Post-Stroke Shoulder Pain Flashcards
%age of stroke patients with hemiplegia that have shoulder pain
70-84% within first few weeks of stroke
What phase of motor recovery does should pain present in?
Spastic phase
Sudeck Atrophy
Another name for CRPS
Which type of CRPS is also known as RSD
Type 1
Which type of CRPS is also known as causalgia
Type 2
Most common subtype of RSD in stroke
shoulder-hand syndrome
Difference between CRPS type 1 and 2 in terms of nerve damage
1 = without major nerve damage 2 = evidence of nerve damage
3 stages of CRPS type 1 (RSD)
- acute
- dystrophic
- atrophic
Which stage of RSD is characterized by burning pain with edema and hyperpathia
1 - acute
Which stage of RSD is characterized by vasomotor changes in hands and fingers
1 - acute
Which stage of RSD is characterized by pain spreading proximally with skin and muscle atrophy
2 - dystrophic
Which stage of RSD is characterized by cold insensitivity and decreased ROM
2 - dsytrophic
Which stage of RSD is characterized by decrease in pain with pale appearing skin and shiny appearance
3 - atrophic
Which stage of RSD is characterized by contractures and flexion deformities of hands and shoulders
3 - atrophic
Most common direction of shoulder subluxation seen
Anterior inferior subluxation
x-ray findings of CRPS
normal in initial stages, then shows periarticular osteopenia
Most sensitive indicator for RSD
Diffusely increased juxta-articular tracer activity on triple phase bone scan
Most consistent early diagnostic sign for CRPS seen on physical exam
Shoulder pain with ROM with no elbow pain and wrist pain in dorsiflexion with edema of fingers.
Gold standard for diagnosis of CRPS type 1
Stellate ganglion block resealing in decrease in pain
Positive predictor for successful stellate ganglion block for patients with CRPS
When patient develops ipsilateral Horner’s syndrome
What phase of CRPS do patients respond to systemic steroids?
Acute phase (stage 1)
Dosage of steroid given for CRPS
Prednisone 100-200mg / day tapered over 2 weeks
What kind of patients are steroids more effective in when treating CRPS
those with a positive bone scan
Palpable gap between the acromion and numeral head
Subluxation
Basmajian Principle
A decrease in trapezius tone can cause the scapula to rotate and sublux the humeral head from the glenoid fossa
Friedland’s theory on shoulder subluxation treatment
Slings do not prevent or correct subluxation and are not necessary to support pain-free shoulder
When is shoulder sling used in shoulder subluxation
During ambulatory for support and prevent trauma
What 2 muscles are involved in shoulder subluxation
Supraspinatus and Deltoid
Bicipital tendinitis will cause shoulder pain in what motion?
Abduction and external rotation
Which test is supination against resistance while flexing elbow and external rotation of humerus?
Yergason’s
Describe yergason’s
Flex elbows at 90 degrees, supinate forearm against resistance while flexing elbow and externally rotating humerus
For a patient with brachial plexus/peripheral nerve injury of the shoulder, what position do you want him placed in at night?
45 degree shoulder-abduction sling for nighttime position
How do bisphosphonates work in preventing HO
Blocks the late phase of bone formation by preventing conversion of amorphous calcium phosphate to hydroxyapatite
6 main DDx of post-stroke shoulder pain
- CRPS type 1
- Impingement
- Inferior subluxation
- Rotator Cuff Tear
- Adhesive Capsulitis
- Biceps Tendinitis
FES can be used for treatment of what?
Inferior subluxation
What 2 types of shoulder pain can be diagnosed by a diagnostic subacromial lidocaine injection?
- Rotator Cuff Tear
2. Impingement Syndrome
MCP Compression Test
Physical Exam Sign for CRPS
What motion is lost in Frozen shoulder
External rotation becomes less than 15 degrees
