Shoulder Subluxation and Shoulder-Hand Syndrome After Stroke; Effect of Brain Lesion Location and Side

Abstract

Aim The effect of brain lesion location and involved brain side in the development of shoulder subluxation (SS) and shoulder hand syndrome (SHS) is still unclear. The aim of the current study was to evaluate the relationships of SS and SHS with brain lesion location and stroke side. Material and Methods The inpatient files of the hemiplegic patients, who were hospitalized for rehabilitation, were evaluated resrospectively. Brain lesion location and involved hemisphere side were assessed by brain CT at the insult time. Brain lesion location groups were comprised as following 4 groups which included 35 patients in each group. Group I: Small superficial infarct. This type infarcts involve small area infarct (no more than 20 mm in diameter) on a cerebral lobe, such as a small right or left frontal lobe infarct. Group II: Large superficial infarct. Infarcts more than 20 mm in diameter on a cerebral lobe or two or more lobes of one cerebral hemisphere, such as a frontoparietal infarct in the left cerebral hemisphere or frontotemporo-parietal infarct in right or left cerebral hemisphere. Group III: Deep infarct. Infarcts of the internal capsule, basal ganglia or thalamus. Group IV: Combination of deep and large superficial infarcts (combined group II+III). Internal capsule or basal ganglia or thalamic infarct combined with fronto-temporal or fronto-parietal or temporoparieto- occipital infarct on one cerebral hemisphere. A total of 140 hemiplegic patients then devided into 2 groups according to the development of SS and/or SHS. Results A significant correlation was found between brain lesion locations and SS and/or SHS development. The groups with combined deep and large superficial, and large superficial infarcts showed more frequent SS and/or SHS development. Patients with SS and/or SHS had got low stages at baseline in the upper extremity according to upper extremity Brunnstroma level, upper extremity Ashworth stage and low stages of functional independence measure (FIM) scores. There wasn't significant difference in shoulder problem development in terms of involved hemisphere side. Conclusions In our study, brain lesion location especially combined deep and large superficial, and large superficial infarcts seem to be a predictor factor for development of SS and/or SHS. But involved hemisphere side is not a predictor factor. Prospective trials are needed to make definite conclusions.