Correlation of clinical and ultrasonographic findings with functional status in patients with hemiplegic shoulder pain

Shoulder pain is a common and important complication affecting functional outcome in hemiplegic patients. The prevalence of hemiplegic shoulder pain is reported to be 5-84%. Ultrasonography (USG) is a non-invasive, easily accessible and low-cost imaging modality used to detect soft tissue pathologies of the shoulder. Another advantage of ultrasonography is the possibility of comparative and dynamic imaging. The aim of this study was to compare the clinical characteristics and ultrasonographic findings of patients at different stages of upper extremity motor recovery after hemiplegia and to evaluate the relationship between these findings and hemiplegic shoulder pain. The study included 53 volunteer patients diagnosed with hemiplegia. They were divided into 2 groups with similar age, gender and demographic characteristics. The groups were defined as poor upper extremity motor function group with Brunnstrom recovery stages 1-2-3 and good upper extremity motor function group with Brunnstrom recovery stages 4-5-6. Clinical and ultrasonographic evaluations were performed in both groups. In ultrasonographic evaluation, the biceps, supraspinatus, infraspinatus, subscapularis tendons, subacromial subdeltoid bursa and acromioclavicular joint in the hemiplegic shoulder were examined. Numeric Rating Scale (NRS) was used to determine the severity of hemiplegic shoulder pain. The level of dependency in activities of daily living was assessed with the Barthel Index (BI). Depression symptoms of the patients were evaluated with the Beck Depression Inventory (BDI). There were no significant differences between the groups in terms of age, gender, BMI (Body Mass Index), duration of hemiplegia, hemiplegic side, dominant hand. The incidence of subacromial-subdeltoid bursa pathologies was significantly higher in patients with poor upper extremity motor function than in patients with good upper extremity motor function (p<0.05). Abduction, flexion, internal and external rotation angles were significantly lower in patients with poor upper extremity motor function than in patients with good motor function (p<0.001). The passive extension angle of the shoulder joint was significantly lower in the group with tendon pathology evaluated by ultrasonography compared to the group without tendon pathology ( p<0.05). The Barthel Index was significantly lower in patients with poor upper extremity motor function compared to those with good upper extremity motor function (p<0.001). Patients with at least one pathologic finding on USG had a significantly lower Barthel Index than patients with normal USG. The distance between the acromion and the greater tubercle, which we measured to demonstrate shoulder subluxation ultrasonographically, increased in patients with spasticity compared to patients without spasticity, but this increase was not statistically significant (p>0.05). In conclusion, USG has an important place in the evaluation of soft tissue pathologies associated with shoulder pain in hemiplegic patients as an easily accessible, non-invasive and low-cost technique, and shoulder pathologies detected by USG are associated with poor functional status. Our findings suggest that USG provides important information that can guide the clinical evaluation of patients with HOA and the management of shoulder pain-related problems.