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(Stroke. 2008;39:1808.)
© 2008 American Heart Association, Inc.

Original Contributions

MRI Findings in the Painful Poststroke Shoulder

Rajiv R. Shah, MD; Sepideh Haghpanah, MD; Elie P. Elovic, MD; Steven R. Flanagan, MD; Anousheh Behnegar, MD; Vu Nguyen, MD; Stephen J. Page, PhD; Zi-Ping Fang, PhD John Chae, MD

From the Departments of Radiology (R.R.S.) and Physical Medicine and Rehabilitation (S.H., J.C.), Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio; Kessler Medical Rehabilitation Research and Education Center (E.P.E.), West Orange, NJ; the Department of Rehabilitation Medicine (S.R.F., A.B.), Mt Sinai School of Medicine, New York, NY; the Department of Physical Medicine and Rehabilitation (N.V.), Carolina Rehabilitation, Charlotte, NC; the Department of Rehabilitation Sciences (S.J.P.), University of Cincinnati, Cincinnati, Ohio; and NeuroControl Corporation (Z.P.F.), North Ridgeville, Ohio. Z.P.F. is now affiliated with NBI Development, San Francisco, Calif.

Correspondence to John Chae, MD, Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109. E-mail jchae{at}metrohealth.org

Background and Purpose— We describe the structural abnormalities in the painful shoulder of stroke survivors and their relationships to clinical characteristics.

Method— Eighty-nine chronic stroke survivors with poststroke shoulder pain underwent T1- and T2-weighted multiplanar, multisequence MRI of the painful paretic shoulder. All scans were reviewed by one radiologist for the following abnormalities: rotator cuff, biceps and deltoid tears, tendinopathies and atrophy, subacromial bursa fluid, labral ligamentous complex abnormalities, and acromioclavicular capsular hypertrophy. Clinical variables included subject demographics, stroke characteristics, and the Brief Pain Inventory Questions 12. The relationship between MRI findings and clinical characteristics was assessed through logistic regression.

Results— Thirty-five percent of subjects exhibited a tear of at least one rotator cuff, biceps or deltoid muscle. Fifty-three percent of subjects exhibited tendinopathy of at least one rotator cuff, bicep or deltoid muscle. The prevalence of rotator cuff tears increased with age. However, rotator cuff tears and rotator cuff and deltoid tendinopathies were not related to severity of poststroke shoulder pain. In approximately 20% of cases, rotator cuff and deltoid muscles exhibited evidence of atrophy. Atrophy was associated with reduced motor strength and reduced severity of shoulder pain.

Conclusions— Rotator cuff tears and rotator cuff and deltoid tendinopathies are highly prevalent in poststroke shoulder pain. However, their relationship to shoulder pain is uncertain. Atrophy is less common but is associated with less severe shoulder pain.

Key Words: magnetic resonance imaging • rotator ruff • shoulder pain • tendonopathy