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Lin TY, Shen PC, Chang KV, Wu WT, Özçakar L. Shoulder ultrasound imaging in the post-stroke population: a systematic review and meta-analysis. J Rehabil Med 2023; 55:jrm13432. [PMID: 37615388 PMCID: PMC10461179 DOI: 10.2340/jrm.v55.13432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Post-stroke shoulder pain is a serious challenge for stroke survivors. The aim of this meta-analysis was to review the literature to confirm information on structural changes in post-stroke shoulders detected by ultrasound examination. METHODS PubMed, Embase, Web of Science and ClinicalTrials.gov were searched until 7 December 2022, for studies describing shoulder sonographic findings in stroke patients. Two independent authors selected the studies, extracted the data, and performed the critical appraisal. RESULTS A total of 23 clinical studies were included. The most prevalent pathologies in hemiplegic shoulders pertained to the biceps long head tendon (41.4%), followed by the supraspinatus tendon (33.2%), subdeltoid bursa (29.3%), acromioclavicular joint (15.0%), and subscapularis tendon (9.2%). The common pathological findings encompassed bicipital peritendinous effusion (39.2%), biceps tendinopathy (35.5%), subdeltoid bursitis (29.3%) and supraspinatus tendinopathy (24.6%). Biceps long head tendon and supraspinatus tendon abnormalities were observed significantly more in the hemiplegic (vs contralateral) shoulders, with odds ratios of 3.814 (95% confidence interval 2.044-7.117) and 2.101 (95% confidence interval 1.257-3.512), respectively. No correlation was observed between motor function and shoulder pathology. CONCLUSION Ultrasonography enabled the identification of common shoulder pathologies after stroke. Further research is needed to establish the association between these changes and the clinical course of stroke patients.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Peng-Chieh Shen
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Kim MG, Lee SA, Park EJ, Choi MK, Kim JM, Sohn MK, Jee SJ, Kim YW, Son JE, Lee SJ, Hwang KS, Yoo SD. Elastic Dynamic Sling on Subluxation of Hemiplegic Shoulder in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9975. [PMID: 36011613 PMCID: PMC9408021 DOI: 10.3390/ijerph19169975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Background: Shoulder subluxation occurs in 17−64% of hemiplegic patients after stroke and develops mostly during the first three weeks of hemiplegia. A range of shoulder orthoses has been used in rehabilitation to prevent subluxation. However, there is little evidence of their efficacy. AIM: This study aimed to investigate whether there is a difference in the subluxation distance, pain, and functional level of the hemiplegic upper extremity among patients with two different shoulder orthoses. Design: This is a prospective, randomized controlled trial with intention-to-treat analysis. SETTING: Multicenter, rehabilitation medicine department of two university hospitals in South Korea. Population: Forty-one patients with subacute stroke with shoulder subluxation with greater than 0.5 finger width within 4 weeks of stroke were recruited between January 2016 and October 2021. Methods: The experimental group used an elastic dynamic sling while sitting and standing to support the affected arm for eight weeks. The control group used a Bobath sling while sitting and standing. The primary outcome was to assess the distance of the shoulder subluxation on radiography. The secondary outcomes were upper-extremity function, muscle power, activities of daily living, pain and spasticity. Result: The horizontal distance showed significant improvement in the elastic dynamic sling group, but there were no significant differences in the vertical distance between the elastic dynamic and Bobath sling groups. Both groups showed improvements in upper-extremity movements and independence in daily living after 4 and 8 weeks of using shoulder orthoses, and the differences within the groups were significant (p < 0.05). However, there were no significant differences in upper-extremity movements and independence in daily living between the two groups. Conclusions: The subluxation distance showed better results in the elastic dynamic sling, which has both proximal and distal parts, than in the Bobath sling, which holds only the proximal part. Both shoulder orthoses showed improvements in the modified Barthel index, upper-extremity function, and manual muscle testing.
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Affiliation(s)
- Min Gyun Kim
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
- Department of Physical Medicine and Rehabilitation, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Seung Ah Lee
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Eo Jin Park
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Min Kyu Choi
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Ji Min Kim
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon 35015, Korea
| | - Yeong Wook Kim
- Department of Rehabilitation Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Korea
| | - Jung Eun Son
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Seo Jun Lee
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Keum Sun Hwang
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
- Department of Medicine, AgeTech-Service Convergence Major, Kyung Hee University, Seoul 02447, Korea
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Kumar P, Fernando C, Mendoza D, Shah R. Risk and associated factors for hemiplegic shoulder pain in people with stroke: a systematic literature review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.2019369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Praveen Kumar
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Chiara Fernando
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Deanna Mendoza
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Riya Shah
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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Hirayama K, Fuchigami T, Morioka S. Transcranial direct electrical stimulation for hand function in a stroke patient with severe upper limb paralysis due to lenticulostriate artery occlusion: a case report. J Med Case Rep 2021; 15:582. [PMID: 34903298 PMCID: PMC8667432 DOI: 10.1186/s13256-021-03137-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation, a therapeutic modality to modulate the excitability of injured and uninjured brain hemispheres in stroke patients, is expected to be effective in treating upper limb paralysis. We describe the use of transcranial direct current stimulation to improve the function and frequency of use of the paralyzed hand of a patient with lenticulostriate artery occlusion. CASE PRESENTATION A Japanese man in his fifties developed a left internal hindfoot perforator branch infarction owing to lenticulostriate artery occlusion, and presented with severe right upper and lower limb paralysis. Multiple interventions for the paralyzed hand, primarily robot therapy, did not noticeably change his hand function or frequency of use in daily life. Therefore, transcranial direct current stimulation was used in combination with upper limb functional exercises for 20 minutes a day, five times a week, for 6 weeks. Consequently, scores for the hand items of the Fugl-Meyer Assessment of the upper extremities improved, and pain and subluxation around the shoulder joint were reduced. Furthermore, the frequency of use and the quality of movement of the paralyzed hand were improved. CONCLUSIONS Upper limb functional training and transcranial direct current stimulation improved the function and frequency of use of the paralyzed hand in a stroke patient with severe upper limb paralysis, suggesting that this combined intervention could effectively improve hand function in patients with severe upper limb paralysis.
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Affiliation(s)
- Koichiro Hirayama
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan.
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan.
| | - Takeshi Fuchigami
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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Li X, Yang Z, Wang S, Xu P, Wei T, Zhao X, Li X, Zhang Y, Li Y, Mei N, Wu Q. Impact of shoulder subluxation on peripheral nerve conduction and function of hemiplegic upper extremity in stroke patients: A retrospective, matched-pair study. Neurol Res 2021; 43:511-519. [PMID: 33402052 DOI: 10.1080/01616412.2020.1870360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To investigate the impact of shoulder subluxation (SS) on peripheral nerve conduction and function of the hemiplegic upper extremity (HUE) in poststroke patients.Methods: Thirty post-stroke patients were selected (SS group: 15 patients, non-SS group: 15 patients, respectively). Evaluation of nerve conduction in upper limbs: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median, and ulnar nerves; the motor and sensory conduction velocity and the sensory nerve action potential (SNAP) amplitude of median, ulnar, and radial nerves. The Brunnstrom stage scale was used to evaluate the HUE motor function.Results: Compared with the healthy side, the CMAP and SNAP amplitudes of tested nerves on the HUE in both groups were lower, and the CMAP latency of the suprascapular, axillary and musculocutaneous nerves on the HUE in the SS group was longer (P < 0.05). Compared with the HUE in non-SS group, the CMAP amplitude of tested nerves (except ulnar) was decreased more (P < 0.05), the motor conduction velocity of the median nerve was lower (P < 0.05), and the Brunnstrom stage of the HUE was lower in SS group (P < 0.05).Conclusions: Stroke may lead to extensive abnormal nerve conduction on the HUE, and SS may aggravate the abnormality, which may disturb the recovery of upper limb function.
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Affiliation(s)
- Xiangzhe Li
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Zhiwei Yang
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Sheng Wang
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Panpan Xu
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Tianqi Wei
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Xiaomeng Zhao
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Xifeng Li
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Yanmei Zhang
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Ying Li
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Na Mei
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
| | - Qinfeng Wu
- Rehabilitation Medical Center, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, People's Republic of China
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Kumar P, Turton A, Cramp M, Smith M, McCabe C. Management of hemiplegic shoulder pain: A UK‐wide online survey of physiotherapy and occupational therapy practice. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1874. [PMID: 33241633 DOI: 10.1002/pri.1874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Praveen Kumar
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Ailie Turton
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Mary Cramp
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
| | - Mark Smith
- Leith Community Treatment Centre Edinburgh Scotland UK
| | - Candy McCabe
- Department of Allied Health Professions Faculty of Health and Applied Sciences University of West of England Bristol UK
- Dorothy House Hospice Care Winsley UK
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Xie H, Lu K, Lyu G, Kang G, Huang Q, Liu S, Huo M, Onoda K, Maruyama H, Nobori H. Reliability of ultrasonographic measurement of the supraspinatus thickness at different angles of shoulder abduction in patients with stroke. J Phys Ther Sci 2020; 32:257-259. [PMID: 32184543 PMCID: PMC7064348 DOI: 10.1589/jpts.32.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/24/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The primary purpose of this study was to evaluate the usefulness of the
intraclass correlation coefficient for evaluating the reliability of the measurement of
the supraspinatus thickness on shoulder ultrasonography at different angles in a resting
position in patients with stroke. [Participants and Methods] The study included 20
patients with stroke. The supraspinatus thickness was measured on both sides on
ultrasonography, with the participants’ shoulders in abduction at 3 testing angles (0°,
30°, and 60° abduction). Each measurement was performed three times, and the average of
the three measurements was recorded. The intraclass correlation coefficient was
calculated, with the supraspinatus thickness measured twice at an interval of 24 hours as
the factor. [Results] All intraclass correlation coefficients for the hemiplegic and
normal sides were greater than 0.93 when the shoulders were at the three testing angles.
[Conclusion] In this investigation, the reliability of measuring the supraspinatus
thickness on shoulder ultrasonography at each angle for 3 times was evaluated and was
found to be excellent.
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Affiliation(s)
- Hualong Xie
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Kuan Lu
- Beijing Chaoyang Integrative Medicine Emergency Medical Center, China
| | - Guochen Lyu
- Beijing Chaoyang Integrative Medicine Emergency Medical Center, China
| | - Guoxin Kang
- Beijing Chaoyang Integrative Medicine Emergency Medical Center, China
| | - Qiuchen Huang
- Capital Medical University, School of Rehabilitation Medicine, China.,China Rehabilitation Research Center, China
| | - Shan Liu
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Ming Huo
- Department of Physical Therapy, Faculty of Medical Health, Himeji Dokkyo University, Japan
| | - Ko Onoda
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Hitoshi Maruyama
- Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Otawara City, Tochigi 324-8501, Japan
| | - Hiroshi Nobori
- Department of Judo Therapy, Teikyo University of Science, Japan
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8
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Ünlüer NÖ, Ozkan T, Yaşa ME, Ateş Y, Anlar Ö. An investigation of upper extremity function in patients with multiple sclerosis, and its relation with shoulder position sense and disability level. Somatosens Mot Res 2019; 36:189-194. [PMID: 31393220 DOI: 10.1080/08990220.2019.1644998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose: The purposes of this study were to investigate upper extremity function and shoulder position sense in patients with multiple sclerosis and its relation with disability level. Materials and methods: In this study, 20 multiple sclerosis and 20 healthy subjects participated. The disability level was determined by the Expanded Disability Status Scale. Mental state was assessed using the Mini-Mental State Examination. Upper extremity function was measured with the 9-Hole Peg Test and shoulder position sense was evaluated with a Dualer IQTM digital inclinometer. The study protocol was also registered at http://clinicaltrials.gov (NCT03846336). Results: Upper extremity function scores were lower and shoulder position sense error scores were greater in patients with multiple sclerosis in comparison to healthy controls (p < .05). While disability level was associated with dominant and non-dominant upper extremity function, no relationship was found between the disability level and shoulder position sense (p < .05). Only the dominant side shoulder position senses at 30° and 60° abduction were found to be associated with upper extremity function (p < .05). Conclusions: These results indicate that shoulder position sense and upper extremity function were affected in patients with multiple sclerosis with mild to moderate disability. Upper extremity functions were associated with shoulder abduction joint sense in patients with multiple sclerosis. In the assessment of upper extremity functions, joint position sense should be taken into account even at early stages of multiple sclerosis, so it may provide guidance in planning rehabilitation programs.
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Affiliation(s)
- Nezehat Özgül Ünlüer
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Taskin Ozkan
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Mustafa Ertuğrul Yaşa
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Yasemin Ateş
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University , Ankara , Turkey
| | - Ömer Anlar
- Faculty of Health Science, Physiotherapy and Rehabilitation, Ankara Yildirim Beyazit University , Ankara , Turkey
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Efficiency of Neuromuscular Electrical Stimulation and Transcutaneous Nerve Stimulation on Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:1730-1739. [DOI: 10.1016/j.apmr.2018.04.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/09/2018] [Accepted: 04/18/2018] [Indexed: 11/20/2022]
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Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6085961. [PMID: 30065941 PMCID: PMC6051292 DOI: 10.1155/2018/6085961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/19/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
Abstract
Background Glenohumeral subluxation (GHS) is common in patients with acute hemiplegia caused by stroke. GHS and upper limb function are closely related. Objective Using musculoskeletal ultrasonography (MSUS) to objectively evaluate the efficacy of functional magnetic stimulation (FMS) in the treatment of GHS in acute hemiplegic patients after stroke. Methods The study used prospective case control study. Stroke patients with GHS were recruited and assigned to control group and FMS group. Control group received electrode stimulation at the supraspinatus and deltoid muscles of the hemiplegic side, while FMS group was stimulated at the same locations. Before and after treatment, the distances of the acromion-greater tuberosity (AGT), acromion-lesser tuberosity (ALT), acromiohumeral distance (AHD), supraspinatus thickness (SST), and deltoid muscle thickness (DMT) in patients' bilateral shoulder joint were measured by MSUS, respectively. Meanwhile, Fugl-Meyer Assessment (FMA) was used to evaluate the improvement of upper limb function. Results 30 patients were recruited. After FMS treatment, there was a significant decrease in the difference value between ipsilateral side and contralateral side of AGT [t = 8.595, P < 0.01], ALT [t = 11.435, P < 0.01], AHD [t = 8.375, P < 0.01], SST [t = 15.394, P < 0.01], and DMT [t = 24.935, P < 0.01], and FMA score increased [t = −13.315, P < 0.01]. Compared with control group, FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT [t = 2.161, P < 0.05], ALT [t = 3.332, P < 0.01], AHD [t = 8.768, P < 0.01], SST [t = 6.244, P < 0.01], and the DMT [t = 3.238, P < 0.01], and FMA score increased more significantly in FMS group [t = 7.194, P < 0.01]. Conclusion The study preliminarily shows that the MSUS can objectively and dynamically evaluate the treatment effect of GHS in hemiplegic patients. Meanwhile, compared with control group, the FMS is more effective and has fewer side effects, and the long-term effect of FMS is worth further study. This trial is registered with ChiCTR1800015352.
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Arya KN, Pandian S, Vikas, Puri V. Rehabilitation methods for reducing shoulder subluxation in post-stroke hemiparesis: a systematic review. Top Stroke Rehabil 2017; 25:68-81. [DOI: 10.1080/10749357.2017.1383712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kamal Narayan Arya
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vinod Puri
- Department of Neurology, GB Pant Post Graduate Institute of Medical Education and Research, New Delhi, India
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12
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Idowu BM, Ayoola OO, Adetiloye VA, Komolafe MA, Afolabi BI. Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders. J Ultrason 2017; 17:106-112. [PMID: 28856018 PMCID: PMC5516080 DOI: 10.15557/jou.2017.0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 11/22/2022] Open
Abstract
Aim of the study To evaluate the usefulness of ultrasonographic acromion-greater tuberosity distance measurement and Shoulder ratio in detecting post-stroke inferior shoulder subluxation. Material and methods Forty-five hemiplegic stroke patients and 45 controls underwent shoulder sonography to measure their acromion-greater tuberosity distance. Side-to-side acromion-greater tuberosity distance differences and Shoulder ratios were derived from the acromion-greater tuberosity distance values. The long head of biceps tendon, subscapularis tendon, supraspinatus tendon, and the infraspinatus tendon were also evaluated to exclude full thickness tendon tears. Data were analyzed using the Statistical Package for Social Sciences version 20.0 for windows. Normality of data distribution was checked using the Kolmogorov–Smirnov test. Mann–Whitney U test and Chi-square tests were utilized. Results Hemiplegic and control shoulders’ acromion-greater tuberosity distance values were 2.8 ± 0.6 cm and 2.4 ± 0.4 cm, respectively (p = 0.001). Hemiplegic and control shoulder ratios were 1.3 ± 0.3 and 1.1 ± 0.1, respectively; p < 0.001. Point biserial correlation showed that the presence of subluxation correlated moderately with higher shoulder ratios in all the hemiplegics (rpb = 0.520; p < 0.001). Conclusion Our results suggest that acromion-greater tuberosity distance measurement is useful for detecting inferior shoulder subluxation. Shoulder ratio may be of complementary or supplemental value to acromion-greater tuberosity distance difference.
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Affiliation(s)
- Bukunmi M Idowu
- Departments of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Oluwagbemiga O Ayoola
- Departments of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Victor A Adetiloye
- Departments of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Morenikeji A Komolafe
- Internal Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Babalola I Afolabi
- Departments of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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Idowu BM, Ayoola OO, Adetiloye VA, Komolafe MA. Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders. Pol J Radiol 2017; 82:141-148. [PMID: 28382186 PMCID: PMC5360429 DOI: 10.12659/pjr.899684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/08/2016] [Indexed: 12/15/2022] Open
Abstract
Background Stroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices. Material/Methods Forty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-subdeltoid bursitis or effusion and adhesive capsulitis. Results Hemiplegic shoulders exhibited significantly higher number of pathologies compared to the unaffected shoulders and shoulders of controls (p=0.000). One or more structural abnormalities were found in all 45 (100%) hemiplegic shoulders, 25 (55.6%) unaffected shoulders of the stroke subjects, and 39 (43.3%) control shoulders. The most frequent pathologies in the hemiplegic shoulders were the following: tendinosis of the long head of bicep tendon (48.9%), inferior shoulder subluxation (44.4%), co-existing subacromial-subdeltoid bursa/long head of bicep tendon sheath effusion (44.4%), and long head of bicep tendon sheath effusion only (40%). Tendinosis of the long head of bicep tendon was commoner in hemiplegic shoulders with poor motor status than those with good motor status. Conclusions Hemiplegic shoulders have significantly higher number of structural abnormalities than unaffected shoulders and the shoulders of controls. Hemiplegic stroke patients should undergo ultrasonography of the hemiplegic shoulder to define the nature and extent of soft tissue injuries prior to physical therapy.
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Affiliation(s)
- Bukunmi Michael Idowu
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | | | - Victor Adebayo Adetiloye
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
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dos Santos GL, Souza MB, Desloovere K, Russo TL. Elastic Tape Improved Shoulder Joint Position Sense in Chronic Hemiparetic Subjects: A Randomized Sham-Controlled Crossover Study. PLoS One 2017; 12:e0170368. [PMID: 28099472 PMCID: PMC5242462 DOI: 10.1371/journal.pone.0170368] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 01/04/2017] [Indexed: 11/26/2022] Open
Abstract
Background Elastic tape has been widely used in clinical practice in order to improve upper limb (UL) sensibility. However, there is little evidence that supports this type of intervention in stroke patients. Objective To verify the effect of elastic tape, applied to the paretic shoulder, on joint position sense (JPS) during abduction and flexion in subjects with chronic hemiparesis compared to sham tape (non-elastic tape). Furthermore, to verify if this potential effect is correlated to shoulder subluxation measurements and sensorimotor impairment. Methods A crossover and sham-controlled study was conducted with post-stroke patients who were randomly allocated into two groups: 1) those who received Sham Tape (ST) first and after one month they received Elastic Tape (ET); 2) those who received Elastic Tape (ET) first and after one month they received Sham Tape (ST). The JPS was evaluated using a dynamometer. The absolute error for shoulder abduction and flexion at 30° and 60° was calculated. Sensorimotor impairment was determined by Fugl-Meyer, and shoulder subluxation was measured using a caliper. Results Thirteen hemiparetic subjects (average time since stroke 75.23 months) participated in the study. At baseline (before interventions), the groups were not different for abduction at 30° (p = 0.805; p = 0.951), and 60° (p = 0.509; p = 0.799), or flexion at 30° (p = 0.872; p = 0.897) and 60° (p = 0.853; p = 0.970). For the ET group, differences between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° p<0.010) and 60° (p<0.010) were observed. For the ST group, differences were also observed between pre and post-elastic tape for abduction at 30° (p<0.010) and 60° (p<0.010), and flexion at 30° (p<0.010,) and 60° (p<0.010). Potential effects were only correlated with shoulder subluxation during abduction at 30° (p = 0.001, r = -0.92) and 60° (p = 0.020, r = -0.75). Conclusion Elastic tape improved shoulder JPS of subjects with chronic hemiparesis regardless of the level of UL sensorimotor impairment. However, this improvement was influenced by the subluxation degree at abduction.
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Affiliation(s)
- Gabriela Lopes dos Santos
- Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil
- * E-mail: (GLS); (TLR)
| | - Matheus Bragança Souza
- Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
- Clinical Motion Analysis Laboratory (CERM), University Hospital Pellenberg, Pellenberg, Belgium
| | - Thiago Luiz Russo
- Laboratory of Neurological Physiotherapy Research, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil
- * E-mail: (GLS); (TLR)
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Santos GL, García-Salazar LF, Souza MB, Oliveira AB, Camargo PR, Russo TL. Torque steadiness and muscle activation are bilaterally impaired during shoulder abduction and flexion in chronic post-stroke subjects. J Electromyogr Kinesiol 2016; 30:151-60. [PMID: 27451360 DOI: 10.1016/j.jelekin.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To characterize sensorimotor control and muscle activation in the shoulder of chronic hemiparetic during abduction and flexion in maximal and submaximal isometric contractions. Furthermore, to correlate submaximal sensorimotor control with motor impairment and degree of shoulder subluxation. METHODS Thirteen chronic hemiparetic post-stroke age-gender matched with healthy were included. Isometric torques were assessed using a dynamometer. Electromyographic activity of the anterior and middle deltoid, upper trapezius, pectoralis major and serratus anterior muscles were collected. Variables were calculated for torque: peak, time to target, standard deviation (SD), coefficient of variation (CV), and standard error (RMSE); for muscle activity: maximum and minimum values, range and coefficient of activation. Motor impairment was determined by Fugl-Meyer and shoulder subluxation was measured with a caliper. RESULTS Paretic and non-paretic limbs reduced peak and muscle activation during maximal isometric contraction. Paretic limb generated lower force when compared with non-paretic and control. Paretic and non-paretic presented higher values of SD, CV, RMSE, and CV for prime mover muscles and minimum values for all muscles during steadiness. No correlation was found between sensorimotor control, motor impairment and shoulder subluxation. CONCLUSION Chronic hemiparetic presented bilateral deficits in sensorimotor and muscle control during maximal and submaximal shoulder abduction and flexion.
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Affiliation(s)
- Gabriela Lopes Santos
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil.
| | - Luisa Fernanda García-Salazar
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil; Physical Therapy Program, School of Medicine and Health Science, University of Rosario, Bogotá, D.C., Colombia
| | - Matheus Bragança Souza
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Ana Beatriz Oliveira
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Paula Rezende Camargo
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Thiago Luiz Russo
- Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Electroencephalographic markers of robot-aided therapy in stroke patients for the evaluation of upper limb rehabilitation. Int J Rehabil Res 2016; 38:294-305. [PMID: 26317486 DOI: 10.1097/mrr.0000000000000125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Stroke is the leading cause of permanent disability in developed countries; its effects may include sensory, motor, and cognitive impairment as well as a reduced ability to perform self-care and participate in social and community activities. A number of studies have shown that the use of robotic systems in upper limb motor rehabilitation programs provides safe and intensive treatment to patients with motor impairments because of a neurological injury. Furthermore, robot-aided therapy was shown to be well accepted and tolerated by all patients; however, it is not known whether a specific robot-aided rehabilitation can induce beneficial cortical plasticity in stroke patients. Here, we present a procedure to study neural underpinning of robot-aided upper limb rehabilitation in stroke patients. Neurophysiological recordings use the following: (a) 10-20 system electroencephalographic (EEG) electrode montage; (b) bipolar vertical and horizontal electrooculographies; and (c) bipolar electromyography from the operating upper limb. Behavior monitoring includes the following: (a) clinical data and (b) kinematic and dynamic of the operant upper limb movements. Experimental conditions include the following: (a) resting state eyes closed and eyes open, and (b) robotic rehabilitation task (maximum 80 s each block to reach 4-min EEG data; interblock pause of 1 min). The data collection is performed before and after a program of 30 daily rehabilitation sessions. EEG markers include the following: (a) EEG power density in the eyes-closed condition; (b) reactivity of EEG power density to eyes opening; and (c) reactivity of EEG power density to robotic rehabilitation task. The above procedure was tested on a subacute patient (29 poststroke days) and on a chronic patient (21 poststroke months). After the rehabilitation program, we observed (a) improved clinical condition; (b) improved performance during the robotic task; (c) reduced delta rhythms (1-4 Hz) and increased alpha rhythms (8-12 Hz) during the resting state eyes-closed condition; (d) increased alpha desynchronization to eyes opening; and (e) decreased alpha desynchronization during the robotic rehabilitation task. We conclude that the present procedure is suitable for evaluation of the neural underpinning of robot-aided upper limb rehabilitation.
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Tao W, Fu Y, Hai-Xin S, Yan D, Jian-Hua L. The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review. J Phys Ther Sci 2015; 27:3007-10. [PMID: 26504346 PMCID: PMC4616147 DOI: 10.1589/jpts.27.3007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/25/2015] [Indexed: 01/12/2023] Open
Abstract
[Purpose] This review article is designed to expose the application of sonography in
shoulder pain after stroke. [Methods] A range of databases was searched to identify
articles that address sonography examination, with or without ultrasound guided
corticosteroid injection for hemiplegic shoulder pain (HSP). The electronic databases of
PubMed, CENTRAL, CINAHL, Cochrane Library, Medline were searched. [Results] According to
the articles identified in our databases research, sonographic technique has potential to
provide objective measurements in patients with HSP. The main sonography finding of HSP
included subacromial subdeltoid (SASD) bursal effusion, tendinosis of the supraspinatus
and subscapularis tendon, long head of biceps tendon sheath effusion, and shoulder
subluxation. Our analysis also revealed significantly decreased pain score (VAS) and
increased passive external rotation degree in the steroid injection group than control
group. [Conclusion] The sonography examination is useful for HSP assessment and ultrasound
guided technique is recommended for HSP injection treatment.
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Affiliation(s)
- Wu Tao
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Yu Fu
- Department of Rehabilitation Medicine, Alxa League Central Hospital, China
| | - Song Hai-Xin
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Dong Yan
- Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang CAPF, China
| | - Li Jian-Hua
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
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Dos Santos GL, Salazar LFG, Lazarin AC, de Russo TL. Joint position sense is bilaterally reduced for shoulder abduction and flexion in chronic hemiparetic individuals. Top Stroke Rehabil 2015; 22:271-80. [PMID: 26258452 DOI: 10.1179/1074935714z.0000000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND The stroke is the leading cause of adult disability in the world. One of the main complaints of individuals post-stroke refers to the loss of function of the upper limb, as evidenced during the performance of activities of daily living. This difficulty may be related to an important component of sensorimotor control, joint position sense, a submodality of proprioception. OBJECTIVES To investigate whether the proprioception of both shoulders of chronic hemiparetic patients is altered during abduction and flexion. METHODS Thirteen subjects with chronic hemiparesis due to ischemic stroke and 13 healthy subjects matched for gender and age was included. The joint sense position was assessed using a dynamometer. Absolute error for shoulder abduction and flexion at the 30 and 60° was calculated. RESULTS No difference was found between the paretic and non-paretic limbs in movements at both 30 and 60°. Higher values of absolute error for both paretic and non-paretic limbs compared to the control were observed during abduction at 30 and at 60°. CONCLUSIONS Chronic ischemic post-stroke patients have bilateral proprioceptive deficits in the shoulder during abduction and flexion. But these deficits are dependent on the movement performed and the angle tested. The results demonstrate the need to include bilateral exercises and/or visual feedback in the rehabilitation program.
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Assessment of glenohumeral subluxation in poststroke hemiplegia: comparison between ultrasound and fingerbreadth palpation methods. Phys Ther 2014; 94:1622-31. [PMID: 25060958 DOI: 10.2522/ptj.20130303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Glenohumeral subluxation (GHS) is a common poststroke complication. Treatment of GHS is hampered by the lack of objective, real-time clinical measurements. OBJECTIVE The aims of this study were: (1) to compare an ultrasound method of GHS measurement with the fingerbreadth palpation method using a receiver operating characteristic curve (ROC) and (2) to report the sensitivity and specificity of this method. DESIGN A prospective study was conducted. SETTING The study was conducted in local hospitals and day centers in the southwest of England. PATIENTS One hundred five patients who had one-sided weakness following a first-time stroke (51 men, 54 women; mean age=71 years, SD=11) and who gave informed consent were enrolled in the study. MEASUREMENTS Ultrasound measurements of acromion-greater tuberosity (AGT) distance were used for the assessment of GHS. Measurements were undertaken on both shoulders by a research physical therapist trained in shoulder ultrasound with the patient seated in a standardized position. Fingerbreadth palpation assessment of GHS was undertaken by a clinical physical therapist based at the hospital, who also visited the day centers. RESULTS The area under the ROC curve was 0.73 (95% confidence interval [95% CI]=0.63, 0.83), suggesting that the ultrasound method has good agreement compared with the fingerbreadth palpation method. A cutoff point of ≥0.2 cm AGT measurement difference between affected and unaffected shoulders generated a sensitivity of 68% (95% CI=51%, 75%), a specificity of 62% (95% CI=47%, 80%), a positive likelihood ratio of 1.79 (95% CI=1.1, 2.9), and a negative likelihood ratio of 0.55 (95% CI=0.4, 0.8). LIMITATIONS Clinical therapists involved in the routine care of patients conducted the fingerbreadth palpation method. It is likely that they were aware of the patients' subluxation status. CONCLUSION The ultrasound method can detect minor asymmetry (≤0.5 cm) and has the potential advantage over the fingerbreadth palpation method of identifying patients with minor subluxation.
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