HEMİPLEJİDE AĞRILI OMUZ GELİŞİMİNİN GLENOHUMERAL SUBLUKSASYON VE FONKSİYONEL DURUM İLE İLİŞKİSİ

Abstract

Amaç: Çalışmanın amacı hemiplejik omuz ağrısı (HOA) ve glenohumeral (GH) subluksasyon arasındaki ilişkinin belirlenmesi, HOA ve GH subluksasyon gelişimini etkileyebilecek faktörlerin değerlendirilmesi ve HOA’nın fonksiyonel bağımsızlık ve GYA üzerine etkilerini saptamaktır. Gereç ve Yöntem: Çalışmaya inme polikliniğine başvuran 61 hemiplejik hasta dahil edildi. Hastalarda anamnez ve klinik muayene ile omuz ağrısı, subluksasyon sıklığı ve spastisite değerlendirildi. Üst ekstremite fonksiyonları brunnstrom motor evrelemesi; Günlük yaşam aktiviteleri ve bağımsızlık, Fonksiyonel Bağımsızlık Ölçeği (FBÖ) ve Modifiye Barthel İndeksi (MBİ) ile değerlendirildi. Bulgular: HOA’nın, inmenin süresiyle, üst ekstremitenin brunnstrom motor evresiyle, GH subluksasyon varlığıyla, spastisiteyle ilişkisi bulunamamıştır (p>0,05), ancak omuz abduksiyon ve fleksiyon hareketlerinde kısıtlılık ile omuzda ağrı gelişmesi arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur (p<0,05). GH subluksasyonun spastisite varlığı ve derecesiyle ilişkisi bulunamamıştır (p>0,05), ancak üst ekstremitenin brunnstrom motor evresiyle anlamlı derecede ilişkili olduğu bulunmuştur (p<0,01). Üst ekstremitenin Brunnstrom motor iyileşme evresi arttıkça subluksasyon görülme sıklığının azaldığı tespit edilmiştir. FBÖ, MBİ skorlarıyla ile omuz ağrısı ve GH subluksasyon arasında da anlamlı bir ilişki tespit edilememiştir (p>0,05). Sonuç: Bu çalışmada omuz ağrısının GH subluksasyon ile ilişkisi belirlenmemiş, ancak hareket kısıtlılığı ile HOA ilişkisi olası yumuşak doku lezyonlarını düşündürmekte, bu açıdan rehabilitasyon programları içinde omuz korunmasına yönelik eğitime önem verilmesi gerekmektedir. GH subluksasyon ile motor gelişim ilişkisi göz önüne alıdığında rehabilitasyon programında omuz kaslarının erken dönemde aktivasyonunun sağlanması üzerinde önemle durulmalıdır.

Keywords

• hemipleji
• omuz
• subluksayon
• ağrı
• glenohumeral
• fonksiyon

THE RELATIONSHIP OF PAINFUL SHOULDER DEVELOPMENT IN HEMIPLEJIA WITH GLENOHUMERAL SUBLUXATION AND FUNCTIONAL STATE

Abstract

Objective: The aim of the study is to determine the relationship between hemiplegic shoulder pain (HSP) and glenohumeral (GH) subluxation, to evaluate the factors that may affect the development of HSP and GH subluxation, and to determine the effects of HSP on functional independence and activities of daily living (ADL). Material and Method: Sixty-one hemiplegic patients who admitted to the stroke clinic were included in the study. Shoulder pain, frequency of subluxation, and spasticity were evaluated with anamnesis and clinical examination. Upper limb functions brunnstrom motor stage; Activities of daily living and independence were evaluated with Functional Independence Scale (FIM) and Modified Barthel Index (MBI). Results: The HSP was not associated with the duration of stroke, the Brunnstrom motor stage of the upper extremity, the presence of GH subluxation, or spasticity (p> 0.05), but a statistically significant relationship was found between the limitation of shoulder abduction and flexion movements and the development of pain in the shoulder (p <0 , 05). GH subluxation was not found to be associated with the presence and degree of spasticity (p> 0.05), but it was found to be significantly associated with the Brunnstrom motor stage of the upper extremity (p <0.01). It was found that as the Brunnstrom motor recovery stage of the upper extremity increased, the incidence of subluxation decreased. There was also no significant relationship between FIM, MBI scores and shoulder pain and GH subluxation (p> 0.05). Conclusion: In this study, the relationship between shoulder pain and GH subluxation was not determined, but the relationship between limitation of motion and HSP suggests possible soft tissue lesions, and in this respect, education for shoulder protection should be given importance in rehabilitation programs. Considering the relationship between GH subluxation and motor development, early activation of shoulder muscles should be emphasized in the rehabilitation program.

Keywords

• hemiplegia
• shoulder
• pain
• subluxation
• function
• glenohumeral

References

1. 1. Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34(9):2181-6.
2. 2. Gillot AJ, Holder-Walls A, Kurtz JR, Varley NC. Perceptions and experiences of two survivors of stroke who participated in constraint-induced movement therapy home programs. American Journal of Occupational Therapy. 2003;57(2):168-76.
3. 3. Suethanapornkul S, Kuptniratsaikul PS, Kuptniratsaikul V, Uthensut P, Dajpratha P, Wongwisethkarn J. Post stroke shoulder subluxation and shoulder pain: a cohort multicenter study. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2008;91(12):1885-92.
4. 4. Kalichman L, Ratmansky M. Underlying pathology and associated factors of hemiplegic shoulder pain. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 2011;90(9):768-80.
5. 5. Koog YH, Jin SS, Yoon K, Min BI. Interventions for hemiplegic shoulder pain: systematic review of randomised controlled trials. Disabil Rehabil. 2010;32(4):282-91.
6. 6. Barlak A, Unsal S, Kaya K, Sahin-Onat S, Ozel S. Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes. International journal of rehabilitation research Internationale Zeitschrift fur Rehabilitationsforschung Revue internationale de recherches de readaptation. 2009;32(4):309-15.
7. 7. Paci M, Nannetti L, Rinaldi LA. Glenohumeral subluxation in hemiplegia: An overview. Journal of rehabilitation research and development. 2005;42(4):557-68.
8. 8. Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clinical Rehabilitation. 2002;16(3):276-98.

9. 9. UZUNCA K. Upper Extremity Complications After Stroke. Turk J Phys Med Rehab.2006;52(Suppl B):B23-B29.
10. 10. Paci M, Nannetti L, Taiti P, Baccini M, Rinaldi L. Shoulder subluxation after stroke: relationships with pain and motor recovery. Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2007;12(2):95-104.
11. 11. Ikai T, Tei K, Yoshida K, Miyano S, Yonemoto K. Evaluation and treatment of shoulder subluxation in hemiplegia: relationship between subluxation and pain. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 1998;77(5):421-6.
12. 12. Van Langenberghe HV, Hogan BM. Degree of pain and grade of subluxation in the painful hemiplegic shoulder. Scandinavian journal of rehabilitation medicine. 1988;20(4):161-6.
13. 13. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical therapy. 1987;67(2):206-7.
14. 14. Sawner KA, LaVigne JM, Brunnstrom S. Brunnstrom's movement therapy in hemiplegia: a neurophysiological approach: Lippincott; 1992.
15. 15. Küçükdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant A. Adaptation of the Functional Independence Measure for use in Turkey. Clinical Rehabilitation. 2001;15(3):311-9.
16. 16. Kucukdeveci AA, Yavuzer G, Tennant A, Suldur N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scandinavian journal of rehabilitation medicine. 2000;32(2):87-92.
17. 17. Koseoglu B. SHOULDER PAIN IN HEMIPLEGIC PATIENTS Aysegul Demirci, Begum Ocek, Fusun Koseoglu. J PMR Sci. 2007.
18. 18. Jespersen HF, Jorgensen HS, Nakayama H, Olsen TS. Shoulder pain after a stroke. International journal of rehabilitation research Internationale Zeitschrift fur Rehabilitationsforschung Revue internationale de recherches de readaptation. 1995;18(3):273-6.
19. 19. Zorowitz RD, Hughes MB, Idank D, Ikai T, Johnston MV. Shoulder pain and subluxation after stroke: correlation or coincidence? The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 1996;50(3):194-201.
20. 20. Cheng P-T, Lee C-E, Liaw M-Y, Wong M-K, Hsueh T-C. Risk Factors of Hemiplegic Shoulder Pain in Stroke Patients. Journal of Musculoskeletal Pain. 1995;3(3):59-73.
21. 21. Lindgren I, Jönsson AC, Norrving B, Lindgren A. Shoulder pain after stroke: a prospective population-based study. Stroke. 2007;38(2):343-8.
22. 22. Aras MD, Gokkaya NK, Comert D, Kaya A, Cakci A. Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists. 2004;83(9):713-9.
23. 23. Lee IS, Shin YB, Moon TY, Jeong YJ, Song JW, Kim DH. Sonography of patients with hemiplegic shoulder pain after stroke: correlation with motor recovery stage. AJR American journal of roentgenology. 2009;192(2):W40-4.
24. 24. Hakuno A, Sashika H, Ohkawa T, Itoh R. Arthrographic findings in hemiplegic shoulders. Arch Phys Med Rehabil. 1984;65(11):706-11.
25. 25. Rizk TE, Christopher RP, Pinals RS, Salazar JE, Higgins C. Arthrographic studies in painful hemiplegic shoulders. Arch Phys Med Rehabil. 1984;65(5):254-6.
26. 26. Lee S, Kim A, Chang W, Kim J-s, Kim D. Hemiplegic Shoulder Pain in Shoulder Subluxation after Stroke: Associated with Range of Motion Limitation. Brain & Neurorehabilitation. 2018;11.
27. 27. Bender L, McKenna K. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil. 2001;23(16):698-705.
28. 28. Hecht JS. Subscapular nerve block in the painful hemiplegic shoulder. Arch Phys Med Rehabil. 1992;73(11):1036-9.
29. 29. Yelnik AP, Colle FM, Bonan IV, Vicaut E. Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A. Journal of neurology, neurosurgery, and psychiatry. 2007;78(8):845-8.
30. 30. Lim JY, Koh JH, Paik NJ. Intramuscular botulinum toxin-A reduces hemiplegic shoulder pain: a randomized, double-blind, comparative study versus intraarticular triamcinolone acetonide. Stroke. 2008;39(1):126-31.
31. 31. Pedreira G, Cardoso E, Melo A. Botulinum toxin type A for refractory post-stroke shoulder pain. Arq Neuropsiquiatr. 2008;66(2a):213-5.
32. 32. Braun RM, West F, Mooney V, Nickel VL, Roper B, Caldwell C. Surgical treatment of the painful shoulder contracture in the stroke patient. The Journal of bone and joint surgery American volume. 1971;53(7):1307-12.
33. 33. Benlidayi I, Ozgozen S, Guzel R. Relation of Quantitative Glenohumeral Subluxation with Clinical Variables in Patients with Post-Stroke Hemiplegic Shoulder Pain. Gazi Medical Journal. 2018;29:276-9.
34. 34. Huang YC, Liang PJ, Pong YP, Leong CP, Tseng CH. Physical findings and sonography of hemiplegic shoulder in patients after acute stroke during rehabilitation. J Rehabil Med. 2010;42(1):21-6.
35. 35. Gamble GE, Barberan E, Bowsher D, Tyrrell PJ, Jones AK. Post stroke shoulder pain: more common than previously realized. European journal of pain (London, England). 2000;4(3):313-5.