POST-STROKE ARTHROPATHIES: PHENOMENOLOGY AND STRUCTURAL JOINT ABNORMALITIES

Cover Page

Cite item

Abstract

Background: In the post-stroke period, arthropathies of paretic limbs are frequently seen. They may lead to formation of contractures, with significant limitation of active and passive movements due to severe pain in affected joints. This can hinder restoration of motor functions and consequently lead to a dramatic deterioration of quality of life.

Aim: To study phenomenology of a post-stroke arthropathic syndrome and specific types of joint abnormalities.

Materials and methods: The study included 148 patients with post-stroke hemiparesis. In all patients we analyzed demographic characteristics, stroke type, localization and size, absence or presence of concurrent circulatory encephalopathy and diabetes mellitus. A full neurologic examination was done with assessment of a degree of motor dysfunction. Pathogenetic subtypes of ischemic strokes were determined by means of duplex scanning of major head arteries, assessment of blood rheology and lipid profile. Assessment of joints was done by ultrasound examination and computer tomography.

Results: One hundred and eighteen of 148 patients had post-stroke hemiparesis without joint abnormalities, whereas 30 patients had post-stroke hemiparesis with associated arthropathies. Most patients were elderly (≥ 60 years, 75 patients), 16 of them having arthropathies. One hundred and twenty of patients had ischemic strokes, 28 patients had hemorrhagic strokes. A lacunar subtype of stroke was the most prevalent among all patients (29 of patients, or 24%), whereas among those with arthropathies, the most prevalent type of stroke was cardioembolic (8 of patients, 33%). From 30 patients with arthropathies, isolated shoulder arthropathy was seen in 26, in combination with other arthropathies, in 2; isolated wrist arthropathy was seen in 2 patients. Arthropathies manifested within the first two to three weeks after a stroke in 9 patients (including shoulder arthropathies in 7 of them). In all other patients, arthropathies manifested within the first two months (after 3 weeks).

Conclusion: Post-stroke arthropathies are quite common and affect 20% of all patients with poststroke hemiparesis, mainly in the elderly and in the middle-aged patients. Arthropathies were more prevalent in patients with right hemispheric lesions and with a cardioembolic subtype of stroke. In patients with severe and advanced paresis, arthropathies were seen significantly more often.

About the authors

A. A. Telenkov

Research Center of Neurology

Author for correspondence.
Email: alex-telenko@yandex.ru

Neurologist, III Neurological Department

Russian Federation

A. S. Kadykov

Research Center of Neurology

Email: fake@neicon.ru

MD, PhD, Professor; Head of III Neurological Department

Russian Federation

N. B. Vuytsik

Research Center of Neurology

Email: fake@neicon.ru

PhD, Senior Research Fellow, Laboratory of Ultrasound Diagnostics

Russian Federation

A. V. Kozlova

Research Center of Neurology

Email: fake@neicon.ru

Doctor, Laboratory of Ultrasound Diagnostics

Russian Federation

I. A. Krotenkova

Research Center of Neurology

Email: fake@neicon.ru

Doctor, Department of Radiation Diagnostics

Russian Federation

References

  1. Суслина ЗА, Пирадов МА, ред. Инсульт: диагностика, лечение, профилактика. М.: МЕДпресс-информ; 2008. 288 с. Suslina ZA, Piradov MA, editors. Insul't: diagnostika, lechenie, profilaktika [Stroke: diagnostics, treatment, prevention]. Moscow: MEDpress- inform; 2008. 288 p. (in Russian).
  2. Кадыков АС. Трофические изменения суставов парализованных конечностей у больных, перенесших инсульт. Клиническая медицина. 1973;(9):65–8. Kadykov AS. Troficheskie izmeneniya sustavov paralizovannykh konechnostey u bol'nykh, perenesshikh insul't [Trophic abnormalities in joints of paretic limbs in post-stroke patients]. Klinicheskaya meditsina. 1973;(9):65–8 (in Russian).
  3. Столярова ЛГ, Ткачева ГР. Реабилитация больных с постинсультными двигательными расстройствами. М.: Медгиз; 1978. 216 с. Stolyarova LG, Tkacheva GR. Reabilitatsiya bol'nykh s postinsul'tnymi dvigatel'nymi rasstroystvami [Rehabilitation of patients with post-stroke motor dysfunction]. Moscow: Medgiz; 1978. 216 p. (in Russian).
  4. Culham EG, Noce RR, Bagg SD. Shoulder complex position and glenohumeral subluxation in hemiplegia. Arch Phys Med Rehabil. 1995;76(9):857–64.
  5. Chironna RL, Hecht JS. Subscapularis motor point block for the painful hemiplegic shoulder. Arch Phys Med Rehabil. 1990;71(6):428–9.
  6. Кадыков АС. Реабилитация после инсульта. М.: Миклош; 2003. 176 с. Kadykov AS. Reabilitatsiya posle insul'ta [The post-stroke rehabilitation]. Moscow: Miklosh; 2003. 176 p. (in Russian).
  7. Столярова ЛГ, Кадыков АС, Ткачева ГС. Система оценок двигательных функций у больных с постинсультным гемипарезом. Журнал невропатологии и психиатрии им. С.С. Корсакова. 1982;82(9):15–8. Stolyarova LG, Kadykov AS, Tkacheva GS. Sistema otsenok dvigatel'nykh funktsiy u bol'nykh s postinsul'tnym gemiparezom [A system for assessment of motor functions in patients with a post-stroke hemiparesis]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 1982;82(9):15–8 (in Russian).
  8. Новиков НВ, Яхно НН. Синдром рефлекторной симпатической дистрофии. Журнал неврологии и психиатрии им. С.С. Корсакова. 1994;94(5):103–7. Novikov NV, Yakhno NN. Sindrom reflektornoy simpaticheskoy distrofii [A syndrome of reflectory sympatic dystrophy]. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 1994;94(5):103– 7 (in Russian).
  9. Никифоров АС, Мендель ОИ. Болевой синдром в плечелопаточной области: современные подходы к диагностике и лечению. Русский медицинский журнал. 2008;16(12):1700–5. Nikiforov AS, Mendel' OI. Bolevoy sindrom v plechelopatochnoy oblasti: sovremennye podkhody k diagnostike i lecheniyu [Humeroscapular pain syndrome: modern approaches to diagnosis and treatment]. Russian Medical Journal. 2008;16(12):1700–5 (in Russian). 10. Широков ВА. Боль в плече. Патогенез. Диагностика. Лечение. М.: МЕДпресс-информ; 2012. 240 c. Shirokov VA. Bol' v pleche. Patogenez. Diagnostika. Lechenie [Painful shoulder. Pathophysiology. Diagnostics. Treatment]. Moscow: MEDpressinform; 2012. 240 p. (in Russian).
  10. Яхно НН, ред. Болевой синдром: патофизиология, клиника, лечение. М.: ИМА-пресс; 2011. 72 с. Yakhno NN, editor. Bolevoy sindrom: patofiziologiya, klinika, lechenie [Pain syndrome: pathophysiology, clinical manifestation and treatment]. Moscow: IMA-press; 2011. 72 p. (in Russian).
  11. Вейн АМ, Авруцкий МЯ. Боль и обезболивание. М.: Медицина; 1997. 280 с. Veyn AM, Avrutskiy MYa. Bol' i obezbolivanie
  12. [Pain and analgesia]. Moscow: Meditsina; 1997. 280 p. (in Russian).
  13. Меньшикова ИВ, Сергиенко СА, Пак ЮВ, Морозов СП, Виноградова ЕВ. Боль в области коленного и плечевого суставов (алгоритмы дифференциальной диагностики). М.: Медпрактика; 2007. 140 с. Men'shikova IV, Sergienko SA, Pak YuV, Morozov SP, Vinogradova EV. Bol' v oblasti kolennogo i plechevogo sustavov (algoritmy differentsial'noy diagnostiki) [Knee and shoulder joint pain (algorithms of differential diagnosis)]. Moscow: Medpraktika; 2007. 140 p. (in Russian).
  14. Сашина МБ, Кадыков АС, Черникова ЛА. Постинсультные болевые синдромы. Атмосфера. Нервные болезни. 2004;(3):25–7. Sashina MB, Kadykov AS, Chernikova LA. Postinsul'tnye bolevye sindromy [Post-stroke pain syndromes]. Atmosphere. Nerve Diseases. 2004;(3):25–7 (in Russian).

Copyright (c) 2016 Telenkov A.A., Kadykov A.S., Vuytsik N.B., Kozlova A.V., Krotenkova I.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies