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ORIJINAL ARAŞTIRMA

İnme Sonrası Hemipleji Hastalarında Ağrısız Omuzun Ultrasonografik Değerlendirilmesi
Ultrasonographic Evaluation of Painless Shoulder in Patients with Post-Stroke Hemiplegia
Received Date : 22 Aug 2022
Accepted Date : 22 Nov 2022
Available Online : 24 Nov 2022
Doi: 10.31609/jpmrs.2022-92996 - Makale Dili: EN
J PMR Sci. 2023;26(1):94-102
ÖZET
Amaç: Bu çalışma, omuz ağrısı olmayan hemiplejik hastaların omuz ultrason (US) bulgularını değerlendirmek ve bunların motor evre, günlük yaşam aktiviteleri (GYA) ve fonksiyonel durum ile ilişkisini değerlendirmek amacıyla yapıldı. Gereç ve Yöntemler: Bu kesitsel çalışmaya, toplam 22 hemiplejik hasta ve 18 sağlıklı kontrol dâhil edildi. Tüm katılımcıların demografik verileri ile hemiplejik hastaların Brunnstrom motor evrelemesi [Brunnstrom recovery scale (BRS)], fonksiyonal ambulasyon skalası (FAS), Barthel indeksi ve kas tonusu analiz edildi. Sağlıklı kontroller ile hemiplejik hastaların omuz kıkırdak kalınlığı, akromiyoklaviküler eklem (AKE) derinliği ve omuz patolojisi derecelendirme ölçeği [ultrasound shoulder pathology rating scale (USPRS)] US ile değerlendirildi. Bulgular: Hasta ve sağlıklı kontrol gruplarının demografik verileri benzerdi. Hemiplejik omuzda total USPRS skoru ile ölçeğin her bir bileşenin skorları sağlıklı kontrollere göre anlamlı derecede yüksekti (p<0,01). Hemiplejik taraftaki kıkırdak kalınlığı ile AKE derinliğinin ortalama değeri, sağlıklı kontrollerin ölçümlerinden istatistiksel olarak farklıydı (p<0,017). USPRS skorları ile Barthel indeksi, BRS ve FAS arasında anlamlı ve orta düzeyde negatif bir korelasyon vardı (sırasıyla p=0,009, rho=-0,546; p=0,023, rho=-0,482; p=0,016, rho=-0,516). Sonuç: US, omuz kuşağındaki yumuşak doku değişikliklerini değerlendirmek için basit, noninvaziv ve erişilebilir bir yöntemdir. Ağrısız omuzu olan hemiplejik hastalarda US bulguları GYA, fonksiyonel durum ve motor iyileşme evreleri ile korele idi.
ABSTRACT
Objective: This study was performed to evaluate the shoulder ultrasound (US) findings of the hemiplegic patients without shoulder pain and to evaluate the relationship between the sonographic findings and the motor stage, activities of daily living (ADL), and functional status. Material and Methods: This cross-sectional study included a total of 22 hemiplegic patients and 18 healthy controls. The demographic data of all participants, and, Brunnstrom recovery scale (BRS), functional ambulation scale (FAC) scores, Barthel index, and muscle tone, were analyzed. Shoulder cartilage, deep joint space of the acromioclavicular joint (ACJ), and ultrasound shoulder pathology rating scale (USPRS) scores of healthy controls and hemiplegic patients were evaluated by the US. Results: The demographic data of the patient and healthy control groups were comparable. The total USPRS score and the scores of each component were significantly higher in the hemiplegic shoulder compared to healthy controls (p<0.01). The mean score of cartilage thickness and the width of the ACJ on the hemiplegic side were statistically significantly different from the measurements of the healthy controls (p<0.017). There was a significant and moderate negative correlation between the USPRS scores and Barthel index, BRS, and FAC (p=0.009, rho=-0.546; p=0.023, rho=-0.482; p=0.016, rho=-0.516 respectively). Conclusion: The US was a simple, non-invasive, and accessible method by which to evaluate soft tissue changes in the shoulder girdle. Its findings were correlated with ADL, functional status, and motor recovery stage in hemiplegic patients with painless shoulders
REFERENCES
  1. Joshi D, Chija j. Effect of scapular proprioceptive neuromuscular facilitation on shoulder pain, range of motion, and upper extremity function in hemiplegic patients: A randomized controlled trial. Indian Journal of Health Sciences and Biomedical Research (KLEU) 2017;10(3):276. [Crossref] 
  2. Doğun A, Karabay İ, Hatipoğlu C, et al. Ultrasound and magnetic resonance findings and correlation in hemiplegic patients with shoulder pain. Top Stroke Rehabil. 2014;21 Suppl 1:S1-7. [Crossref]  [PubMed] 
  3. de Jesus JO, Parker L, Frangos AJ, et al. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009;192:1701-7. [Crossref]  [PubMed] 
  4. Middleton WD, Payne WT, Teefey SA, et al. Sonography and MRI of the shoulder: comparison of patient satisfaction. AJR Am J Roentgenol. 2004;183:1449-52. [Crossref]  [PubMed] 
  5. Lin PH. Sonographic findings of painful hemiplegic shoulder after stroke. J Chin Med Assoc. 2018;81:657-61. [Crossref]  [PubMed] 
  6. Lee IS, Shin YB, Moon TY, et al. Sonography of patients with hemiplegic shoulder pain after stroke: correlation with motor recovery stage. AJR Am J Roentgenol. 2009;192:W40-4. [Crossref]  [PubMed] 
  7. Lindgren I, Jönsson AC, Norrving B, et al. Shoulder pain after stroke: a prospective population-based study. Stroke. 2007;38:343-8. [Crossref]  [PubMed] 
  8. Bal DT, Koca T, Berk E ve ark. İnme hastalarında çift yönlü görev aktivitesinin etkinliği [The efficacy of dual task activity in stroke patients]. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi. 2020;15:60-8. [Crossref] 
  9. Brose SW, Boninger ML, Fullerton B, et al. Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury. Arch Phys Med Rehabil. 2008;89:2086-93. [Crossref]  [PubMed] 
  10. Precerutti M, Formica M, Bonardi M, et al. Acromioclavicular osteoarthritis and shoulder pain: a review of the role of ultrasonography. J Ultrasound. 2020;23:317-25. [Crossref]  [PubMed]  [PMC] 
  11. Poncelet E, Demondion X, Lapègue F, et al. Anatomic and biometric study of the acromioclavicular joint by ultrasound. Surg Radiol Anat. 2003;25:439-45. [Crossref]  [PubMed] 
  12. Steppacher SD, Hanke MS, Zurmühle CA, et al. Ultrasonic cartilage thickness measurement is accurate, reproducible, and reliable-validation study using contrast-enhanced micro-CT. J Orthop Surg Res. 2019;14:67. [Crossref]  [PubMed]  [PMC] 
  13. Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149-60. [Crossref]  [PubMed] 
  14. Elgyoum AMA, Mohammed MH, Abdelrahim A, et al. Measurements of rotator cuff tendons, acromioclavicular joint space, and subacromion-subdeltoid bursa in the adults sudanese population using ultrasonography. Journal of Radiation Research and Applied Sciences 2021;14:495-501. [Crossref] 
  15. Koo TK, Li MY. A Guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155-63. [Crossref]  [PubMed]  [PMC] 
  16. Kumar P. Hemiplegic shoulder pain in people with stroke: present and the future. Pain Manag. 2019;9:107-10. [Crossref]  [PubMed] 
  17. Murie-Fernández M, Carmona Iragui M, Gnanakumar V, et al. [Painful hemiplegic shoulder in stroke patients: causes and management]. Neurologia. 2012;27:234-44. [Crossref]  [PubMed] 
  18. Terzi R, Ölmez N, Memiş A. Hemiplejik hastalarda omuz ağrısına eşlik eden subluksasyon ve yumuşak doku değişikliklerinin magnetik rezonans görüntüleme bulguları [The magnetic resonance findings of soft tissue changes and subluxation accompanying to shoulder pain in hemiplegic patients]. Kocaeli Tıp Dergisi. 2012;1:17-22. [Link] 
  19. Vasudevan JM, Browne BJ. Hemiplegic shoulder pain: an approach to diagnosis and management. Phys Med Rehabil Clin N Am. 2014;25:411-37. [PubMed] 
  20. Jeon S, Kim Y, Jung K, et al. The effects of electromyography-triggered electrical stimulation on shoulder subluxation, muscle activation, pain, and function in persons with stroke: a pilot study. NeuroRehabilitation. 2017;40:69-75. [Crossref]  [PubMed] 
  21. Niessen M, Janssen T, Meskers C, et al. Kinematics of the contralateral and ipsilateral shoulder: a possible relationship with post-stroke shoulder pain. J Rehabil Med. 2008;40:482-6. [Crossref]  [PubMed] 
  22. Pong YP, Wang LY, Wang L, et al. Sonography of the shoulder in hemiplegic patients undergoing rehabilitation after a recent stroke. J Clin Ultrasound. 2009;37:199-205. [Crossref]  [PubMed] 
  23. Huang YC, Liang PJ, Pong YP, et al. Physical findings and sonography of hemiplegic shoulder in patients after acute stroke during rehabilitation. J Rehabil Med. 2010;42(1):21-6. [Crossref]  [PubMed] 
  24. Tunç H, Oken O, Kara M, et al. Ultrasonographic measurement of the femoral cartilage thickness in hemiparetic patients after stroke. Int J Rehabil Res. 2012;35:203-7. [Crossref]  [PubMed] 
  25. Yalçın S, Kara M, Öztürk GT, et al. Ultrasonographic measurements of the metacarpal and talar cartilage thicknesses in hemiplegic patients after stroke. Top Stroke Rehabil. 2017;24:1-4. [Crossref]  [PubMed] 
  26. Shah RR, Haghpanah S, Elovic EP, et al. MRI findings in the painful poststroke shoulder. Stroke. 2008;39(6):1808-13. [Crossref]  [PubMed]  [PMC] 
  27. Korkmaz N, Yaşar E, Demir Y, et al. Sonographic predictors in patients with hemiplegic shoulder pain: a cross-sectional study. J Stroke Cerebrovasc Dis. 2020;29:105170. [Crossref]  [PubMed]