A novel approach using potable diagnostic ultrasound to inform treatment choices for hemiplegic shoulder pain – A case study report

Introduction: Hemiplegic shoulder pain (HSP) has a reported incidence of up to 84% on the affected side following a stroke. NICE recommends HSP should be managed according to each person’s needs.The purpose of this case study was to report findings from a patient with HSP who received problem specific treatment following real-time scanning of shoulder region with a portable diagnostic ultrasound. Case Description: The patient was a 45 year-old woman with right sided-hemiparesis resulting from a clot in December 2013. Patient was undergoing rehabilitation in a private clinic and reported shoulder pain since November 2014. On examination patient had pain (VAS 7/10) during shoulder movements. Patient was receiving the following treatment: over-arm exercises, electrical stimulation to deltoid, stretches, and Saebo exercises. Ultrasound scanning was undertaken on 23rd February 2015 to record acromion-greater tuberosity (AGT) distance (Affected AF-3.35 cm, Unaffected UAF-2.04 cm), diameter of supraspinatus in resting state (AF-1.16 cm, UAF-1.42cm) and contracted state (AF-1.14cm, UAF-1.63cm). Treatment was modified to include isometric exercises to supraspinatus muscle, and electrical stimulation was provided under ultrasound guidance. Results: Real time US measurement suggested reduction in AGT (2.9cm) immediately following treatment. Eight weeks later, VAS score reduced to 3/10 and patient was able to use arm more for various functional tasks. Changes in diameter of supraspinatus on the affected side (resting: 1.30 cm and contracted: 1.42cm) suggested improvements. Patient continued with modified rehabilitation programme and when seen in September had no pain. Discussion: Despite reduction in pain, patient continued to have GHS (2.6cm), although this was getting better with rehabilitation. Conclusion: This case report demonstrates potential benefits of real-time ultrasound as an assessment tool to inform treatment choices for HSP in a chronic patient with stroke. Further studies using appropriate design are required to capitalise the benefits of ultrasound in the management of HSP.