Association between ultrasound assessment of glenohumeral subluxation and shoulder pain, muscle strength, active range of movement and upper limb function in people with stroke

Abstract

Background: Glenohumeral subluxation (GHS) is a commonly reported post-stroke complication which has a negative effect on rehabilitation.

Objective: To explore the association between GHS and other clinical outcomes in people with post-stroke hemiplegia.

Methods: Patients with post-stroke hemiplegia (n = 105, 71 ± 11 years, median time since stroke 5.6 weeks), who gave informed consent, were recruited. GHS was assessed by the ultrasound method. Assessment of shoulder pain (visual analogue scale), active range of movement (AROM), muscle strength (Medical Research Council Scale), muscle tone (Modified Ashworth Scale) and the upper limb section of the Motor Assessment Scale (MAS) was undertaken.

Results: GHS was present in 65 (62%) patients. There was a moderate negative correlation between GHS and muscle strength (r= −0.54, p < .01); MAS score (r= −0.58, p < .01); flexion (r= −0.54, p < .01), abduction (r= −0.53, p < .01), and external rotation (r= −0.52, p < .01) but not between GHS and muscle tone (r= −0.18, p > .05) and pain (r = 0.06, p > .05). Stepwise linear regression analysis showed that muscle strength, external rotation of the shoulder and GHS were associated with upper limb function (adjusted R²=0.83, p < .01).

Conclusion: The relationship between GHS, shoulder AROM, muscle strength and upper limb function suggests that patients with GHS are more like to have a poor motor recovery.

Keywords:

• Glenohumeral subluxation
• pain
• muscle strength
• active range of movement
• upper limb function
• ultrasound

Acknowledgements

This research was undertaken as part of a doctoral thesis funded by the University of West of England, Bristol, UK. We thank all participants, Sonosite Limited, Hitchin, United Kingdom (loan of ultrasound equipment), the manager/support staff at the Bristol Area Stroke Foundation (help with recruitment) and Dr Paul White (statistical help). Special thanks to the following clinical therapists (Clinical investigators) for help with recruitment: Marianne Mardon, Paul Cunningham, Carol Jenkins, Karen Martyn-Jones (University Hospital Bristol), Fiona Henchie (Weston General Hospital), and Lucy Holl, Rebecca Wedeman (Chippenham Community Hospital).

Ethical approval

This study received ethical approval from Frenchay Research Ethics Committee, North Bristol NHS Trust, UK

Each patient gave informed written consent to take part and, for those who lacked mental capacity, appropriate procedures were followed and involved a family member signing a ‘personal consultee agreement form’ in the presence of the patient.

Disclosure statement

No potential conflict of interest was reported by the authors.