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Shoulder pain after stroke: a prospective population-based study
Ingrid Lindgren1, Ann-Cathrin Jönsson, Bo Norrving
1Department of Neurology, Clinical Sciences, Lund University, Lund, Sweden. ingrid.a.lindgren@skane.se
Insights
Shoulder pain affects nearly one-third of stroke survivors, often with moderate to severe intensity. Impaired arm function and lower general health status increase the risk, highlighting the need for focused post-stroke care.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Outcomes
Background:
- Shoulder pain is a common complication following stroke.
- Limited data exists on its prevalence, predictors, and outcomes in unselected stroke populations.
Purpose of the Study:
- To investigate the prevalence, predictors, and functional impact of shoulder pain in a population-based stroke cohort.
- To identify risk factors associated with shoulder pain development and persistence after stroke.
Main Methods:
- A 1-year prospective study of 416 first-ever stroke patients from the Lund Stroke Register.
- Assessment of shoulder pain (intensity, onset), arm motor function, and functional status (Barthel Index) at 4 and 16 months post-stroke.
- General health status (NIH Stroke Scale) recorded at stroke onset.
Main Results:
- 22% of patients developed shoulder pain within 4 months post-stroke, with 79% experiencing moderate-to-severe pain.
- Impaired arm motor function and higher NIH Stroke Scale scores were significant predictors of shoulder pain.
- Shoulder pain frequently restricted dressing and ambulation, impacting daily life significantly at both follow-ups.
Conclusions:
- Nearly one-third of stroke patients develop shoulder pain, often severe, significantly impacting daily activities.
- Impaired arm motor function and lower general status are key risk factors, necessitating targeted interventions in post-stroke care.
- Early identification and management of shoulder pain are crucial for improving functional recovery and quality of life after stroke.
Background And Purpose:
Shoulder pain is a well-known complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited.
Methods:
During a 1-year period, 416 first-ever stroke patients were included in the population-based Lund Stroke Register. After 4 months, 327 patients were followed up and 1 year later, the surviving 305 patients were followed up again. General status (National Institutes of Health Stroke Scale score) was registered at stroke onset. Shoulder pain intensity (visual analog scale, score 0 to 30=no-mild and 40 to 100=moderate-severe pain); arm motor function; restricted dressing and/or ambulating; and functional status (Barthel Index) were registered at both follow ups.
Results:
Shoulder pain onset within 4 months after stroke was reported by 71 patients (22%). Among the 61 patients able to score the visual analog scale, 79% had moderate-severe pain. One year later, 8 of these 71 patients had died, 17 had no remaining pain, and 28 additional patients had developed shoulder pain since the first follow up. Lost or impaired arm motor function and high National Institutes of Health Stroke Scale score were predictors of shoulder pain. Shoulder pain restricted daily life often or constantly when dressing for 51%/31% and when ambulating for 29%/13% of the patients at 4 and 16 months, respectively.
Conclusions:
Almost one third of the 327 patients developed shoulder pain after stroke onset, a majority with moderate- severe pain. Shoulder pain restricts patients' daily life after stroke. The increased risk of shoulder pain for patients with impaired arm motor function and/or low general status needs close attention in poststroke care.
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