Enhanced-MRI and ultrasound evaluation of painful shoulder in patients after stroke: A pilot study

Alessandra Pompa, Alessandro Clemenzi, Elio Troisi, Marco Di Mario, Angelo Tonini, Luca Pace, Paolo Casillo, Alessandro Cuccaro, Maria Grazia Grasso

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Epidemiological and radiological studies have previously been performed to identify the possible causes of hemiplegic shoulder pain (HSP). Many different etiologies have been postulated, though no clear correlations have emerged, and a multifactorial pathogenesis of HSP has been proposed. Recently, two MRI-based studies have described different shoulder findings as possible causes of pain in chronic stroke survivors. Purpose: The aim of this study was to describe the structural abnormalities of the painful shoulder in the first months after stroke by ultrasound and enhanced MRI. The secondary aims were to identify possible predisposing factors for HSP and to evaluate its impact on motor recovery. Methods: One hundred and fifty-three first-time stroke patients, admitted to the Santa Lucia Foundation for rehabilitation, were investigated for HSP. Twenty-five stroke patients with HSP and 16 stroke patients without shoulder pain were included. An ultrasound evaluation and enhanced shoulder MRI were performed for all the patients. Results: Among the shoulder abnormalities detected by both imaging studies, only capsulitis, which was detected by enhanced shoulder MRI in 88% of the HSP patients, was independently associated with pain (p <0.001) and proven to be predictive of pain intensity as expressed by the VAS score (p <0.003). HSP correlated with a worse global recovery (p <0.05) as well as with male sex (p = 0.006), neglect (p = 0.02) and subluxation (p = 0.03), although none of these features were found to be independent predictors of pain. Conclusion: Adhesive capsulitis was found to be a possible cause of HSP. However, MRI, which is more expensive than other diagnostic tools, may be considered the gold standard tool for understanding the etiology of HSP.

Original languageEnglish
Pages (from-to)175-181
Number of pages7
JournalEuropean Neurology
Volume66
Issue number3
DOIs
Publication statusPublished - Sep 2011

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Shoulder Pain
Stroke
Bursitis
Pain
Chronic Pain
Causality
Survivors
Epidemiologic Studies
Rehabilitation

Keywords

  • Enhanced MRI
  • Hemiplegic shoulder pain
  • Stroke
  • Ultrasound

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Enhanced-MRI and ultrasound evaluation of painful shoulder in patients after stroke : A pilot study. / Pompa, Alessandra; Clemenzi, Alessandro; Troisi, Elio; Di Mario, Marco; Tonini, Angelo; Pace, Luca; Casillo, Paolo; Cuccaro, Alessandro; Grasso, Maria Grazia.

In: European Neurology, Vol. 66, No. 3, 09.2011, p. 175-181.

Research output: Contribution to journalArticle

Pompa, A, Clemenzi, A, Troisi, E, Di Mario, M, Tonini, A, Pace, L, Casillo, P, Cuccaro, A & Grasso, MG 2011, 'Enhanced-MRI and ultrasound evaluation of painful shoulder in patients after stroke: A pilot study', European Neurology, vol. 66, no. 3, pp. 175-181. https://doi.org/10.1159/000330657
Pompa, Alessandra ; Clemenzi, Alessandro ; Troisi, Elio ; Di Mario, Marco ; Tonini, Angelo ; Pace, Luca ; Casillo, Paolo ; Cuccaro, Alessandro ; Grasso, Maria Grazia. / Enhanced-MRI and ultrasound evaluation of painful shoulder in patients after stroke : A pilot study. In: European Neurology. 2011 ; Vol. 66, No. 3. pp. 175-181.
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AB - Background: Epidemiological and radiological studies have previously been performed to identify the possible causes of hemiplegic shoulder pain (HSP). Many different etiologies have been postulated, though no clear correlations have emerged, and a multifactorial pathogenesis of HSP has been proposed. Recently, two MRI-based studies have described different shoulder findings as possible causes of pain in chronic stroke survivors. Purpose: The aim of this study was to describe the structural abnormalities of the painful shoulder in the first months after stroke by ultrasound and enhanced MRI. The secondary aims were to identify possible predisposing factors for HSP and to evaluate its impact on motor recovery. Methods: One hundred and fifty-three first-time stroke patients, admitted to the Santa Lucia Foundation for rehabilitation, were investigated for HSP. Twenty-five stroke patients with HSP and 16 stroke patients without shoulder pain were included. An ultrasound evaluation and enhanced shoulder MRI were performed for all the patients. Results: Among the shoulder abnormalities detected by both imaging studies, only capsulitis, which was detected by enhanced shoulder MRI in 88% of the HSP patients, was independently associated with pain (p <0.001) and proven to be predictive of pain intensity as expressed by the VAS score (p <0.003). HSP correlated with a worse global recovery (p <0.05) as well as with male sex (p = 0.006), neglect (p = 0.02) and subluxation (p = 0.03), although none of these features were found to be independent predictors of pain. Conclusion: Adhesive capsulitis was found to be a possible cause of HSP. However, MRI, which is more expensive than other diagnostic tools, may be considered the gold standard tool for understanding the etiology of HSP.

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