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Neurological Rehabilitation

Clinical and Ultrasound Characteristics of Muscle in Post Stroke Shoulder Pain

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Original Research Theater

    Poster Presenter(s)

  • Kai Sheng Khor, MD

    Postdoctoral Research Fellow
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

    • Co-Author(s)

  • Jonny Huang, DPT

    Physical Therapist
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

  • AE

    Azin Etemadimanesh, MD

    Research Coordinator
    Johns Hopkins University PM&R Program - Baltimore, MD
    Baltimore, Maryland

  • RN

    Robert W. Nickl, PhD

    Research Associate
    Johns Hopkins School of Medicine
    Baltimore, Maryland

  • SB

    Steve Bonwit, Other

    Physical Therapist Assistant
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

  • PR

    Preeti Raghavan, MD

    Associate Professor
    Johns Hopkins University School of Medicine
    Baltimore, Maryland

Disclosure(s):
Kai Sheng Khor, MD: No financial relationships to disclose
Jonny Huang, DPT: No financial relationships to disclose
Background and/or Objectives: Post stroke shoulder pain (PSSP) occurs in 30-70% of patients with stroke and contributes to disability and impaired motor recovery. The limitation in shoulder external rotation range of motion (ROM) is strongly correlated with the degree of PSSP. This study characterizes the state of the shoulder muscles that contribute to the ROM limitation in PSSP on the paretic and non-paretic sides using instrumented physical exam and ultrasound assessments.

Design: Prospective study

Setting : Outpatient clinical research lab

Participants : 40 chronic stroke survivors with PSSP without central pain

Interventions: NA

Main Outcome Measures: PSSP was diagnosed using the Hand Behind the Neck Maneuver. Pain-pressure thresholds in the shoulder internal and external rotator muscles (pectoralis major and infraspinatus) were measured using an algometer, muscle stiffness was assessed using the stiffness rating scale and PACT Sense, and muscle echointensity was assessed using the Heckmatt and Modified Heckmatt Rating Scales on the paretic and non-paretic sides. Questionnaires were administered to assess pain interference, catastrophizing, anxiety, and depression.

Results: There were significant differences in the paretic shoulder internal and external rotator muscles compared to the non-paretic side. For the pectoralis major, the mean (±SD) for the paretic vs. non-paretic sides were: pain-pressure thresholds (8.17±3.23 vs. 10.35±3.94), stiffness rating scale scores (2.56±0.67 vs. 0.68±0.65) and PACT Sense stiffness scale scores (8.37±1.38 vs. 6.93±1.70). For the infraspinatus, the mean (±SD) for the paretic vs. non-paretic sides were: pain-pressure thresholds (11.05±3.98 vs. 13.36±4.67), stiffness rating scale scores (1.71±0.78 vs. 0.59±0.63) and PACT Sense stiffness scale scores (11.12±2.14 vs. 11.10±1.95). There were also significant differences (p < 0.05) in muscle echointensity between paretic and non-paretic infraspinatus and pectoralis major muscles.

Conclusions: PSSP is characterized by muscle pain and stiffness, which can contribute to the limitation in ROM and pain. Treatments to alleviate muscle pain and stiffness may be helpful in relieving PSSP.