Post-Stroke Shoulder Pain

Question 1

%age of stroke patients with hemiplegia that have shoulder pain

Answer 1

70-84% within first few weeks of stroke

Question 2

What phase of motor recovery does should pain present in?

Answer 2

Spastic phase

Question 3

Sudeck Atrophy

Answer 3

Another name for CRPS

Question 4

Which type of CRPS is also known as RSD

Answer 4

Type 1

Question 5

Which type of CRPS is also known as causalgia

Answer 5

Type 2

Question 6

Most common subtype of RSD in stroke

Answer 6

shoulder-hand syndrome

Question 7

Difference between CRPS type 1 and 2 in terms of nerve damage

Answer 7

1 = without major nerve damage
2 = evidence of nerve damage

Question 8

3 stages of CRPS type 1 (RSD)

Answer 8

1. acute
2. dystrophic
3. atrophic

Question 9

Which stage of RSD is characterized by burning pain with edema and hyperpathia

Answer 9

1 - acute

Question 10

Which stage of RSD is characterized by vasomotor changes in hands and fingers

Answer 10

1 - acute

Question 11

Which stage of RSD is characterized by pain spreading proximally with skin and muscle atrophy

Answer 11

2 - dystrophic

Question 12

Which stage of RSD is characterized by cold insensitivity and decreased ROM

Answer 12

2 - dsytrophic

Question 13

Which stage of RSD is characterized by decrease in pain with pale appearing skin and shiny appearance

Answer 13

3 - atrophic

Question 14

Which stage of RSD is characterized by contractures and flexion deformities of hands and shoulders

Answer 14

3 - atrophic

Question 15

Most common direction of shoulder subluxation seen

Answer 15

Anterior inferior subluxation

Question 16

x-ray findings of CRPS

Answer 16

normal in initial stages, then shows periarticular osteopenia

Question 17

Most sensitive indicator for RSD

Answer 17

Diffusely increased juxta-articular tracer activity on triple phase bone scan

Question 18

Most consistent early diagnostic sign for CRPS seen on physical exam

Answer 18

Shoulder pain with ROM with no elbow pain and wrist pain in dorsiflexion with edema of fingers.

Question 19

Gold standard for diagnosis of CRPS type 1

Answer 19

Stellate ganglion block resealing in decrease in pain

Question 20

Positive predictor for successful stellate ganglion block for patients with CRPS

Answer 20

When patient develops ipsilateral Horner’s syndrome

Question 21

What phase of CRPS do patients respond to systemic steroids?

Answer 21

Acute phase (stage 1)

Question 22

Dosage of steroid given for CRPS

Answer 22

Prednisone 100-200mg / day tapered over 2 weeks

Question 23

What kind of patients are steroids more effective in when treating CRPS

Answer 23

those with a positive bone scan

Question 24

Palpable gap between the acromion and numeral head

Answer 24

Subluxation

Question 25

Basmajian Principle

Answer 25

A decrease in trapezius tone can cause the scapula to rotate and sublux the humeral head from the glenoid fossa

Question 26

Friedland’s theory on shoulder subluxation treatment

Answer 26

Slings do not prevent or correct subluxation and are not necessary to support pain-free shoulder

Question 27

When is shoulder sling used in shoulder subluxation

Answer 27

During ambulatory for support and prevent trauma

Question 28

What 2 muscles are involved in shoulder subluxation

Answer 28

Supraspinatus and Deltoid

Question 29

Bicipital tendinitis will cause shoulder pain in what motion?

Answer 29

Abduction and external rotation

Question 30

Which test is supination against resistance while flexing elbow and external rotation of humerus?

Answer 30

Yergason’s

Question 31

Describe yergason’s

Answer 31

Flex elbows at 90 degrees, supinate forearm against resistance while flexing elbow and externally rotating humerus

Question 32

For a patient with brachial plexus/peripheral nerve injury of the shoulder, what position do you want him placed in at night?

Answer 32

45 degree shoulder-abduction sling for nighttime position

Question 33

How do bisphosphonates work in preventing HO

Answer 33

Blocks the late phase of bone formation by preventing conversion of amorphous calcium phosphate to hydroxyapatite

Question 34

6 main DDx of post-stroke shoulder pain

Answer 34

1. CRPS type 1
2. Impingement
3. Inferior subluxation
4. Rotator Cuff Tear
5. Adhesive Capsulitis
6. Biceps Tendinitis

Question 35

FES can be used for treatment of what?

Answer 35

Inferior subluxation

Question 36

What 2 types of shoulder pain can be diagnosed by a diagnostic subacromial lidocaine injection?

Answer 36

1. Rotator Cuff Tear

2. Impingement Syndrome

Question 37

MCP Compression Test

Answer 37

Physical Exam Sign for CRPS

Question 38

What motion is lost in Frozen shoulder

Answer 38

External rotation becomes less than 15 degrees