Mapping of ultrasonography methods and shoulder soft-tissue injury locations in patients with stroke: a scoping review
DOI:
https://doi.org/10.2340/jrm.v57.43179Keywords:
shoulder soft-tissue injury, stroke, ultrasonographyAbstract
Objective: To map studies that use ultrasonography to assess shoulder soft-tissue injuries in stroke survivors and identify the methods and soft-tissue injury locations.
Design: Scoping review.
Methods: A literature search was performed through PubMed and ICHUSI from 1966 to May 2023 using the terms “stroke”, “shoulder soft-tissue injury”, and “ultrasonography”. Original articles that used ultrasonography to evaluate shoulder soft-tissue injuries in patients with stroke were selected. Extracted data included study design, phase, sample size, ultrasonographic methods (probe, evaluation position, frequency, and assessment site), and soft-tissue injury location.
Results: Among 249 articles identified, 10 met the inclusion and exclusion criteria. In ultrasonographic methods, over half the studies used linear transducer probes, evaluated participants in a sitting position, and applied frequencies of 5–7 MHz. Common assessment sites were the supraspinatus tendon, long head of the biceps tendon, subscapularis tendon, infraspinatus tendon, and subacromial-subdeltoid bursa. The most common locations of shoulder soft-tissue injuries were the long head of the biceps tendon (effusion/tendinitis) and the supraspinatus tendon (tear/tendinitis).
Conclusion: This study identified ultrasonographic methods and hemiplegic shoulder soft-tissue injury locations. These findings may help facilitate evaluations and enable proper assessment of shoulder soft-tissue injuries in patients with stroke using ultrasonography in clinical practice.
Downloads
References
O’Flaherty D, Ali K. Recommendations for upper limb motor recovery: an overview of the UK and European rehabilitation after stroke guidelines (2023). Healthcare 2024; 12: 1433.
https://doi.org/10.3390/healthcare12141433 DOI: https://doi.org/10.3390/healthcare12141433
Kimberley TJ, Plow EB. Rehabilitation drives post-stroke motor recovery. Lancet Neurol 2025; 24: 373–375.
https://doi.org/10.1016/S1474-4422(25)00100-0 DOI: https://doi.org/10.1016/S1474-4422(25)00100-0
Lang CE, Beebe JA. Relating movement control at 9 upper extremity segments to loss of hand function in people with chronic hemiparesis. Neurorehabil Neural Repair 2007; 21: 279–291.
https://doi.org/10.1177/1545968306296964 DOI: https://doi.org/10.1177/1545968306296964
Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: a prospective, observational trial. J Neurol 2010; 257: 1067–1072.
https://doi.org/10.1007/s00415-010-5463-1 DOI: https://doi.org/10.1007/s00415-010-5463-1
Tsur A, Ring H. Axillary nerve conduction changes in hemiplegia. J Brachial Plex Peripher Nerve Inj 2008; 3: 26.
https://doi.org/10.1186/1749-7221-3-26 DOI: https://doi.org/10.1186/1749-7221-3-26
Aras MD, Gokkaya NK, Comert D, Kaya A, Cakci A. Shoulder pain in hemiplegia: results from a national rehabilitation hospital in Turkey. Am J Phys Med Rehabil 2004; 83: 713–719.
https://doi.org/10.1097/01.phm.0000138739.18844.88 DOI: https://doi.org/10.1097/01.PHM.0000138739.18844.88
Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess 2003; 7: 1–166.
https://doi.org/10.3310/hta7290 DOI: https://doi.org/10.3310/hta7290
Huang YC, Liang PJ, Pong YP, Leong CP, Tseng CH. Physical findings and sonography of hemiplegic shoulder in patients after acute stroke during rehabilitation. J Rehabil Med 2010; 42: 21–26.
https://doi.org/10.2340/16501977-0488 DOI: https://doi.org/10.2340/16501977-0488
Tat J, Tat J, Theodoropoulos J. Clinical applications of ultrasonography in the shoulder for the orthopedic surgeon: a systematic review. Orthop Traumatol Surg Res 2020; 106: 1141–1151.
https://doi.org/10.1016/j.otsr.2020.06.005 DOI: https://doi.org/10.1016/j.otsr.2020.06.005
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA–ScR): checklist and explanation. Ann Intern Med 2018; 169: 467–473.
https://doi.org/10.7326/M18-0850 DOI: https://doi.org/10.7326/M18-0850
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol Theor Pract 2005; 8: 19–32.
https://doi.org/10.1080/1364557032000119616 DOI: https://doi.org/10.1080/1364557032000119616
Xu Y, Bai P, Liu X, Liu H. Application value of high-frequency ultrasound in hemiplegic shoulder rehabilitation of stroke patients. Minerva Surg 2023; 78: 721–723.
https://doi.org/10.23736/S2724-5691.22.09491-6 DOI: https://doi.org/10.23736/S2724-5691.22.09491-6
Idowu BM, Ayoola OO, Adetiloye VA, Komolafe MA. Sonographic evaluation of structural changes in post-stroke hemiplegic shoulders. Pol J Radiol 2017; 82: 141–148.
https://doi.org/10.12659/PJR.899684 DOI: https://doi.org/10.12659/PJR.899684
Idowu BM, Ayoola OO, Adetiloye VA, Komolafe MA, Afolabi BI. Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders. J Ultrason 2017; 17: 106–112.
https://doi.org/10.15557/JoU.2017.0015 DOI: https://doi.org/10.15557/JoU.2017.0015
Hanayama T, Suzuki J, Ueda H, Mizutani J, Kawamoto T, Kawamura M. Ultrasound imaging findings and features of physical function in patients with hemiplegic shoulder pain. J Aichi Physical Therapy Society 2016; 28: 10–15.
Kim YH, Jung SJ, Yang EJ, Paik NJ. Clinical and sonographic risk factors for hemiplegic shoulder pain: a longitudinal observational study. J Rehabil Med 2014; 46: 81–87.
https://doi.org/10.2340/16501977-1238 DOI: https://doi.org/10.2340/16501977-1238
Huang SW, Liu SY, Tang HW, Wei TS, Wang WT, Yang CP. Relationship between severity of shoulder subluxation and soft-tissue injury in hemiplegic stroke patients. J Rehabil Med 2012; 44: 733–739.
https://doi.org/10.2340/16501977-1026 DOI: https://doi.org/10.2340/16501977-1026
Pong YP, Wang LY, Huang YC, Leong CP, Liaw MY, Chen HY. Sonography and physical findings in stroke patients with hemiplegic shoulders: a longitudinal study. J Rehabil Med 2012; 44: 553–557.
https://doi.org/10.2340/16501977-0987 DOI: https://doi.org/10.2340/16501977-0987
Pong YP, Wang LY, Wang L, Leong CP, Huang YC, Chen YK. Sonography of the shoulder in hemiplegic patients undergoing rehabilitation after a recent stroke. J Clin Ultrasound 2009; 37: 199–205.
https://doi.org/10.1002/jcu.20573. DOI: https://doi.org/10.1002/jcu.20573
Park GY, Kim JM, Sohn SI, Shin IH, Lee MY. Ultrasonographic measurement of shoulder subluxation in patients with post-stroke hemiplegia. J Rehabil Med 2007; 39: 526–530.
https://doi.org/10.2340/16501977-0099 DOI: https://doi.org/10.2340/16501977-0099
Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Baños J, et al. Painful shoulder: comparison of physical examination and ultrasonographic findings. Ann Rheum Dis 2002; 61: 132–136.
https://doi.org/10.1136/ard.61.2.132 DOI: https://doi.org/10.1136/ard.61.2.132
van Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, et al. US depiction of partial-thickness tear of the rotator cuff. Radiology 1995; 197: 443–446.
https://doi.org/10.1148/radiology.197.2.7480690 DOI: https://doi.org/10.1148/radiology.197.2.7480690
Zanetti M, Hodler J. Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound. Eur J Radiol 2000; 35: 119–125.
https://doi.org/10.1016/s0720-048x(00)00227-8 DOI: https://doi.org/10.1016/S0720-048X(00)00227-8
Holling A. Sonography of the rotator cuff: an overview. J Diagn Med Sonogr 2001; 17: 144–150.
https://doi.org/10.1177/87564790122250336 DOI: https://doi.org/10.1177/87564790122250336
Lee IS, Shin YB, Moon TY, Jeong YJ, Song JW, Kim DH. Sonography of patients with hemiplegic shoulder pain after stroke: correlation with motor recovery stage. AJR Am J Roentgenol 2009; 192: W40–W44.
https://doi.org/10.2214/AJR.07.3978 DOI: https://doi.org/10.2214/AJR.07.3978
Korkmaz N, Yaşar E, Demir Y, Tezen Ö, Gurcay E. Sonographic predictors in patients with hemiplegic shoulder pain: a cross-sectional study. J Stroke Cerebrovasc Dis 2020; 29: 105170.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105170 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105170
Melis B, DeFranco MJ, Lädermann A, Barthelemy R, Walch G. The teres minor muscle in rotator cuff tendon tears. Skeletal Radiol 2011; 40: 1335–1344.
https://doi.org/10.1007/s00256-011-1178-3 DOI: https://doi.org/10.1007/s00256-011-1178-3
Kamper DG, Schmit BD, Rymer WZ. Effect of muscle biomechanics on the quantification of spasticity. Ann Biomed Eng 2001; 29: 1122–1134.
https://doi.org/10.1114/1.1424918 DOI: https://doi.org/10.1114/1.1424918
Davis ME, Stafford PL, Jergenson MJ, Bedi A, Mendias CL. Muscle fibers are injured at the time of acute and chronic rotator cuff repair. Clin Orthop Relat Res 2015; 473: 226–232.
https://doi.org/10.1007/s11999-014-3860-y DOI: https://doi.org/10.1007/s11999-014-3860-y
Tu Y, Peng W, Wang J, Hao Q, Wang Y, Li H, et al. Acupuncture therapy on patients with flaccid hemiplegia after stroke: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2022; 2022: 2736703.
https://doi.org/10.1155/2022/2736703 DOI: https://doi.org/10.1155/2022/2736703
Ada L, Foongchomcheay A, Canning C. Supportive devices for preventing and treating subluxation of the shoulder after stroke. Cochrane Database Syst Rev 2005; 2005: CD003863.
https://doi.org/10.1002/14651858.CD003863.pub2 DOI: https://doi.org/10.1002/14651858.CD003863.pub2
Turner-Stokes L, Jackson D. Shoulder pain after stroke: a review of the evidence base to inform the development of an integrated care pathway. Clin Rehabil 2002; 16: 276–298.
https://doi.org/10.1191/0269215502cr491oa DOI: https://doi.org/10.1191/0269215502cr491oa
Niessen M, Janssen T, Meskers C, Koppe P, Konijnenbelt M, Veeger D. Kinematics of the contralateral and ipsilateral shoulder: a possible relationship with post-stroke shoulder pain. J Rehabil Med 2008; 40: 482–486. DOI: https://doi.org/10.2340/16501977-0201
https://doi.org/10.2340/16501977-020
Iamsoontorn K. Prevalence and factors related to post stroke shoulder pain in hemiplegic patients receiving home-based rehabilitation in post-acute phase. Asean J Rehabil Med 2020; 30: 54–59
Blennerhassett JM, Gyngell K, Crean R. Reduced active control and passive range at the shoulder increase risk of shoulder pain during inpatient rehabilitation post-stroke: an observational study. J Physiother 2010; 56: 195–199.
https://doi.org/10.1016/s1836-9553(10)70025-4 DOI: https://doi.org/10.1016/S1836-9553(10)70025-4
Dressler D, Rychlik R, Kreimendahl F, Schnur N, Lambert-Baumann J. Long-term efficacy and safety of incobotulinumtoxinA and conventional treatment of poststroke arm spasticity: a prospective, non-interventional, open-label, parallel-group study. BMJ Open 2015; 5: e009358.
https://doi.org/10.1136/bmjopen-2015-009358 DOI: https://doi.org/10.1136/bmjopen-2015-009358
Published
How to Cite
License
Copyright (c) 2025 Masayuki Dogan, Daisuke Ito, Shota Watanabe, Tetsuya Tsuji, Michiyuki Kawakami

This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.