Use of portable diagnostic ultrasound to inform treatment choices for hemiplegic shoulder pain in people with Chronic Stroke: A case series

Kumar, Praveen; Brouwers, Jakko

Abstract

Abstract Introduction
Hemiplegic shoulder pain (HSP) has a reported incidence of up to 84% of patients. HSP is multi-factorial in nature and interventions are very varied but are generally unsatisfactory. The objective of this case series study is to report findings on patients with HSP who underwent scanning using portable diagnostic ultrasound and received problem specific treatment.

Abstract Method
Six patients with HSP were receiving rehabilitation (over-arm exercises, electrical stimulation, stretches, Saebo exercises) in a private clinic but were not showing any improvement. Ultrasound scanning was undertaken and following problems were identified: glenohumeral subluxation (GHS), supraspinatus atrophy (diameter of supraspinatus), rotator cuff tears, and bicipital tendinitis. Treatment included: 1) ultrasound guided electrical stimulation to supraspinatus; lateral deltoid (GHS, supraspinatus atrophy) 2) rotator cuff training / isometric exercises (Rotator cuff tears, supraspinatus atrophy). 3) Avoiding of over-arm activities. Other treatment included scapula setting exercises (for posture and muscle imbalance).

Abstract Results
Results: At 12 weeks, patients showed 50-75% reduction in pain, 40-60% improvement in GHS (up to 1 cm affected to unaffected difference), increase in diameter of supraspinatus at rest (0.4 cm) and contracted state (0.8cm), increase in range of movement (flexion – 30 degrees, abduction – 45 degrees, external rotation – 40 degrees), improved use of arm for function / rehabilitation, and patients reported improvement in activities of daily living. Clinicians reported improvements in designing and delivery of exercise programme.

Abstract Discussion
Portable diagnostic ultrasound has potential to inform treatment choices for HSP and improve patient outcomes.

• Journal Article Type: Article
• Acceptance Date: Nov 19, 2017
• Online Publication Date: Nov 19, 2017
• Publication Date: Nov 19, 2017
• Deposit Date: Nov 12, 2018
• Publicly Available Date: Dec 18, 2018
• Journal: International Journal of Stroke
• Print ISSN: 1747-4930
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 12
• Issue: 5S
• Pages: 7-59
• DOI: https://doi.org/10.1177/1747493017732216
• Keywords: shoulder pain, shoulder subluxation, portable diagnostic ultrasound, stroke
• Public URL: https://uwe-repository.worktribe.com/output/878949
• Publisher URL: http://dx.doi.org/10.1177/1747493017732216
• Additional Information: Additional Information : This work was presented as a poster at the UK Stroke Forum, Liverpool, Nov 2017. The proceedings have been published in the International Journal of Stroke
• Contract Date: Dec 18, 2018