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Musculoskeletal ultrasonographic findings of the affected and unaffected shoulders in hemiplegic patients



There are many sonographic changes in affected and unaffected shoulders in patients with established hemiplegia.


The aim of this study was to evaluate the sonographic findings of hemiplegic shoulder in patients after acute stroke and the detection of the correlation between the physical or sonographic findings and early-onset hemiplegic shoulder pain.

Patients and methods

Shoulders of 30 patients with cerebrovascular stroke (six male and 24 female patients), 18 with right-sided and 12 with left-sided established hemiplegia, were tested. Wasting and weakness of the deltoid were recorded in the involved side. Musculoskeletal ultrasonography examination of both affected and unaffected shoulders of all patients was carried out. Two physicians classified the severity of the injury on a six-point rating scale, and Brunnström motor recovery stages and Brief Pain Inventory score were assessed.


Biceps tendon calicification, tendinosis, and tear (73.3, 76.6, and 13.3%, respectively), deltoid calcification and tendinosis (33.3 and 33.3%, respectively), supraspinatus calcification and tear (53.3 and 26.7%, respectively), and the subacromial–subdeltoid bursitis (43.75%) were the most frequent abnormalities in the affected painful shoulder. No significant relationship (P = 0.1) was found between the US grades of the painful hemiplegic shoulder and the Brunnström motor recovery stages. Ultrasonographic grades of the unaffected shoulder correlated with the stroke duration (P = 0.001). The ultrasonographic rating scores of hemiplegic shoulders correlated with age, duration of stroke, shoulder pain duration, limitation of shoulder movement, the Brief Pain Inventory score and degree of spasticity (P = 0.04, 0.03, 0.001, 0.03, 0.046, and 0.001, respectively).


Hemiplegic stroke results in injury to the affected shoulder and the shoulder on the unaffected side. Musculoskeletal ultrasonography is an essential method in the evaluation of poststroke painful hemiplegic shoulder. However, the US grades did not correlate with the stages of motor recovery.


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Correspondence to Rasha A. Abdel-Magied.

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Ali, F., Hamdy, M., Abdel-Magied, R.A. et al. Musculoskeletal ultrasonographic findings of the affected and unaffected shoulders in hemiplegic patients. Egypt Rheumatol Rehabil 43, 14–20 (2016).

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  • Ashworth scale
  • Brunnström motor recovery
  • hemiplegic shoulder pain
  • Medical Research Council scoring system
  • spasticity