Relation of Quantitative Glenohumeral Subluxation with Clinical Variables in Patients with Post-Stroke Hemiplegic Shoulder Pain

Objective: The objective of the present study was to evaluate the relationship between glenohumeral subluxation (GHS) and the clinical variables in patients with post-stroke hemiplegia. The hypothesis, "Spasticity, motor recovery and ambulatory status are associated with GHS in hemiplegic patients" was tested. Methods: Post-stroke hemiplegic patients who had undergone anteroposterior shoulder radiography with a complaint of shoulder pain were included in the study. In this retrospectively designed study, demographic features (age, sex), disease duration, Functional Ambulation Scale (FAC) score, upper extremity Brunnstrom's motor recovery stage, spasticity grade of the affected upper limb according to the Modified Ashworth Scale (MAS) were recorded from the electronic medical database. It was also noted whether the patients were diagnosed with GHS or not. In patients with GHS, vertical and horizontal distances were measured on anteroposterior shoulder radiographs, which were taken at the time of physical examination. Results: Data of 47 hemiplegic patients underwent anteroposterior shoulder radiographs due to shoulder pain was obtained. Following the application of exclusion criteria, 41 patients with a mean age of 66.2 +/- 12.1 were analysed. Of them, 22 (53.7%) had GHS. Subluxation rate was significantly higher among patients in Brunnstrom category I (Brunnstrom 1-3) than those in category II (Brunnstrom 4-6) (p<0.05). When the patients were categorised according to the spasticity score [Category I (MAS 0-2) and Category II (MAS 3-4)], subluxation rate did not differ between two groups (p>0.05). Subluxation frequency was also similar between patients with non-functional (FAC 0-2) and functional ambulation (FAC 3-5) (p>0.05). In patients with GHS, vertical and horizontal distances did not differ by FAC and MAS category (p>0.05). Since Brunnstrom category II did not have enough number of patients for statistical tests, comparative analysis could not be applied. Conclusion: Among patients with post-stroke hemiplegia, presence of GHS is related to the motor recovery stage, but is regardless of ambulation and spasticity level. In patients with GHS, level of ambulation and spasticity had no impact on the quantitative measures of subluxation.