Risk factors for hemiplegic shoulder pain: a systematic review

A systematic review was conducted to postulate risk factors for hemiplegic shoulder pain in the context of an etiological model and to evaluate the evidence for these risk factors. Studies on risk factors for hemiplegic shoulder pain were identified by a systematic search through MEDLINE and the Cumulative Index of Nursing and Allied Health Literature, and an etiological model was subsequently constructed. To evaluate the evidence for these risk factors, the methodological quality of the studies was rated according to a criteria list. Eleven studies on risk factors for hemiplegic shoulder pain were identified. The relationship between hemiplegic shoulder pain and subluxation and muscle tone has been investigated most frequently, but no consistent findings have been reported. Overhead pulley seems to increase the incidence of hemiplegic shoulder pain. Although much speculation is found in the literature about the etiological processes and risk factors for hemiplegic shoulder pain, there is only weak evidence that an increase in muscle tone increases the occurrence of hemiplegic shoulder pain. Overhead pulley may lead to repeated traumas of the shoulder and cannot be recommended

Effect of triamcinolone acetonide injections on hemiplegic shoulder pain: a randomized clinical trial.

Background and Purpose - Hemiplegic shoulder pain is not uncommon after stroke. Its origin is still unknown, and although many different methods of treatment are applied, none have yet been proved to be effective. We sought to study the efficacy of 3 injections of intra-articular triamcinolone acetonide on pain and arm function in stroke patients with hemiplegic shoulder pain. Methods - In a multicenter, randomized, placebo-controlled clinical trial, patients with hemiplegic shoulder pain received either 3 intra-articular injections of 40 mg triamcinolone acetonide or 1 mL physiological saline solution (placebo). Primary outcomes were pain measured according to 3 visual analogue scales (score range, 0 to 10), and arm function was measured by means of the Action Research Arm test and the Fugl-Meyer assessment scale; secondary outcomes were passive external rotation of the shoulder and general functioning measured according to Barthel Index and the Rehabilitation Activities Profile. Results - In the triamcinolone group (n=18), the median decrease in pain, 3 weeks after the last injection, was 2.3 (interquartile range, 0.3 to 4.3) versus 0.2 (interquartile range, -0.5 to 2.2) in the placebo group. This result was not statistically significant. The change in the other outcome measures did not differ significantly between the 2 treatment groups. Twenty-five patients reported side effects. Conclusions - In the 37 participants included in this study, triamcinolone injections seemed to decrease hemiplegic shoulder pain and to accelerate recovery, but this effect was not statistically significant. Therefore, on the basis of the results of this study, these injections cannot be recommended for the treatment of patients with hemiplegic shoulder pain

Exercise therapy for arm function in stroke patients: a systematic review of randomized controlled trials

Assessment of the available evidence for the effectiveness of exercise therapy to improve arm function in patients who have suffered from a stroke. A systematic search of bibliographical databases and reference checking were performed to identify publications on randomized controlled trials (RCTs) which evaluated the effect of exercise therapy on arm function in stroke patients. The methodological quality was assessed systematically by two raters, based on a standardized list of methodological criteria. Study characteristics, such as the chronicity and severity of impairment of the patient population, the amount and duration of interventions, and specific methodological criteria, were related to reported effects. Thirteen RCTs were identified, six of which reported positive results on an arm function test. In five of these six studies there was a contrast in amount or duration of exercise therapy between groups. Methodological scores ranged from 5 to 15 (maximum possible score: 19 points). Insufficient evidence made it impossible to draw definitive conclusions about the effectiveness of exercise therapy on arm function in stroke patients. The difference in results between studies with and without contrast in the amount or duration of exercise therapy between groups suggests that more exercise therapy may be beneficia