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CC BY-NC-ND 4.0 · Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin
DOI: 10.1055/a-2147-0259
Review

Study On The Pathogenesis Of Post-Stroke Shoulder Pain Based On The Characteristics Of Magnetic Resonance Imaging-A Retrospective Study

Studie zur Pathogenese von Schulterschmerzen nach Schlaganfall anhand charakteristischer MRT-Merkmale: eine retrospektive Studie
Wenjuan Yu  ‡
1   Traditional Chinese Medicine Department, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
,
Luoluo Wang‡
2   Rehabilitation Department, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
,
Yige Li
2   Rehabilitation Department, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
,
Shuwei Tao
3   Radiological Department, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
,
Qingrui Li
4   Medical Department, Suzhou Vocational Health College, Suzhou, China
,
Mingyue Zhu
2   Rehabilitation Department, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Abstract

Background High morbidity has been proved frequently happened in post-stroke shoulder pain (PSSP), but the specific pathogenesis of PSSP still remains unclear. Therefore, further research needs to be done to investigate this field.

Objective The aim of this study which reviewed the features of magnetic resonance imaging (MRI) on shoulder joint of patients with PSSP, is to find the consequence of pathogenesis.

Methods This study starts from June 2017 to August 2021, 74 PSSP patients who accepted MRI examination were selected in the Department of rehabilitation medicine of the Second Affiliated Hospital of Nanjing Medical University (inpatient and outpatient). This study sorted out and summarized patients’ MRI characteristics, analyzing differences of MRI appearance according to age, gender, hemiplegic side, stroke type and onset time.

Results After examining all PSSP patients’ MRI characteristics, this study found 56 (75.67%) had supraspinatus tendon injury, 11 (14.86%) infraspinatus tendon injury, 24 (32.43%) subscapular tendon injury, 2 (2.7%) teres minor tendon injury, 60 (81.08%) tendon sheath effusion (inflammation) of long head of biceps brachii, 23 (31.08%) humeral head bone marrow edema and 64 (86.49%) shoulder joint capsule effusion. Moreover, there were 6 cases of acromial descending sac effusion (8.11%), 11 cases of coracoid descending sac effusion (14.86%), 8 cases of synovial thickening (10.81%), and 1 case of ossifying myositis (1.35%).

Conclusion No significant differences were found in MRI features according to gender and hemiplegic side .The results showed the injury of supraspinatus tendon significantly increased in the older group compared to the younger group (P=0.039).The patients with supraspinatus tendon injury and tendon sheath effusion (inflammation) of long head of biceps brachii have higher cerebral infarction than patients with cerebral hemorrhage (P=0.002, P=0.028). Based on the time of onset, the participants were divided into three groups: within 1 month, 1–3 months and more than 3 months. The results suggested significant differences in humeral head bone marrow edema and shoulder joint capsule effusion numbers among the three groups (P=0.049, P=0.002). The results of this research could help to improve the accuracy of clinical diagnosis and treatment of PSSP, putting forward a more reasonable treatment scheme.

Zusammenfassung

Hintergrund Es hat sich gezeigt, dass Schulterschmerzen nach Schlaganfall häufig mit hoher Morbidität einhergehen, doch ist die genaue Pathogenese noch nicht geklärt. Daher sind weiteren Studien in diesem Bereich erforderlich.

Ziel Ziel der vorliegenden Studie war es, durch die Untersuchung der Auffälligkeiten in der Magnetresonanztomographie (MRT) des Schultergelenks bei Patienten mit Schulterschmerzen nach Schlaganfall die sich aus der Pathogenese ergebenden Folgezustände zu ermitteln.

Methodik Im Rahmen der Studie wurden in der Abteilung für Rehabilitationsmedizin des zweiten angegliederten Krankenhauses der Medizinischen Universität Nanjing 74 (stationäre oder ambulante) Patienten mit Schulterschmerzen nach Schlaganfall, die zwischen Juni 2017und August 2021 einer MRT-Untersuchung zugestimmt hatten, ausgewählt. In der Studie wurden die MRT-Merkmale der Patienten ermittelt und zusammengefasst. MRT-Auffälligkeiten wurden nach Alter, Geschlecht, Seite der Hemiplegie, Schlaganfalltyp und Zeitpunkt des Auftretens analysiert.

Ergebnisse Nach Untersuchung der MRT-Veränderungen bei allen in die Studie aufgenommenen Patienten mit Schulterschmerzen nach Schlaganfall ergab sich folgende Verteilung: 56 (75, 67%) Patienten mit Verletzung der Supraspinatussehne, 11 (14, 86%) mit Verletzung der Infraspinatussehne, 24 (32, 43%) mit Verletzung der Subscapularissehne, 2 (2, 7%) mit Verletzung der Sehne des Musculus teres minor, 60 (81, 08%) mit Sehnenscheidenerguss (Entzündung) der Sehne des Caput longum des Musculus biceps brachii, 23 (31, 08%) mit Knochenmarködem im Bereich des Humeruskopfes und 64 (86, 49%) mit Erguss der Schultergelenkskapsel. Darüber hinaus gab es 6 Fälle mit Erguss der Bursa subakromialis (8, 11%), 11 Fälle mit Erguss der Bursa subcoracoidea (14, 86%), 8 Fälle mit Verdickung der Synovia (10, 81%) und 1 Fall mit Myositis ossificans (1, 35%).

Schlussfolgerung Es fanden sich keine signifikanten Unterschiede in den MRT-Merkmalen in Bezug auf das Geschlecht und die Seite der Hemiplegie. Die Ergebnisse zeigten, eine signifikante Zunahme der Verletzung der Supraspinatussehne in der Gruppe der älteren Patienten im Vergleich zur Gruppe der jüngeren Patienten (P=0, 039). Bei Patienten mit einer Verletzung der Supraspinatussehne und einem Sehnenscheidenerguss (Entzündung) der Sehne des Caput longum des M. biceps brachii liegt häufiger ein Hirninfarkt vor als eine Hirnblutung (P=0, 002, P=0, 028). Je nach Zeitpunkt des Auftretens wurden die Teilnehmer in drei Gruppen eingeteilt: innerhalb von 1 Monat, 1–3 Monaten und mehr als 3 Monaten.

Die Ergebnisse weisen auf signifikante Unterschiede in der Anzahl der Knochenmarködeme des Humeruskopfes und der Ergüsse der Schultergelenkkapsel zwischen den drei Gruppen hin (P=0, 049, P=0, 002). Die Ergebnisse dieser Untersuchung könnten dazu beitragen, die Genauigkeit der klinischen Diagnose und Therapie von Patienten mit Schulterschmerzen nach Schlaganfall zu verbessern und ein sinnvolleres Behandlungsschema zu entwickeln.

Key words

nuclear magnetic resonance imaging features - pathogenesis - post-stroke shoulder pain

Schlüsselwörter

Merkmale in der Magnetresonanztomographie (MRT) - Pathogenese - Schulterschmerzen nach Schlaganfall


Publication History

Received: 30 November 2022

Accepted: 20 July 2023

Article published online:
06 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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