Temporal changes in electrophysiological, clinical and radiological parameters in the hemiplegic's shoulder

The relationship between electrophysiological, clinical and radiological parameters in the shoulder of hemiplegic patients was examined in a group of 24 subjects. Measurements and observations were made about the fourth month after CVA and again some eight months later. Total follow-up period extended to a maximum of 28 months. Electrophysiological tests included concentric needle EMG and conduction tests. In the shoulder X-ray four stages were described: normal, V-shaped space, initial subluxation and advanced subluxation. The presence of pain, reflex sympathetic dystrophy, atrophy and return of movement were registered. The most striking findings, consistent with lower motor neuron lesion, were those of parallel changes in axillary nerve latencies (obtained through stimulation from Erb's point) and shoulder X-ray stage. Age and time lapse between examinations turned out to be significantly related to such changes: younger patients did better and changes were registered even after one year from the first examination. An anatomical explanation linking the axillary nerve with humeral head disposition on the hemiplegic side is offered.