Investigation of factors affecting shoulder pain in stroke survivors

Abstract

Background: Shoulder pain is influenced by multiple factors in stroke survivors. Purpose: This study investigated factors contributing to shoulder pain in stroke survivors and quantified their impact. Study Design: Sixty-two stroke patients (21 females, 41 males; mean age: 63.97 ± 10.02 years) at Brunnstrom stage 3 or higher were included. Methods: Shoulder pain was assessed using the Visual Analog Scale, muscle tone with the Modified Ashworth Scale, and myofascial trigger points through palpation. A universal goniometer measured the range of motion, and the Fugl-Meyer Upper Extremity Assessment evaluated upper limb function. Soft tissue conditions were assessed using the Neer Impingement, Apprehension, Acromioclavicular Shear, and Speed tests. Results: Hemiplegic shoulder pain (HSP) was present in 50% of patients, primarily in the anterior (35.5%) and lateral (32.3%) shoulder. Burning and stinging sensations were common. No significant associations were found with age, gender, or time since stroke. However, HSP correlated with rehabilitation initiation time (p = 0.007, r = −0.34), Brunnstrom stage (p = 0.015, r = 0.31), and Fugl-Meyer score (p = 0.015, r = 0.31). Increased muscle tone in the subscapularis (p = 0.046, r = 0.26) and pectoralis major (p = 0.002, r = 0.38) was linked to HSP. Myofascial trigger points in the levator scapulae, supraspinatus, upper trapezius, teres major, teres minor, and infraspinatus muscles showed significant correlations Soft tissue pathology, indicated by the Neer Impingement (p = 0.000, r = 0.46), speed (p = 0.007, r = 0.34), and apprehension (p = 0.000, r = 0.52) tests, was also associated with HSP. Conclusions: HSP in stroke survivors is influenced by myofascial trigger points, soft tissue injuries, delayed rehabilitation, increased muscle tone, and lower motor function. Early intervention focusing on shoulder mobility is crucial for prevention and management, promoting functional recovery. © 2025 Elsevier B.V., All rights reserved.