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Proximal neuropathies in patients with poststroke shoulder pain

Abstract

Background

Poststroke shoulder pain (PSSP) could be due to proximal neuropathy or upper trunk brachial plexus lesion.

Aim

The aim was to detect any electrophysiological abnormality in the proximal nerves supplying shoulder structures that could contribute to PSSP.

Settings and design

Cross-sectional study at institution: a university hospital, tertiary level of clinical care.

Materials and methods

Nerve conduction studies of the axillary, musculocutaneous, suprascapular, and lateral antebrachial nerves were done on both sides. In addition, electromyography of the deltoid, biceps brachii and infraspinatus on the hemiplegic side was performed on 30 stroke survivors with PSSP.

Statistical analysis used

Statistical Package for the Social Sciences (SPSS ver.20). Description and analysis of the obtained data were done using appropriate tests.

Results

Axillary and musculocutaneous motor nerve latencies on the hemiplegic side were significantly prolonged compared with the normal side (P=0.012, 0.029, respectively). Moreover, axillary and suprascapular nerve amplitudes on the hemiplegic side were significantly lower than those on the normal side (P=0.008, 0.002, respectively). Twelve (40%) patients had electrophysiological abnormalities. Upper trunk brachial plexopathy was the most common abnormality which occurred in six (20%) patients. In addition, isolated axillary or suprascapular nerve lesion occurred at a similar frequency (10%).

Conclusion

Proximal nerve lesions are not uncommon in PSSP patients.

References

  1. Ring H, Leillen B, Server S, Luz Y, Solzi P. Temporal changes in electrophysiological, clinical and radiological parameters in the hemiplegic’s shoulder. Scand J Rehabil Med Suppl 1985; 12:124–127.

    CAS  PubMed  Google Scholar 

  2. Moskowitz E, Porter JI. Peripheral nerve lesions in the upper extremity in hemiplegic patients. N Engl J Med 1963; 269:776–778.

    Article  CAS  Google Scholar 

  3. Tsur A,Ring H. Axillary nerve conduction changes in hemiplegia. J Brachial Plex Peripher Nerve Inj 2008; 3:26.

    PubMed  PubMed Central  Google Scholar 

  4. Lee KH, Khunadorn F. Painful shoulder in hemiplegic patients: a study of the suprascapular nerve. Arch Phys Med Rehabil 1986; 67:818–820.

    CAS  PubMed  Google Scholar 

  5. World Health Organization. World health report-mental health: new understanding, new hope statistical annex. Geneva: World Health Organization; 2001. 151–155

    Google Scholar 

  6. Medical Research Council. Aids to the investigation of peripheral nerve injuries. 2nd ed. London: Her Majesty’s Stationery Office; 1943.

    Google Scholar 

  7. Silliman JF, Hawkins RJ. Classification and physical diagnosis of instability of the shoulder. Clin Orthop Reiat Res 1993; 291:7–19.

    Google Scholar 

  8. Jia X, Ji JH, Petersen SA, Freehill MT, McFarland EG. An analysis of shoulder laxity in patients undergoing shoulder surgery. J Bone Joint Surg Am 2009; 91:2144–2150.

    Article  Google Scholar 

  9. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67:206–207.

    Article  CAS  Google Scholar 

  10. Meredith J, Taft G, Kaplan P. Diagnosis and treatment of the hemiplegic patient with brachial plexus injury. Am J Occup Ther 1981; 35:656–660.

    Article  CAS  Google Scholar 

  11. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The poststroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975; 7:13–31.

    CAS  PubMed  Google Scholar 

  12. Buschbacher R, Prahlow ND. Manual of nerve conduction studies. 2nd ed. New York: Demos Medical Publishing, LLC; 2006.

    Google Scholar 

  13. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders clinical electrophysiological correlations. 2nd ed. Philadelphia: Elsevier Butterworth Heinemann; 2007.

    Google Scholar 

  14. Kingery WS, Date ES, Bocobo CR. The absence of brachial plexus injury in stroke. Am J Phys Med Rehabil 1993; 72:127–135.

    Article  CAS  Google Scholar 

  15. Chokroverty S, Medina J. Electrophysiological study of hemiplegia motor nerve conduction velocity, brachial plexus latency, and electromyography. Arch Neurol 1978; 35:360–363.

    Article  CAS  Google Scholar 

  16. Andresen LT. Shoulder pain in hemiplegia. Am J Occup Therap 1985; 39:11–19.

    Article  Google Scholar 

  17. Chino N. Electrophysiological investigation on shoulder subluxation in hemiplegics. Scand J Rehabil Med 1981; 13:17–21.

    CAS  PubMed  Google Scholar 

  18. Steinmann SP, Moran EA. Axillary nerve injury: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9:328–335.

    Article  CAS  Google Scholar 

  19. Takebe K, Narayan MG, Kukulka C, Basmajian JV. Slowing of nerve conduction velocity in hemiplegia: possible factors. Arch Phys Med Rehabil 1975; 56:285–289.

    CAS  PubMed  Google Scholar 

  20. Cowley LH, Cress RH, Fleming WC. Motor nerve conduction velocity studies on lower extremities of hemiplegics. South Med J 1967; 60:1324–1327.

    Article  CAS  Google Scholar 

  21. Namba T, Schuman MH, Grob D. Conduction velocity in the ulnar nerve in hemiplegic patients. J Neurol Sci 1971; 12:177–186.

    Article  CAS  Google Scholar 

  22. McComas AJ, Sica REP, Upton ARM, Aruilera N. Functional changes in motoneurones of hemiparetic patients. J Neurol Neurosurg Psych 1973; 36:183–193.

    Article  CAS  Google Scholar 

  23. Zalis AW, Lafratta CW, Fauls LB, Oester YT. Electrophysiological studies in hemiplegia: lower motor neuron findings and correlates. Electromyogr Clin Neurophysiol 1976; 16:151–162.

    CAS  PubMed  Google Scholar 

  24. Benecke R, Berthold A, Conrad B. Denervation activity in the EMG of patients with upper motor neuron lesions: time course, local distribution and pathogenetic aspects. J Neurol 1983; 230:143–151.

    Article  CAS  Google Scholar 

  25. Hara Y, Masakado Y, Chino N. The physiological functional loss of single thenar motor units in the stroke patients: when does it occur? Does it progress? Clin Neurophysiol 2004; 115:97–103.

    Article  Google Scholar 

  26. Qiu Y, Wada Y, Otomo E, Tsukagoshi H. Morphometric study of cervical anterior horn cells and pyramidal tracts in the medulla oblongata and spinal cord in patients with cerebrovascular diseases. J Neurol Sci 1991; 102:137–143.

    Article  CAS  Google Scholar 

  27. Lukács M. Electrophysiological signs of changes in motor units after ischaemic stroke. Clin Neurophysiol 2005; 116:1566–1570.

    Article  Google Scholar 

  28. Taksandea B, Ambadea M, Josh R. Delayed axillary nerve motor conduction latency and reduced CMAP amplitudes in the paretic limbs of patients with a cerebrovascular episode. J Neurol Res 2011; 1:210–214.

    Google Scholar 

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Correspondence to Marwa A. Amer MD.

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Shafshak, T.S., Abdelhamid, M.M. & Amer, M.A. Proximal neuropathies in patients with poststroke shoulder pain. Egypt Rheumatol Rehabil 46, 195–201 (2019). https://doi.org/10.4103/err.err_58_18

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