Original articlePersistent Shoulder Pain in the First 6 Months After Stroke: Results of a Prospective Cohort Study
Section snippets
Participants
All consecutive stroke patients (age, ≥18y) admitted to the stroke units of 2 teaching hospitals in The Netherlands (Ziekenhuisgroep Twente and Medisch Spectrum Twente) with a clinical diagnosis of stroke were screened for participation between May and December 2009.
All stroke patients who had sustained a first-ever cortical or subcortical unilateral stroke (infarction or hemorrhage) resulting in somatosensory and/or motor symptoms or signs were deemed eligible. Based on the screening of
pPSSP Development
Thirty-seven patients entered the study (see fig 1). Three patients were lost to follow-up. PSSP was observed at all time points, with the highest frequency at t1 (n=11, 32%). Nine patients developed PSSP at both t1 and t2 and formed the pPSSP group. None of the patients with pPSSP could be classified as having SHS or CPSP. Patients who recovered from PSSP after t1 (n=2) or developed CPSP at another location (n=1) were excluded from the analysis. The remaining patients formed the NoPSSP group
Discussion
The aim of the present study was to identify factors associated with pPSSP in the first 6 months after stroke. pPSSP was associated with impaired voluntary motor control, diminished proprioception, tactile extinction, abnormal sensation, spasticity of the elbow flexor muscles, restricted ROM for both shoulder abduction and shoulder external rotation, trophic changes, and DM-2. The associations depended on the time after stroke, suggesting that different factors may be involved in the initiation
Conclusions
The findings suggest a multifactorial etiology of pPSSP and warrant a multifactorial approach to both prevention and treatment. The association of pPSSP with restricted passive pain-free joint ROM and with signs indicative of somatosensory sensitization may implicate a vicious cycle of pain, limited ROM, reinjury, and somatosensory sensitization that seems to establish itself quite rapidly (ie, within 3mo after PSSP onset). Prevention of (repetitive) (micro)trauma at the shoulder should
References (46)
- et al.
Central post-stroke pain: clinical characteristics, pathophysiology, and management
Lancet Neurol
(2009) - et al.
Defining post-stroke pain: diagnostic challenges
Lancet Neurol
(2010) - et al.
Predictability of simple clinical tests to identify shoulder pain after stroke
Arch Phys Med Rehabil
(2007) - et al.
Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation
Arch Phys Med Rehabil
(2008) - et al.
Post stroke shoulder pain: more common than previously realized
Eur J Pain
(2000) - et al.
Poststroke shoulder pain: a prospective study of the association and risk factors in 152 patients from a consecutive cohort of 205 patients presenting with stroke
Eur J Pain
(2002) - et al.
Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4)
Pain
(2005) - et al.
Linguistic validation of the DN4 for use in international studies
Eur J Pain
(2010) - et al.
Risk factors of atherosclerosis and shoulder pain—is there an association?A systematic review
Eur J Pain
(2008) - et al.
Musculoskeletal disorders in diabetes mellitus: an update
Best Pract Res Clin Rheumatol
(2003)
Central hypersensitivity in chronic pain: mechanisms and clinical implications
Phys Med Rehabil Clin N Am
Prevalence and intensity of pain after stroke: a population based study focusing on patients' perspectives
J Neurol Neurosurg Psychiatry
Risk factors for stroke-related pain 1 year after first-ever stroke
Eur J Neurol
Post-stroke pain on long-term follow-up: the Bergen stroke study
J Neurol
Hemiplegic shoulder pain: defining the problem and its management
Disabil Rehabil
Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway
Clin Rehabil
Painful Hemiplegic Shoulder
Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome
Scand J Rehabil Med
Shoulder-hand syndrome after strokeA complex regional pain syndrome
Eura Medicophys
Poststroke complex regional pain syndrome
Top Stroke Rehabil
Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey
Am J Phys Med Rehabil
Shoulder pain in hemiplegia: statistical relationship with five variables
Arch Phys Med Rehabil
Predictor factors of hemiplegic shoulder pain in a group of stroke patients
Iran Red Crescent Med J
Cited by (0)
Supported by the AMPHoraest Foundation, Leusden, The Netherlands.
Clinical Trial Registration Number: NTR1746.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the authors