HEMİPLEJİDE AĞRILI OMUZ GELİŞİMİNİN GLENOHUMERAL SUBLUKSASYON VE FONKSİYONEL DURUM İLE İLİŞKİSİ

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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