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Biceps tendon effusion: (A and B) axial and long-axis ultrasound of the shoulder reveals hypoechoic fluid surrounding the biceps tendon (asterisks). (C and D) Coronal T2WI and axial fat-suppression MRI reveals high fluid signal surrounding the biceps tendon.
Source publication
The use of high frequency ultrasound has been increased in the diagnosis of musculoskeletal abnormalities.AimTo detect the structural abnormalities in patient with poststroke painful shoulder as a first objective, and the second objective to assess the diagnostic accuracy of US in detecting these abnormalities.Patients and methodsThe study included...
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Background
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Background
Gluteal tendinopathy is commonly reported in the literature, but there is a need for a validated magnetic resonance imaging (MRI)-based scoring system to grade the severity of the tendinopathy.
Purpose
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Aim of the work
To compare the efficacy of ultrasound-guided platelet rich plasma (PRP) versus corticosteroid injection for treatment of rotator cuff tendinopathy (RCT).
Patients and methods
Thirty patients with RCT of the shoulder were randomly divided into 2 equal groups (15 each) treated by subacromial subdeltoid ultrasound-guided injection of...
Lateral premalleolar bursitis of the ankle is a rarely reported disorder in the English literature although it is not uncommon in Asian countries where people commonly sit on their feet. Here, we present the case of a 66-year-old woman with recalcitrant lateral premalleolar bursitis associated with lateral ankle instability which was successfully t...
Citations
... A further 19 articles were excluded: 13 did not report specific shoulder pathological findings, 4 did not evaluate shoulder structures, and 2 included only patients with low motor function (Table SIII). A total of 23 studies (13)(14)(15)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) were included in the final quantitative analysis (Fig. 1). Details of data extraction from the included trials are listed in Table SIV. ...
... Only 3 studies (22,24,25) performed power calculations and therefore fulfilled Item 3 (justified and satisfactory sample size). One point was deducted from Item 6 (validated method) in 8 articles (21,22,25,27,28,30,37,38) due to the lack of a detailed description of the ultrasound findings. ...
... Only 3 studies (22,24,25) performed power calculations and therefore fulfilled Item 3 (justified and satisfactory sample size). One point was deducted from Item 6 (validated method) in 8 articles (21,22,25,27,28,30,37,38) due to the lack of a detailed description of the ultrasound findings. Lee et al. (32) did not elaborate on the stroke type of the participants and lost 1 point in Item 4 (ascertainment of diagnosis). ...
Objective:
Post-stroke shoulder pain is a serious challenge for stroke survivors. The aim of this meta-analysis was to review the literature to confirm information on structural changes in post-stroke shoulders detected by ultrasound examination.
Methods:
PubMed, Embase, Web of Science and ClinicalTrials.gov were searched until 7 December 2022, for studies describing shoulder sonographic findings in stroke patients. Two independent authors selected the studies, extracted the data, and performed the critical appraisal.
Results:
A total of 23 clinical studies were included. The most prevalent pathologies in hemiplegic shoulders pertained to the biceps long head tendon (41.4%), followed by the supraspinatus tendon (33.2%), subdeltoid bursa (29.3%), acromioclavicular joint (15.0%), and subscapularis tendon (9.2%). The common pathological findings encompassed bicipital peritendinous effusion (39.2%), biceps tendinopathy (35.5%), subdeltoid bursitis (29.3%) and supraspinatus tendinopathy (24.6%). Biceps long head tendon and supraspinatus tendon abnormalities were observed significantly more in the hemiplegic (vs contralateral) shoulders, with odds ratios of 3.814 (95% confidence interval 2.044-7.117) and 2.101 (95% confidence interval 1.257-3.512), respectively. No correlation was observed between motor function and shoulder pathology.
Conclusion:
Ultrasonography enabled the identification of common shoulder pathologies after stroke. Further research is needed to establish the association between these changes and the clinical course of stroke patients.
... Many studies stated that there was high prevalence of bicipital tendinitis, gleno-humeral joint effusion and subacromial/sub-deltoid bursitis in patients with hemiplegic shoulder pain [45,46]. These were matched with current study as we concluded that there was high prevalence of gleno-humeral joint effusion, bicipital tendinitis and subacromial/sub-deltoid bursitis in 74 hemiplegic patients with shoulder pain. ...
... This was in agreement with the study of El-Shewi et al. they reported that US is less accurate in diagnosis minimal subacromial/ subdeltoid bursitis [48]. This study was also in agreement with the study of Zaiton et al. they reported that US had high sensitivity and specificity for diagnosis of subacromial/subdeltoid bursitis (81% and 98%, respectively) [46]. ...
... This was in agreement with the study of Choi and Kim they reported that there was a good correlation between ability of MRI and US for accurate measurements of axillary recess capsule thickness in patient with adhesive capsulitis [21]. Also this study results were in agreement with study of Zaiton et al. they reported that there was excellent agreement between US and MRI in diagnosis of subacromial/subdeltoid bursitis, diagnosis of bicipital tendinitis, effusion or tear and diagnosis of gleno-humeral joint effusion [46]. ...
Background
Hemiplegic shoulder pain (HSP) is one of the most common complications of stroke. This work aimed to evaluate and analyze the clinical and radiological features of painful shoulder in hemiplegic stroke patients with evaluating the diagnostic role of shoulder ultrasound and shoulder MR imaging in assessment of the causes of shoulder pain.
Methods
210 stroke patients with shoulder affection within 3 years of stroke development were enrolled. Clinical assessment including Medical Research Council scoring, The Brunnström motor recovery and Ashworth Scale. Shoulder ultrasound and MR imaging were done for 74 patients with painful hemiplegic shoulder.
Results
The prevalence of HSP was 35.2% with statistically significantly higher proportion of shorter disease duration, lower muscle power, lower BMR stage with higher proportion of bicipital tendinitis and complex regional pain syndrome in major versus moderate dependence ( P < 0.001, P < 0.001, P < 0.001, P = 0.011 and P = 0.001 respectively). On multivariate analysis only short disease duration was statistically significant independent predictor. Participants with disease duration ≤ 2 months have 21.9 times higher odds to exhibit major rather than moderate dependence. By imaging there was high prevalence of joint effusion (47.3%), bicipital tendinitis (44.6%), bursitis (31%) and adhesive capsulitis (29.7%) in painful hemiplegic shoulder with a very good agreement between MRI and US in diagnosis.
Conclusion
HSP has a high prevalence in stroke patient with increased morbidity due to various factors and US can be used as an alternative or a complementary to MRI for diagnosis of hemiplegic shoulder pain.
... They also observed that ESWT reduced knee pain and improved function in stroke patients. A comparison of MRI and high-frequency ultrasound in evaluating 106 patients with post-stroke shoulder joint pain by Zaiton et al. [25] showed that ultrasound provided high diagnostic accuracy and was inexpensive. Similar high diagnostic accuracy was reported in the evaluation of knee joints of patients with osteoarthritis and rheumatoid arthritis [26]. ...
Purpose:
Post-stroke arthritic changes that may compromise rehabilitation have been described in the upper and lower limbs. We aimed at evaluating the soft tissue arthritic changes associated with pain in hemiplegic knees of stroke patients in our environment.
Material and methods:
Hemiplegic and non-hemiplegic knees of 48 stroke patients as well as both knees of 26 apparently healthy controls were evaluated with a 7.5-12 MHz linear ultrasound probe. History of knee pain, and socio-demographic, laboratory, and clinical data were recorded for all study participants. Muscle tone and power as well as functional ambulatory category (FAC) were graded for the stroke patients. Data was analysed using SPSS version 20.
Results:
Pain was reported more often in hemiplegic than non-hemiplegic knees (n = 16 vs. n = 6, p = 0.021). The frequencies of soft tissue arthritic changes found, which included reduced lateral and medial femoral cartilage thickness, suprapatellar effusion, and irregular cartilage-bone margin, were similar between hemiplegic and non-hemiplegic knees (p > 0.05). Suprapatellar effusion and reduced lateral femoral cartilage thickness were more prevalent in the hemiplegic knees compared to the healthy control knees (p < 0.05). Stroke patients with pes anserinus tendinosis had greater risk of hemiplegic knee pain (HKP) when compared to stroke patients without this lesion (OR = 10; 95% CI: 1.7-61). FAC, muscle tone, and power showed no association with HKP.
Conclusions:
Soft tissue arthritic changes associated with knee pain are comparable between hemiplegic and non-hemiplegic knees of stroke patients. The risk of knee pain in stroke is higher in the presence of pes anserinus tendinosis.
... Ultrasonography (US) and MRI have been reported to be similarly accurate in detection of complete rotator cuff tears; however, for partial tear, the US appears less accurate than MRI. [29] Shah et al., [30] whose study constitutes the first MRI-based description of the painful shoulder among chronic stroke survivors, reported a prevalence of rotator cuff tear of 35%. This could be explained by difference in their study design, which included only stroke survivors of at least 3 months' duration after stroke. ...
Background: Poststroke shoulder pain (PSSP) is a complex phenomenon. Defining the exact etiology would facilitate proper management. Aim: The aim of the study is to identify the different causes of PSSP. Settings and Design: Observational cross-sectional study at institution, university hospital, tertiary level of clinical care. Methods: A total of 30 stroke survivors with PSSP were enrolled in this study. Patients were subjected to neuromuscular clinical examination of the shoulder, and evaluation (spasticity assessment using Modified Ashworth scale and Fugl-Meyer upper extremity scale to assess impairment). The shoulder pain was evaluated using the numerical rating scale and the neuropathic pain diagnostic questionnaire (DN4). Electrophysiological studies (nerve conduction and electromyography) and imaging (plain radiograph and magnetic resonance imaging [MRI]) were done to reveal neuromusculoskeletal causes for PSSP. Results: One or more musculoskeletal cause occurred in all patients. These were rotator cuff tear/tendinopathy (90%), impingement syndrome (90%), bursitis (66.7%), and adhesive capsulitis (50%). Concomitant proximal neuropathies including (upper trunk brachial plexopathy, axillary neuropathy, and suprascapular neuropathy) were found in 40% of PSSP patients. The DN4 questionnaire was positive in only two patients. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS version 20 Chicago, IL, USA). Conclusion: The most common causes of PSSP were the musculoskeletal causes. MRI studies were helpful in revealing the common causes of shoulder pain such as rotator cuff tear and bursitis in those disabled population in whom clinical assessment could be difficult.
... Subjects' age, sex, hand dominance, hemiplegic side, time from onset of stroke (stroke symptom duration), and stroke type (ischemic or hemorrhagic) were recorded. Acute hemiplegics were those with stroke symptom duration <3 months, while those hemiplegics with stroke symptom duration of >3 months were classified as chronic [7][8][9]. ...
... All of the examined hemiplegic shoulders (100%) demonstrated at least one structural abnormality. This rate (100%) is much higher than the 60.5-85% reported by other studies [9,17,20,22], and may be due to the fact that some of these studies recruited acute hemiplegics only [9]. Moreover, subluxation was not included among their sonographic variables, which was seen in 44% of hemiplegic shoulders in the present study. ...
... All of the examined hemiplegic shoulders (100%) demonstrated at least one structural abnormality. This rate (100%) is much higher than the 60.5-85% reported by other studies [9,17,20,22], and may be due to the fact that some of these studies recruited acute hemiplegics only [9]. Moreover, subluxation was not included among their sonographic variables, which was seen in 44% of hemiplegic shoulders in the present study. ...
Background
Stroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices.
Material/Methods
Forty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-subdeltoid bursitis or effusion and adhesive capsulitis.
Results
Hemiplegic shoulders exhibited significantly higher number of pathologies compared to the unaffected shoulders and shoulders of controls (p=0.000). One or more structural abnormalities were found in all 45 (100%) hemiplegic shoulders, 25 (55.6%) unaffected shoulders of the stroke subjects, and 39 (43.3%) control shoulders. The most frequent pathologies in the hemiplegic shoulders were the following: tendinosis of the long head of bicep tendon (48.9%), inferior shoulder subluxation (44.4%), co-existing subacromial-subdeltoid bursa/long head of bicep tendon sheath effusion (44.4%), and long head of bicep tendon sheath effusion only (40%). Tendinosis of the long head of bicep tendon was commoner in hemiplegic shoulders with poor motor status than those with good motor status.
Conclusions
Hemiplegic shoulders have significantly higher number of structural abnormalities than unaffected shoulders and the shoulders of controls. Hemiplegic stroke patients should undergo ultrasonography of the hemiplegic shoulder to define the nature and extent of soft tissue injuries prior to physical therapy.
... The exact etiology of post-stroke shoulder pain remains unknown [29], and many factors are typically involved [30]. According to previous epidemiological and radiological studies, pain is related to neurological abnormalities, including thalamic pain [31], sympathetic dystrophy [32] and biomechanical alterations of the hemiplegic limb, resulting in spasmodic or spastic muscles and contracted joints [33,34]. ...
Introduction
This study evaluated the clinical efficacy and safety of acupuncture for the treatment of shoulder pain after stroke.
Methods
This prospective randomized, sham-controlled clinical trial was conducted from May 2013 to December 2013. Subacute or chronic stroke patients with shoulder pain were randomly allocated into either the acupuncture or sham acupuncture (non-acupuncture point shallow penetrating acupuncture) group. Acupuncture was offered to each patient three times a week for 3 weeks, and clinical outcomes were assessed during 3 weeks of treatments and 1 week of follow-up using the following assays: the Visual Analog Scale (VAS), the Pain Rating Scale (PRS), Passive Range of Motion (PROM), the Manual Muscle Test (MMT), the Modified Ashworth Scale (MAS), the Korean version of the Beck Depression Inventory (K-BDI) and the Korean Modified Barthel Index (K-MBI). Adverse events were monitored throughout the study.
Results
Fifty-three participants were included in this study (27 in the acupuncture group and 26 in the sham acupuncture group). At the 3rd week, there were significant differences between the two groups in the mean change in the VAS (mean difference: 2.13, 95% CI: [0.72, 3.54]) and PRS (mean difference: 19.41 [5.70, 33.12]). However, there were no significant differences between the two groups on the PROM, MMT, MAS, K-MBI, or K-BDI at any measurement point. Adverse events related to acupuncture treatment were not reported.
Conclusion
In this study, we found that acupuncture treatment is effective in reducing shoulder pain after stroke. The long-term effect of acupuncture must be assessed in future studies.
... Sixteen studies (53%) were conducted prospectively; one study did not mention time of enrollment. Ten studies reported abnormalities in asymptomatic volunteers 1,11,16,18,21,23,24,33,39,47 ; 5 studies (4 of which were cadaver studies) reported prevalence in the general population 10,14,26,28,49 ; 8 included symptomatic patients 6,7,31,36,44,46,50,51 ; and 7 described patients with acute or chronic shoulder dislocations. 3,27,29,38,42,43,52 The majority of the studies used ultrasound to image the rotator cuff (43%; 13 of 30). ...
Abnormalities of the rotator cuff are more common with age, but the exact prevalence of abnormalities and the extent to which the presence of an abnormality is associated with symptoms are topics of debate. Our aim was to review the published literature to establish the prevalence of abnormalities of the rotator cuff and to determine if the prevalence of abnormalities increases with older age in 10-year intervals. In addition, we assessed prevalence in 4 separate groups: (1) asymptomatic patients, (2) general population, (3) symptomatic patients, and (4) patients after shoulder dislocation.
We searched PubMed, EMBASE, and the Cochrane Library up to February 24, 2014, and included studies reporting rotator cuff abnormalities by age. Thirty studies including 6112 shoulders met our criteria. We pooled the individual patient data and calculated proportions of patients with and without abnormalities per decade (range, younger than 20 years to 80 years and older).
Overall prevalence of abnormalities increased with age, from 9.7% (29 of 299) in patients aged 20 years and younger to 62% (166 of 268) in patients aged 80 years and older (P < .001) (odds ratio, 15; 95% confidence interval, 9.6-24; P < .001). There was a similar increasing prevalence of abnormalities regardless of symptoms or shoulder dislocation.
The prevalence of rotator cuff abnormalities in asymptomatic people is high enough for degeneration of the rotator cuff to be considered a common aspect of normal human aging and to make it difficult to determine when an abnormality is new (e.g., after a dislocation) or is the cause of symptoms.
Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
... The early onset of the painful hemiplegic shoulder (PHS) may hamper the rehabilitation process because patients avoid painful shoulder movement and withdraw from active rehabilitation, thus reducing the effectiveness of any motor restoration technique (2,3). The exact etiology of post-stroke shoulder pain remains unknown (4) and, most commonly many factors were involved (5). ...
... It combines direct multiplanar structural evaluation with dynamic investigation of movement, thereby providing both anatomic and functional elements to the assessment (12). Furthermore, high frequency ultrasonography established its role in the demonstration of different pathologies of the shoulder girdle complex that is difficult to identify by clinical examination (5). ...
Aim of the work
To describe the structural abnormalities of the painful hemiplegic shoulder (PHS) by ultrasound (U/S) and their relationship with some clinical variables.
Materials and methods
Eighty consecutive patients with post-stroke PHS were subjected to both clinical assessment and ultrasonographic examination of both shoulders. Ultrasonographic imaging data were classified into five grades.
Results
The biceps tendon sheath effusion (51.25%) and the SA–SD bursitis (43.75%) were the most frequent abnormalities in the affected painful shoulder. No significant relationship (P = 0.114) was found between the U/S grades of the painful hemiplegic shoulder and the Brunnstrom motor recovery stages. Ultrasonographic grades of the unaffected shoulder were significantly correlated with the stroke duration (P < 0.001), the Brief Pain Inventory score (P < 0.05), shoulder pain duration (P < 0.001), and degree of spasticity (P < 0.001).
Conclusion
Ultrasonography is an essential method in evaluation of post-stroke PHS. However, the U/S grades were not correlated with the stages of motor recovery. Avoiding overuse of the unaffected shoulder will be helpful for prevention of shoulder injuries following hemiplegic stroke.
