| Objective:Hemiplegic shoulder pain after stroke has high incidence,high disabilities,and makes negative impact on patient's rehabilitation,also leaves a heavy burden to patients'family and society.X-ray,articular angiography,CT and MRI examination is applied to study hemiplegic shoulder pain,but it has its' limitations.Recently,musculoskeletal ultrasound was popular in rehabilitation medicine for its' advantages.But musculoskeletal ultrasound applied to HSP to examination soft tissue is rare in domestic,and there few reports about ultrasonic study soft tissue of shoulder.We adopt high-frequency ultrasonic scan to assess each tendon lesions of hemiplegic shoulder and evaluate shoulder pain score,this paper aims to express musculoskeletal ultrasound has value in examinating hemiplegic shoulder after stroke.Materials and methods:Sixty first stroke patients with hemiplegic shoulder who inpatiented in our rehabilitation medicine were enrolled.All patients in accordance with the 1995 Chinese medicine meeting of the fourth national Cerebrovascular Disease Conference diagnostic criteria for,checked by CT or MRI.High frequency ultrasound scan was applied to assessed each tendon of hemiplegic shoulder during subacute phase(3 months after first stroke onset)and chronic phase(6 months after stroke).The examination items including:long head of the biceps?subscapularis tendon?acromioclavicular joint?infraspinatus tendon?teres minor tendon?supraspinatus tendon and subacromial-subdeltoid bursa,Using visual analogue pain scale to assess the scores of shoulder pain during the two stages,the patients with hemiplegic shoulder were divived into the group of HSP whose scores were 4 or more points and the group of without HSP whose scores were less 4.The content of research:1.To compared hemiplegic shoulder pain score when hemiplegic shoulder rotator cuff tendons with or without pathological changes in subacute and chronic phase.2.To compared the difference of shoulder pain score betwwen subacute and chronic,and compared pain score in patients with HSP betwen subacute and chronic phase.3.To compare the difference of shoulder soft tissue lesions between the group of HSP and the group of without HSP in subacute?chronic period.4.To compared each tendon lesion incidence during subacute and chronic phase.5.To analysis the correlation between tendon lesions and VAS score in subacute and chronic phase.Statistical methods:Data analysis by SPSS 22 statistical software,measurement data using(mean +standard deviation),the average number of t test,subacute phase and chronic phase ultrasound abnormalities compared with chi square test.The correlation between HSP score and VAS score of the patients with shoulder joint lesions were analyzed by Pearson correlation coefficient.P<0.05 for the difference was statistically significant.Results:1.The comparison results of hemiplegic shoulder pain score after stroke,and the pain score results in patients with HSP during subacute and chronic phase.The VAS score of post-stroke hemiplegic shoulder pain in subacute was 3.11±0.91,which was significantly lower than chronic phase 3.83±1.92,P=0.02;The VAS score of HSP during the subacute was 4.42±0.71,it was significantly lower than chronic stages 4.85±0.97,P=0.04.Hemiplegic shoulder pain incidence was 55.00%(33/60)in the subacute phase,while its' incidence was 66.67%(40/60)in chronic.2.To compard the pain score of hemiplegic shoulder when hemiplegic shoulder tendons with or without pathological changes during subacute phase and chronic phase.when biceps long head tendon,subscapularis tendon and supraspinatus tendon lesion,its corresponding shoulder pain score was 3.72±1.49?4.45±1.44?3.87±1.39,which were higher than these tendons without pathological changes in subacute phase(2.67±1.99?2.65±1.86?2.43±1.99),P=0.049,0.004,0.004;when infraspinatus tendon?teres minor tendon?subacromial-subdeltoid bursa and acromioclavicular joint was injuryed,the shoulder pain score was(3.02±1.89?3.65±1.66?3.67±1.58),and when tendon above refer was normal,the score was(2.00±2.83?2.74±1.97?2.86±1.95),there was no significant difference between them,p values were respectively 0.46,0.12,0.25.When biceps long head tendon and subscapularis tendon and supraspinatus tendon was lesion in stroke patients with hemiplegic shoulder in chronic stage,corresponding pain score was 3.87±1.23?4.04±0.99?3.96±1.18 were higher than those tendon was normal,the score was respectively 2.67±1.99?2.65±1.87?2.43±1.99,P=0.044,0.02,0.035,when hemiplegic shoulder infraspinatus tendonpathy?teres minor tendonpathy?subacromial-subdeltoid bursitis and acromioclavicular joint lesion in chronic phase,the shoulder pain score was 4.00±0.71?3.80±1.24?4.50±1.84?which was no significant difference between tendon was not injury 3.44±1.59?3.33±1.67?3.70±1.92,P=0.44,0.26,0.23.3.The comparison results of difference shoulder soft tissue lesions between the group of HSP and the group of without HSP in subacute and chronic stages.supraspinatus tendonpathy incidence in HSP group was 54.50%(18/33 cases),which was significantly higher than patients without HSP 18.50%(5/27 cases)(X=8.15,P=8.15)in subacute stage.HSP group and Non-HSP group has no difference in biceps long head tendonpathy?subscapularis tendonpathy?subacromial-subdeltoid bursitis?infraspinatus tendonpathy and acromioclavicular joint incidence,its corresponding incidence was(36.4%,27.3%,33.0%,9.1%,21.2%)and the non-HSP was(22.2%,11.1%,22.2%,3.7%,22.2%),(x=1.44,2.42,0.93,2.42,0.93,P was 0.23,0.12,0.34,0.41,0.52).In chronic stages,the incidence of biceps long head tendonpathy?subscapularis tendonpathy?supraspinatus tendonpathy and subacromial-subdeltoid bursitis in HSP group was respectively(60.00%,50.00%,57.5%,42.50%),which was higher than Non-HSP group(35.00%,20.00%,15.00%,15.00%respectively),it existed obvious difference between them.(x were 4.42,5.00,9.81,4.42,p values were 0.045,0.025,0.002,0.033).HSP gruop and Non-HSP group has no difference in infraspinatus tendonpathy?teres minor tendonpathy?acromioclavicular joint diease incidence in chronic.it incidence was respectively10.00%,17.50%,5.00%,20.00%,and it was no obvious difference(x were 0.44,0.06,P=0.509,0.813).4.The comparison results of each shoulder tendons lesion incidence in subacute and chronic phase.The incidence of biceps long head tendonpathy,subscapularis tendonpathy was 36.40%(12/33),27.30%(9/33)in patients with HSP in subacute stage,which were significantly lower than in chronic[60.00%(24/40),50.00%(20/40)],p values were 0.044 and 0.048.Supraspinatus tendon lesion incidence during subacute and chronic was respectively 54.55%(18/33)?33.33%(11/33).subacromial-subdeltoid bursitis incidence in the two stages was respectively 57.50%(23/40),42.50%(17/40),there no obvious difference between the two periods,P= 0.80,0.42;infraspinatus tendonpathy and teres minor tendonpathy,acromioclavicular joint diease incidence in subacute phase was[10.00%(4/40),17.50%(7/40)],while in chronic phase It was[9.09%(3/33),15.20%(5/33)],there no significant difference between subacute and chronic phase,P=0.54,0.78.5.The correlation between tendons lesions and VAS score in subacute and chronic phase.Stroke patients' hemiplegic shoulder subscapularis tendonpathy?supraspinatus tendonpathy?subacromial-subdeltoid bursitis in subacute phase was correlated with HSP VAS score(P=0.01,0.02,0.03),and hemiplegic shoulder biceps long head tendon lesions?subscapularis tendon lesion?supraspinatus tendon lesions and subacromial-subdeltoid bursitis in chronic phase was associated with HSP VAS score(P=0.042,0.03,0.035,0.03).Conclusion:This paper studied The occurrence of VAS.the scores of in the subacute stage was obvious lower than that of chronic stage,musculoskeletal ultrasound results highly consistency;with the VAS,Two periods hemiplegia shoulder pain in patients with musculoskeletal ultrasound pain degree have a positive correlation with the patient.musculoskeletal ultrasound can be used for dynamic monitoring and evaluation of hemiplegia patients with or without muscle lesions,and degree of lesions.To find and evaluate and reduce after stroke hemiplegia shoulder lesions HSP is beneficial. |
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