Abstract
Rajaratnam
BS, Venketasubramanian N, Kumar PV, Goh JC, Chan Y-H. Predictability of
simple clinical tests to identify shoulder pain after stroke.
Objective
To
identify simple diagnostic musculoskeletal tests that can be performed
early after stroke to predict patients’ likelihood of reporting early
signs of hemiplegic shoulder pain.
Setting
Multicenter acute care hospitals.
Participants
A
total of 152 adults after a first episode of stroke, of whom 135 met
the inclusion criteria. Thirty patients were assigned to the
experimental group because they reported moderate intensity of
hemiplegic shoulder pain at rest. The remaining 105 patients made up the
control group.
Interventions
Not applicable.
Main Outcome Measures
Therapists
measured the performance of combined upper-limb movement including the
hand-behind-neck (HBN) maneuver, passive pain-free ranges of shoulder
motion, 3 musculoskeletal tests, and the strength of deltoid muscles
during each patient’s hospital stay. The numeric rating scale (NRS)
identified those who reported moderate or greater intensities of
hemiplegic shoulder pain during rest and during assessment.
Results
In
our study, 22.2% (95% confidence interval, 15.5−30.2) of the patients
reported hemiplegic shoulder pain, on average 1 week after the onset of
stroke. Positive Neer test (NRS score ≥5) during the HBN maneuver and a
difference of more than 10° of passive range of external rotation
between shoulders had a 98% probability of predicting the presence of
hemiplegic shoulder pain (receiver operating characteristic, .994;
sensitivity, 96.7%; specificity, 99.0%; positive predictive value,
96.7%; negative predictive value, 99.0%; P<.001).
Conclusions
Three
diagnostic clinical tests that can be performed during a bedside
evaluation increase the likelihood of determining those who complain of
hemiplegic shoulder pain after an acute episode of stroke.
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