Temporal trajectory and predictors of hemiplegic shoulder pain after stroke: a 12-month longitudinal clinical-ultrasound study.
Filippo Cotellessa, Maria C May, Valentina Guzzone and 9 others
PMID 42517165WHAT IT FOUND
Shoulder pain after stroke is lowest in the first days, peaks around three months and eases by a year.
Loss of passive shoulder movement tracked pain at every timepoint; subluxation, capsular changes and tendon tears each mattered at different stages.
Key findings
01Mean pain score rose from 0.95 at the first assessment to a peak of 3.98, then fell to 3.40 and 2.73 at the later assessments.
02Loss of passive shoulder movement was the only factor linked to pain at every assessment, and the authors argue it may in part be a consequence of pain rather than a cause, because it was already linked to pain in the first days after stroke when true muscle or capsular shortening is unlikely.
03What went with the pain changed over time: shoulder joint subluxation was linked to 3.53 more points of pain at the first assessment, and at the peak of pain capsular tightening (3.51 points) and tendon tears (0.80 points for each torn tendon) were also independent predictors.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Observational design: it can show what goes together over time, not what causes what. 22 of the 77 (about 29%) did not finish the twelve-month follow-up, including seven who died, and the shrinking numbers at later time points may have hidden weaker links. Everyone received usual care, including drugs and injections when clinically indicated, and later treatments such as ultrasound-guided hydrodistension were not controlled, so some of the weakening of associations at six and twelve months may reflect treatment rather than the natural course. Single stroke unit in Italy, with no comparison group. Ultrasound reading depends on the operator, even though two experienced physiatrists scanned jointly and agreed findings by consensus. Pain was scored during passive movement, so a patient who stops the movement early because of discomfort scores higher, which the authors themselves link to the passive range finding.
Declared interests
The authors state they have no conflict of interest with any financial organisation regarding the material in the manuscript, and they received no external funding for the study.
The easy way to misread this
Do not read the falling pain scores at six and twelve months as the shoulder settling on its own. Most patients whose scans showed capsular changes at three months went on to have ultrasound-guided hydrodistension, one of several treatments given as part of routine care, and the authors say the loss of the link between capsular changes and pain at six months probably reflects that treatment rather than spontaneous recovery.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →