A Correlational Study Of Shoulder Pain,soft Tissue Injury And Motor Function In Patients With Post-stroke Shoulder Pain Based On Ultrasound Imaging

Objective:Post-stroke shoulder pain is a common complication of stroke,occurring in approximately 30%of stroke patients and severely affecting the motor function of the affected upper limb.This article aims to explore the relationship between post-stroke shoulder pain,shoulder soft tissue injuries,and motor function through a correlation analysis of clinical data,shoulder physical examination,and ultrasound images of stroke patients.The goal is to provide objective evidence for personalized clinical treatment of post-stroke shoulder joint.Methods:A total of 118 stroke patients who met the inclusion criteria were selected from the rehabilitation department of Zhujiang Hospital of Southern Medical University.They were divided into a post-stroke shoulder pain group(PSSP,NRS>0,67 cases)and a non-post-stroke shoulder pain group(non-PSSP,NRS=0,51 cases)based on their NRS scores.We first collected all patients with clinical data,shoulder physical examination(shoulder joint range of motion,Manual Muscle Test,Brunnstrom stage,modified Ashworth scale,abbreviated Fugl-Meyer motor function evaluation,and Barthel index).Then shoulder musculoskeletal ultrasound scan was performed with Longhead of the Biceps Brachii Tendon,Subscapularis Tendon,Supraspinatus Tendon,Infraspinatus Tendon,Teres Minor Tendon,Subacromial-Subdeltoid Bursa,Acromion-Greater Tuberosity Distance.The collected data were compared and analyzed with SPSS version of 25.0.Results:1.Compared with non-PSSP patients,PSSP patients were older,had lower muscle strength,Brunstrom stage,and Fugl-Meyer score,had poorer daily living ability,and had smaller passive range of motion(PROM)in shoulder flexion,abduction,external rotation,and internal rotation,with statistically significant differences between the two groups.2.Soft tissue injuries in PSSP patients were subacromial impingement sign in 39 cases(58.2%),partial tear of the rotator cuff in 37 cases(55.2%),and inflammatory lesions of the long head of the biceps brachii in 35 cases(52.2%).Soft tissue injuries in non-PSSP patients after stroke were shoulder joint subluxation in 11 cases(21.6%),longhead tendinous fluid in 10 cases(19.6%),and partial tear of the rotator cuff in 9 cases(17.6%).There were significant statistical differences between the two groups in the incidence of effusion in the tendon sheath effusion of biceps long head,longhead inflammatory lesions of biceps,partial tear of the rotator cuff,subacromial impingement sign,supraspinatus muscle lesions,and shoulder joint subluxation.3.In PSSP patients,28 patients complaint with mild pain(1-3 points),while 30 patients had moderate pain(4-6 points),and 9 patients had severe pain(7-10 points).4.The relationship between various factors and the NRS in PSSP patients is as follows:(1)Shoulder physical examination:The degree of pain is weakly negatively correlated with MMT stage(r=-0.368,P=0.002)and Brunnstrom stage(r=-0.305,P=0.012).(2)Shoulder soft tissue injuries:NRS is weakly positively correlated with tendon sheath effusion of biceps long head(r=0.280,P=0.022)and shoulder joint subluxation(r=0.287,P=0.019).(3)PROM of the shoulder joint:The degree of pain is weakly negatively correlated with the external rotation angle of the shoulder joint(r=-0.316,P=0.009)and moderately negatively correlated with the abduction angle of the shoulder joint(r=-0.424,P<0.001),with a statistical significance.5.The degree of soft tissue injury is closely related to the NRS and motion function,as shown below:① Degree of shoulder pain:The degree of shoulder injury is moderately positively correlated with the NRS score(r=0.603,P<0.001).②Physical examination of the shoulder:The degree of shoulder injury is moderately negatively correlated with the Brunnstrom stage(r=-0.406,P<0.001),weakly negatively correlated with the MMT stage(r=-0.370,P<0.001)and Fugl-Meyer score(r=-0.354,P<0.001).③PROM of the shoulder joint:The degree of shoulder injury is moderately negatively correlated with shoulder joint flexion(r=-0.482,P<0.001)and abduction(r=-0.525,P<0.001),and weakly negatively correlated with shoulder joint external rotation(r=-0.382,P<0.001)and internal rotation(r=-0.290,P=0.002).Conclusions:1.Patients who are elderly,have muscle weakness,poor daily living ability,lower Brunnstrom stage,lower Fugl-Meyer score,and limited passive shoulder flexion,abduction,external rotation,and internal rotation are more likely to develop post-stroke shoulder pain,but further research is needed to explore the causal relationship underline.2.The incidence of PSSP soft tissue injuries is relatively high,with the highest incidence of subacromial impingement syndrome.Compared with non-PSSP patients,PSSP patients are more likely to have biceps tendon lesions,partial tears of the rotator cuff,subacromial impingement syndrome,supraspinatus muscle lesions,and shoulder joint subluxation.3.Most patients with post-stroke hemiplegic shoulder pain experience mild to moderate pain.Factors related to the degree of PSSP include Brunnstrom stage,MMT stage,shoulder abduction and external rotation angles,long head of the biceps tendon sheath effusion,and shoulder joint subluxation,indicating that NRS is closely related to movement dysfunction and soft tissue injury.4.The degree of soft tissue injury in the affected shoulder after stroke is correlated with the NRS score,Brunnstrom stage,MMT stage,Fugl-Meyer score,external rotation,internal rotation,flexion,and abduction,indicating a close relationship between the degree of soft tissue injury and the patient’s movement function.