COMPROBACIÓN DE HIPÓTESIS.
S ECTOR POTENCIAL DE ARTESANÍAS
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No statistically significant differences were found between the sonographic findings of shoulders with hemiplegia of < 3 months and shoulders with hemiplegia of >
3 months duration (Table 14).
There were no statistically significant gender differences in the sonographic features of the hemiplegics (Table 15).
Poor motor status was found in significantly greater number of acute hemiplegics than chronic hemiplegics, P = 0.017 (Table 16). LHBT tendinosis was significantly more prevalent (P = 0.020) in hemiplegic shoulders with poor motor status than those with good motor status (Table 17).
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Table 8: Differences in Sonographic Findings between Both Shoulders in Hemiplegics
Sonographic Findings
Hemiplegic Side Unaffected
Side P
value*
n (%) n (%)
SASD Effusion only 5 (11.1) 6 (13.3) 1.000
LHBT Effusion only 18 (40.0) 11 (24.4) 0.167
SASD & LHBT Effusion 20 (44.4) 2 (4.4) 0.000
Supraspinatus tendon tear 8 (17.8) 8 (17.8) 1.000
LHBT Tendinosis 22 (48.9) 0 (0.00) NA
Subscapularis Tendinosis 6 (13.3) 0 (0.00) NA
Supraspinatus Tendinosis 8 (7.8) 1 (2.2) 0.039
Infraspinatus Tendinosis 0 (0.0) 1 (2.2) NA
LHBT degeneration 1 (2.2) 0 (0.0) NA
Subscapularis tendon degeneration 1 (2.2) 2 (4.4) 1.000
Supraspinatus tendon degeneration 0 (0.0) 1 (2.2) NA
* McNemar’s chi-square test applied
NA – McNemar’s chi-square test not applicable.
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Table 9: Differences in Sonographic Measurements between Both Shoulders in Hemiplegics
Sonographic Measurements Hemiplegic Side
Unaffected Side
Paired samples t test t df P value Bicipital groove depth (mm) 5.16 ± 1.48 4.76 ± 1.19 1.647 44 0.107
AGTD(cm) 2.60 ± 0.72 2.11 ± 0.38 4.168 44 0.000
CHL thickness (mm) 1.12 ± 0.33 1.15 ± 0.36 -0.442 32 0.662 LHBT thickness - SAX (mm) 7.51 ± 1.77 6.11 ± 1.09 5.764 44 0.000 LHBT thickness - LAX (mm) 4.22 ± 1.15 3.87 ± 0.89 2.037 44 0.048 SCT thickness (mm) 5.93 ± 1.36 5.42 ± 1.31 2.588 44 0.013 SST thickness (mm) 6.33 ± 1.31 6.00 ± 1.17 1.414 44 0.164 IST thickness (mm) 2.56 ± 0.66 2.44 ± 0.59 0.868 44 0.390
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Table 10: Differences between the USS Scores of Hemiplegic and Unaffected Sides
Category Hemiplegic Side Unaffected Side
Mean SD Mean SD P value*
Raw Score 2.98 1.29 0.84 0.88 0.000
Graded Score n % n % P value**
Normal 0 0.0 20 44.4 NA
Mild 16 35.6 24 53.3 0.118
Moderate 24 53.3 1 2.2 0.000
Severe 5 11.1 0 0.0 NA
* Wilcoxon Signed rank test applied
** McNemar test applied
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Table 11: Differences in Sonographic Measurements between Hemiplegics with Dominant and Non-dominant Upper Limb Hemiplegia
Variables
Dominant Hand Hemiplegics
Non-dominant Hand
Hemiplegics t df P value (n = 27) (n = 18)
Bicipital groove depth (mm) 4.81 ± 1.18 5.67 ± 1.75 -1.956 43 0.057
AGTD (cm) 2.59 ± 0.69 2.61 ± 0.78 -0.084 43 0.934
CHL thickness (mm) 1.13 ± 0.34 1.17 ± 0.39 -0.283 33 0.779
LHBT thickness on SAX
view (mm) 7.00 ± 1.33 8.28 ± 2.08 -2.518 43 0.016
LHBT thickness on LAX
view (mm) 3.85 ± 0.60 4.78 ± 1.52 -2.865 43 0.006
SCT thickness (mm) 5.67 ± 1.21 6.33 ± 1.50 -1.648 43 0.107
SST thickness (mm) 6.30 ± 1.23 6.39 ± 1.46 -0.229 43 0.820
IST thickness (mm) 2.44 ± 0.64 2.72 ± 0.67 -1.400 43 0.169
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Table 12:Differences in Sonographic Findings between Hemiplegics with Dominant and Non-dominant Upper Limb Hemiplegia
Hemiplegic Side
Dominant Hand Hemiplegics
Non-dominant
Hand
Hemiplegics Total χ2 df P value (n = 27) (n = 18) (N = 45)
SASD Effusion only
Present 4 (14.8) 1 (5.6) 5 (11.1) 0.938 1 0.333
Absent 23 (85.2) 17 (94.4) 40 (88.9)
LHBT Effusion
Present 10 (37.0) 8 (44.4) 18 (40.0) 0.247 1 0.619
Absent 17 (63.0) 10 (55.6) 27 (60.0)
SASD & LHBT Effusion
Present 12 (44.4) 8 (44.4) 20 (44.4) 0.000 1 1.000
Absent 15 (55.6) 10 (55.6) 25 (55.6)
SCT tear
Present 6 (22.2) 4 (22.2) 10 (22.2) 0.000 1 1.000
Absent 21 (77.8) 14 (77.8) 35 (77.8)
SST tear
Present 5 (18.5) 3 (16.7) 8 (17.8) 0.025 1 0.874
Absent 22 (81.5) 15 (83.3) 37 (82.2)
LHBT Tendinosis
Present 9 (33.3) 13 (72.2) 22 (48.9) 6.537 1 0.011
Absent 18 (66.7) 5 (27.8) 23 (51.1)
SCT Tendinosis
Present 1 (3.7) 5 (27.8) 6 (13.3) 5.417 1 0.020
Absent 26 (96.3) 13 (72.2) 39 (86.7)
83 SST Tendinosis
Present 5 (18.5) 3 (16.7) 8 (17.8) 0.025 1 0.874
Absent 22 (81.5) 15 (83.3) 37 (82.2)
LHBT degeneration
Present 1 (3.7) 0 (0.0) 1 (2.2) 0.682 1 0.409
Absent 26 (96.3) 18 (100.0) 44 (97.8)
SCT degeneration
Present 0 (0.0) 1 (5.6) 1 (2.2) 1.534 1 0.215
Absent 27 (100.0) 17 (94.4) 44 (97.8)
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Table 13: Sonographic Findings by Shoulder Pain in Hemiplegics Sonographic findings
HSNP HSP Total
χ2 df P value (n = 29) (n = 16) (N = 45)
SASD Effusion only
Present 5 (17.2) 0 (0.0) 5 (11.1) 3.103 1 0.078
Absent 24 (82.8) 16 (100) 40 (88.9)
LHBT Effusion only
Present 12 (41.4) 6 (37.5) 18 (40.0) 0.065 1 0.799
Absent 17 (58.6) 10 (62.5) 27 (60.0)
SASD & LHBT
Effusion
Present 11 (37.9) 9 (56.2) 20 (44.4) 1.401 1 0.236
Absent 18 (62.1) 7 (43.8) 25 (55.6)
SCT tear
Present 8 (27.6) 6 (37.5) 14 (31.1) 0.473 1 0.492
Absent 21 (72.4) 10 (62.5) 31 (68.9)
SST tear
Present 8 (27.6) 6 (37.5) 14 (31.1) 0.473 1 0.492
Absent 21 (72.4) 10 (62.5) 31 (68.9)
LHBT tendinosis
Present 15 (51.7) 7 (43.8) 22 (48.9) 0.262 1 0.608
Absent 14 (48.3) 9 (56.3) 23 (51.1)
SCT tendinosis
Present 2 (6.9) 4 (25.0) 6 (13.3) 2.924 1 0.087
Absent 27 (93.1) 12 (75.0) 39 (86.7)
85 SST tendinosis
Present 6 (20.7) 3 (18.8) 9 (20.0) 0.024 1 0.876
Absent 23 (79.3) 13 (81.3) 36 (80.0)
IST tendinosis
Present 1 (3.4) 0 (0.0) 1 (2.2) 0.564 1 0.453
Absent 28 (96.6) 16 (100.0) 44 (97.8)
LHBT degeneration
Present 1 (3.4) 0 (0.0) 1 (2.2) 0.564 1 0.453
Absent 28 (96.6) 16 (100.0) 44 (97.8)
SCT degeneration
Present 2 (6.9) 1 (6.3) 3 (6.7) 0.007 1 0.934
Absent 27 (93.1) 15 (93.8) 42 (93.3)
SST degeneration
Present 0 (0.0) 1 (6.3) 1 (2.2) 1.854 1 0.173
Absent 29 (100.0) 15 (93.8) 44 (97.8)
NB: there were no cases of LHBT tear, IST tear or IST degeneration.
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Table 14: Sonographic Findings by Stroke Duration in Hemiplegics Variables
< 3 months > 3 months Total
χ2 df P value (n = 28) (n = 17) (N = 45)
SASD Effusion only
Present 2 (7.1) 3 (17.6) 5 (11.1) 1.182 1 0.277
Absent 26 (92.9) 14 (82.4) 40 (88.9)
LHBT Effusion only
Present 12 (42.9) 6 (35.3) 18 (40.0) 0.252 1 0.616
Absent 16 (57.1) 11 (64.7) 27 (60.0)
SASD & LHBT Effusion
Present 13 (46.4) 7 (41.2) 20 (44.4) 0.118 1 0.731
Absent 15 (53.6) 10 (58.8) 25 (55.6)
SCT tear
Present 7 (25.0) 3 (17.6) 10 (22.2) 0.331 1 0.565
Absent 21 (75.0) 14 (82.4) 35 (77.8)
SST tear
Present 5 (17.9) 3 (17.6) 8 (17.8) 0.000 1 0.986
Absent 23 (82.1) 14 (82.4) 37 (82.2)
LHBT Tendinosis
Present 13 (46.4) 9 (52.9) 22 (48.9) 0.180 1 0.672
Absent 15 (53.6) 8 (47.1) 23 (51.1)
SCT Tendinosis
Present 4 (14.3) 2 (11.8) 6 (13.3) 0.058 1 0.809
Absent 24 (85.7) 15 (88.2) 39 (86.7)
87 SST Tendinosis
Present 7 (25.0) 1 (5.9) 8 (17.8) 2.645 1 0.104
Absent 21 (75.0) 16 (94.1) 37 (82.2)
LHBT degeneration
Present 1 (3.6) 0 (0.0) 1 (2.2) 0.621 1 0.431
Absent 27 (96.4) 17 (100.0) 44 (97.8)
SCT degeneration
Present 1 (3.6) 0 (0.0) 1 (2.2) 0.621 1 0.431
Absent 27 (96.4) 17 (100.0) 44 (97.8)
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Table 15: Sonographic Findings by Gender in Hemiplegics Sonographic
Findings
Male Female Total
χ2 df P
value (n = 24) (n = 21) (N = 45)
SASD Effusion only
Present 1 (4.2) 4 (19.0) 5 (11.1) 2.511 1 0.113 Absent 23 (95.8) 17 (81.0) 40 (88.9)
LHBT Effusion only
Present 9 (37.5) 9 (42.9) 18 (40.0) 0.134 1 0.714 Absent 15 (62.5) 12 (57.1) 27 (60.0)
SASD & LHBT Effusion
Present 12 (50.0) 8 (38.1) 20 (44.4) 0.643 1 0.423 Absent 12 (50.0) 13 (61.9) 25 (55.6)
SCT tear
Present 9 (37.5) 5 (23.8) 14 (31.1) 0.979 1 0.322 Absent 15 (62.5) 16 (76.2) 31 (68.9)
SST tear
Present 12 (50.0) 2 (9.5) 14 (31.1) 8.562 1 0.003 Absent 12 (50.0) 19 (90.5) 31 (68.9)
LHBT tendinosis
Present 10 (41.7) 12 (57.1) 22 (48.9) 1.074 1 0.300 Absent 14 (58.3) 9 (42.9) 23 (51.1)
SCT tendinosis
Present 2 (8.3) 4 (19.0) 6 (13.3) 1.113 1 0.292
Absent 22 (91.7) 17 (81.0) 39 (86.7) SST tendinosis
Present 7 (29.2) 2 (9.5) 9 (20.0) 2.701 1 0.100
Absent 17 (70.8) 19 (90.5) 36 (80.0)
89 IST tendinosis
Present 0 (0.0) 1 (4.8) 1 (2.2) 1.169 1 0.280
Absent 24 (100.0) 20 (95.2) 44 (97.8) LHBT degeneration
Present 1 (4.2) 0 (0.0) 1 (2.2) 0.895 1 0.344
Absent 23 (95.8) 21 100.0) 44 (97.8) SCT degeneration
Present 2 (8.3) 1 (4.8) 3 (6.7) 0.230 1 0.632
Absent 22 (91.7) 20 (95.2) 42 (93.3) SST degeneration
Present 1 (4.2) 0 (0.0) 1 (2.2) 0.895 1 0.344
Absent 23 (95.8) 21 (100.0) 44 (97.8)
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Table 16: Relationship between Stroke Duration and Motor Status in Hemiplegics Stroke duration
Motor status
Total Poor motor status Good motor status
< 3 months 13 (86.7) 15 (50.0) 28 (62.2)
> 3 months 2 (13.3) 15 (50.0) 17 (37.8)
Total 15 (100.0) 30 (100.0) 45 (100.0)
χ2 = 5.720, df = 1; P = 0.017
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Table 17: Sonographic Findings by Motor Status in Hemiplegics
Sonographic Finding
Poor motor status
Good motor
status Total
χ2 df P value SASD Effusion only Yes 1 (6.7) 4 (13.3) 5 (11.1)
0.450 1 0.502 No 14 (93.3) 26 (86.7) 40 (88.9)
LHBT Effusion only Yes 6 (40.0) 12 (40.0) 18 (40.0)
0.000 1 1.000 No 9 (60.0) 18 (60.0) 27 (60.0)
SASD & LHBT
Effusion Yes 7 (46.7) 13 (43.3) 20 (44.4) 0.045 1 0.832 No 8 (53.3) 17 (56.7) 25 (55.6)
SCT tear Absent 14 (93.3) 21 (70.0) 35 (77.8)
3.150 1 0.076 Present 1 (6.7) 9 (30.0) 10 (22.2)
SST tear Absent 13 (86.7) 24 (80.0) 37 (82.2)
0.304 1 0.581 Present 2 (13.3) 6 (20.0) 8 (17.8)
LHBT Tendinosis Present 11 (73.3) 11 (36.7) 22 (48.9)
5.380 1 0.020 Absent 4 (26.7) 19 (63.3) 23 (51.1)
SCT Tendinosis Present 2 (13.3) 4 (13.3) 6 (13.3)
0.000 1 1.000 Absent 13 (86.7) 26 (86.7) 39 (86.7)
SST Tendinosis Present 2 (13.3) 6 (20.0) 8 (17.8)
0.304 1 0.581 Absent 13 (86.7) 24 (80.0) 37 (82.2)
LHBT degeneration Present 0 (0.0) 1 (3.3) 1 (2.2)
0.511 1 0.475 Absent 15 (100.0) 29 (96.7) 44 (97.8)
SST degeneration Present 1 (6.7) 0 (0.0) 1 (2.2)
2.045 1 0.153
Absent 14 (93.3) 30 (100.0) 44 (97.8)
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Hemiplegic shoulder subluxation was present in 20 (44.4%) of hemiplegics (Table 3). Fifteen (75%) of these had a stroke duration of < 3 months compared to 5 (25%) with stroke duration of > 3 months (Table 18). This difference was statistically significant, P = 0.025.
Subluxed hemiplegic shoulders had significantly higher raw USS scores (3.55 ± 1.32) than non – subluxed, hemiplegic shoulders (2.52 ± 1.09), P = 0.006 (Table 19).
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Table 18: Characteristics of Hemiplegics with Shoulder Subluxation
n (%) χ2 df P value
Stroke duration
< 3 months 15 (75.0) 5.000 1 0.025
> 3 months 5 (25.0)
Gender
Male 6 (30.0) 3.200 1 0.074
Female 14 (70.0)
Hemiplegic side
Dominant side 12 (60.0) 0.800 1 0.371
Non-dominant side 8 (40.0)
Stroke type
Ischemic 18 (90.0) 12.800 1 0.000
Hemorrhagic 2 (10.0)
Shoulder pain
HSNP 14 (70.0) 3.200 1 0.074
HSP 6 (30.0)
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Table 19: Differences in USS Score of the Hemiplegic Shoulders by Subluxation
Subluxation Present
Subluxation
Absent Total Statistics df P value Raw score* 3.55 ± 1.32 2.52 ± 1.09 2.98 ± 1.29 2.878 43 0.006 Graded score**
Mild (1 - 2) 4 (20.0) 12 (48.0) 16 (35.6) 5.310 2 0.070 Moderate (3 - 4) 12 (60.0) 12 (48.0) 24 (53.3)
Severe (5 - 6) 4 (20.0) 1 (4.0) 5 (11.1)
*Independent samples t test used to compare means
** Chi square (χ2)test applied for proportions
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Table 20 shows that the very elderly (80+) were significantly more likely to have LHBT degeneration compared to the other age groups (25.0% vs. 0.0%; p = 0.033).
There were no statistically significant differences in the other sonographic parameters among the different age groups in the hemiplegics. The sonographic parameter of controls did not show statistically significant differences among the different age groups.
Figures 15 – 19 depict some of the structural abnormalities seen on shoulder sonography in the study population.
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Table 20: Age Group Differences in Tendon Degeneration among Hemiplegics Present Absent χ2 df P value
LHBT degeneration
Age group (yrs)
40 - 49 0 (0.0) 6 (100.0) 10.483 4 0.033
50 - 59 0 (0.0) 12 (100.0)
60 - 69 0 (0.0) 12 (100.0)
70 - 79 0 (0.0) 11 (100.0)
80+ 1 (25.0) 3 (75.0)
Total 1 (2.2) 44 (97.8)
SCT degeneration Age group (yrs)
40 - 49 0 (0.0) 6 (100.0) 0.925 4 0.921
50 - 59 1 (8.3) 11 (91.7)
60 - 69 1 (8.3) 11 (91.7)
70 - 79 1 (9.1) 10 (90.9)
80+ 0 (0.0) 4 (100.0)
Total 3 (6.7) 42 (93.3)
SST degeneration Age group (yrs)
40 - 49 0 (0.0) 6 (100.0) 2.813 4 0.590
50 - 59 1 (8.3) 11 (91.7)
60 - 69 0 (0.0) 12 (100.0)
70 - 79 0 (0.0) 11 (100.0)
80+ 0 (0.0) 4 (100.0)
Total 1 (2.2) 44 (97.8)
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A B
Figure 15: Sonographic images showing LHBT sheath effusion. [A]
Short axis view - hypoechoic collection surrounding the LHBT (arrow);
[B] Long axis view - hypoechoic crescent deep (arrow) to the LHBT
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Figure 16: Sonographic images showing LHBT tendinosis – swollen, heterogeneous tendon (arrows). [A] Short axis and [B] Long axis view showing a tendon thickness of 9.3 mm
A
B
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Figure 17: Sonographic images showing SASD bursa effusion (arrows) in three different patients, [A] – [C]
A B C
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Figure 19: Sonographic image of the LHBT (long axis view) showing a
focal hypoechoic defect on its bursal surface (arrow) which is consistent
with a partial thickness tear
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Figure 19: Sonographic image of the supraspinatus tendon (short
axis view) showing SST tendinosis – swollen, hypoechoic tendon
measuring 13.4 mm in thickness (long arrow) and foci of
calcifications (arrowhead)
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