Relationship between severity of shoulder subluxation and soft-tissue injury in hemiplegic stroke patients

J Rehabil Med. 2012 Sep;44(9):733-9. doi: 10.2340/16501977-1026.


Objective: The aims of this study were: (i) to determine whether the severity of post-hemiplegic shoulder subluxation in stroke patients correlates with soft-tissue injury; and (ii) to determine the shoulder subluxation measurement cut-off points that are indications for further ultrasound examination for soft-tissue injuries in these patients.

Design: Cross-sectional study.

Patients: A total of 39 stroke patients with shoulder subluxation.

Methods: Shoulder subluxation was evaluated by physical examination, radiography and ultrasound. Soft-tissue injuries were assessed by ultrasound. Subluxation parameters were entered into stepwise logistic regression analyses to predict biceps and supraspinatus tendonitis. With the assumption that shoulder subluxation can be a predisposing factor for tendonitis, receiver operating characteristic curves for shoulder subluxation parameters of the affected side were used to determine cut-off points for optimal sensitivity and specificity of biceps and supraspinatus tendonitis.

Results: Shoulder subluxation lateral distance, measured by physical examination, is a predictor for supraspinatus tendonitis (odds ratio = 34.9, p = 0.036). Further ultrasound investigation for soft-tissue injury is indicated when subluxation lateral distance, measured by physical examination is ≥ 2.25 cm or, measured by radiographic examination, ≥ 3.18 cm for lateral distance, ≥ 3.08 cm for vertical distance, or ≥ 2.65 cm for horizontal distance.

Conclusion: When post-hemiplegic shoulder subluxation measurements exceed the above-mentioned cut-off points in physical or radiographic examinations, further ultrasound evaluation for soft-tissue injury is recommended.

MeSH terms

  • Aged
  • Cross-Sectional Studies
  • Female
  • Hemiplegia / complications*
  • Humans
  • Logistic Models
  • Male
  • ROC Curve
  • Radiography
  • Sensitivity and Specificity
  • Shoulder / diagnostic imaging
  • Shoulder Dislocation / complications
  • Shoulder Dislocation / diagnosis*
  • Shoulder Dislocation / diagnostic imaging
  • Shoulder Injuries*
  • Soft Tissue Injuries / complications
  • Soft Tissue Injuries / diagnosis
  • Soft Tissue Injuries / diagnostic imaging
  • Stroke / complications*
  • Ultrasonography