injury of the shoulder during rehabilitation.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Exercise Therapy / methods
  • Female
  • Follow-Up Studies
  • Hemiplegia / etiology
  • Hemiplegia / physiopathology
  • Hemiplegia / rehabilitation*
  • Hospitals, Teaching
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Muscle Spasticity / diagnostic imaging
  • Muscle Spasticity / rehabilitation
  • Range of Motion, Articular / physiology
  • Rehabilitation Centers
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sex Factors
  • Shoulder Joint / diagnostic imaging*
  • Shoulder Joint / physiopathology
  • Shoulder Pain / diagnostic imaging*
  • Shoulder Pain / etiology
  • Shoulder Pain / rehabilitation
  • Stroke / complications
  • Stroke / diagnosis
  • Stroke Rehabilitation*
  • Taiwan
  • Tomography, X-Ray Computed
  • Ultrasonography, Doppler*