Predictability of Simple Clinical Tests to Identify Shoulder Pain After Stroke

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.

Design

Case control.

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.