Post Stroke Shoulder Subluxation and Shoulder Pain: A Cohort Multicenter Study
Sumalee Suethanapornkul MD*, Patcharawimol Srisa-an Kuptniratsaikul MD**, Vilai Kuptniratsaikul MD***, Pimwipa Uthensut MD*, Piyapat Dajpratha MD***, Jongkolporn Wongwisethkarn MNS*
Affiliation : * Rehabilitation Medicine Department, Phramongkutklao Hospital, Bangkok ** Rehabilitation Medicine Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok *** Rehabilitation Medicine Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Objective : To study the occurrence of shoulder subluxation, shoulder pain in stroke patients and identify
factors associated to these conditions during rehabilitation period.
Material and Method: Stroke patients from 9 rehabilitation centers from March to December 2006 were
enrolled in the present study. All subjects were registered for demographic data including risk factors and type
of stroke. They were assessed for motor recovery, cognitive ability, functional ability, psychological reaction
and quality of life by using Brunnstrom stage, Thai Mental State Examination (TMSE), Barthel ADL Index
(BI), Hospital Anxiety and Depression Scale (HADS) and WHOQOL-BREF questionnaires respectively at the
beginning and the end of the present study. The occurence of shoulder subluxation and shoulder pain were
recorded and then were analyzed for the associated factors. All subjects received the conventional rehabilita-
tion program until they reached their rehabilitation goals or discharge criteria.
Results : Of 376 stroke patients, 327 met the inclusion criteria, 62 patients (19%) were found to have shoulder
pain and 122 (37%) patients had shoulder subluxation. Shoulder pain was significantly more frequent in
subjects with shoulder subluxation (odds ratio (OR) 2.48, 95% confidence interval (CI) 1.38-4.46) and at
2-6 months after stroke onset (OR 4.0, 95%CI 2.06-7.79). Shoulder subluxation was significantly associated
with hemorrhagic type of stroke (OR 2.06, 95%CI 1.08-3.93), loss of proprioceptive sensation (OR 3.03,
95%CI 1.26-7.29) and negatively associated with Brunnstrom’s stage of arm recovery (OR 0.44, 95%CI
0.34-0.56). No significant functional and quality of life impact was found from these conditions.
Conclusion : Post stroke shoulder pain and subluxation were common during the rehabilitation period.
Shoulder pain significantly occurred within 6 months after stroke onset and increased risk in patients with
shoulder subluxation. Shoulder subluxation was correlated with Brunnstrom’s stage, proprioceptive loss and
hemorrhagic type of stroke.
Keywords : Shoulder pain, Subluxation, Stroke, Rehabilitation
