What is the role of radiography in the workup of hemiplegic shoulder pain?

Updated: Feb 08, 2019
  • Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

The need to objectively measure shoulder subluxation, as well as to determine the effectiveness of slings and other supports used in the treatment and prevention of shoulder subluxation, has led to the development of standardized radiographic techniques. Boyd and colleagues describe that basic radiographic evaluation for shoulder subluxation involves the use of qualitative and quantitative radiographic methods. [39]

The qualitative method involves visually inspecting the radiographs in order to classify the degree of subluxation. The quantitative method involves comparing the affected shoulder with the unaffected shoulder, or taking a single radiograph of the affected shoulder to measure the amount of subluxation.

Prevost and coauthors proposed a 3-dimensional (3-D) radiographic technique that was shown to be more precise and reliable than other clinical and radiographic techniques in locating the true spatial position of the humeral head relative to the glenoid fossa. [15] However, since the 3-D technique requires the use of specialized equipment and multiple radiographic exposures, Prevost believes that using one of the more basic 2-dimensional (2-D) techniques is sufficient in assisting with an accurate diagnosis of shoulder subluxation.

Subsequently, Boyd and coauthors proposed their standardized "plane of the scapula method" for classifying subluxation. [39] This method avoids assumptions about the normality or symmetry of the unaffected shoulder and minimizes the number of radiographs required.

This method has shown moderate measurement validity when comparing the radiograph with the 2 most reliable clinical measures, calipers and fingerbreadths. Even though this technique shows valid correlation with clinical measures and good interrater reliability, it may not be feasible to perform because it requires specialized equipment that is not widely available.

In a study by Kumer et al, diagnostic ultrasonography was used to assess shoulder subluxation in stroke patients and to determine intrarater reliability of these measurements. The acromion-greater tuberosity measurements obtained demonstrated intrarater reliability and discriminate validity. The potential use of ultrasonography to measure subluxation is promising but requires further study. [40]

A study by Doğun et al indicated that the use of magnetic resonance imaging (MRI) is preferable to that of ultrasonography in evaluating patients with hemiplegia and shoulder pain. The study, of 68 patients, found that ultrasonographic findings with regard to shoulder pathology were not consistent with MRI results, with ultrasonography, for example, demonstrating supraspinatus tendinitis and acromioclavicular joint degeneration in 54.4% and 26.5% of patients, respectively, compared with 36.8% and 79.7% of patients, respectively, on MRI. [41]


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