SHOULDER ULTRASOUND IMAGING IN THE POST-STROKE POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE: Post-stroke shoulder pain is a serious challenge for stroke survivors. The aim of this meta-analysis was to review the literature to confirm information on structural changes in post-stroke shoulders detected by ultrasound examination. METHODS: PubMed, Embase, Web of Science and ClinicalTrials.gov were searched until 7 December 2022, for studies describing shoulder sonographic findings in stroke patients. Two independent authors selected the studies, extracted the data, and performed the critical appraisal. RESULTS: A total of 23 clinical studies were included. The most prevalent pathologies in hemiplegic shoulders pertained to the biceps long head tendon (41.4%), followed by the supraspinatus tendon (33.2%), subdeltoid bursa (29.3%), acromioclavicular joint (15.0%), and subscapularis tendon (9.2%). The common pathological findings encompassed bicipital peritendinous effusion (39.2%), biceps tendinopathy (35.5%), subdeltoid bursitis (29.3%) and supraspinatus tendinopathy (24.6%). Biceps long head tendon and supraspinatus tendon abnormalities were observed significantly more in the hemiplegic (vs contralateral) shoulders, with odds ratios of 3.814 (95% confidence interval 2.044–7.117) and 2.101 (95% confidence interval 1.257–3.512), respectively. No correlation was observed between motor function and shoulder pathology. CONCLUSION: Ultrasonography enabled the identification of common shoulder pathologies after stroke. Further research is needed to establish the association between these changes and the clinical course of stroke patients. LAY ABSTRACT Stroke is a debilitating disease affecting thousands of people worldwide. Post-stroke shoulder pain is a prevailing complication among stroke survivors that negatively impacts their rehabilitative endeavours and quality of life. Musculoskeletal ultrasound is a practical tool for investigating soft-tissue pathologies. Through comprehensive literature review and analysis, this study found that abnormalities in the biceps long head tendon, supraspinatus tendon, subdeltoid bursa, acromioclavicular joint, and subscapularis tendon were common. Specifically, the most frequent pathologies were bicipital peritendinous effusion, biceps tendinopathy, subdeltoid bursitis, supraspinatus tendinopathy, and supraspinatus partial thickness tear. Ultrasound is useful in uncovering these lesions and guiding relevant interventions in case of painful shoulder after stroke.