Assessment of glenohumeral subluxation in poststroke hemiplegia: Comparison between ultrasound and fingerbreadth palpation methods

Abstract

Background. Glenohumeral subluxation (GHS) is a common poststroke complication. Treatment of GHS is hampered by the lack of objective, real-time clinical measurements. Objective. The aims of this study were: (1) to compare an ultrasound method of GHS measurement with the fingerbreadth palpation method using a receiver operating characteristic curve (ROC) and (2) to report the sensitivity and specificity of this method. Design. A prospective study was conducted. Setting. The study was conducted in local hospitals and day centers in the southwest of England. Patients. One hundred five patients who had one-sided weakness following a first-time stroke (51 men, 54 women; mean age_71 years, SD_11) and who gave informed consent were enrolled in the study. Measurements. Ultrasound measurements of acromion–greater tuberosity (AGT) distance were used for the assessment of GHS. Measurements were undertaken on both shoulders by a research physical therapist trained in shoulder ultrasound with the patient seated in a standardized position. Fingerbreadth palpation assessment of GHS was undertaken by a clinical physical therapist based at the hospital, who also visited the day centers. Results. The area under the ROC curve was 0.73 (95% confidence interval [95% CI]_0.63, 0.83), suggesting that the ultrasound method has good agreement compared with the fingerbreadth palpation method. A cutoff point of _0.2 cm AGT measurement difference between affected and unaffected shoulders generated a sensitivity of 68% (95% CI_51%, 75%), a specificity of 62% (95% CI_47%, 80%), a positive likelihood ratio of 1.79 (95% CI_1.1, 2.9), and a negative likelihood ratio of 0.55 (95% CI_0.4, 0.8). Limitations. Clinical therapists involved in the routine care of patients conducted the fingerbreadth palpation method. It is likely that they were aware of the patients’ subluxation status. Conclusion. The ultrasound method can detect minor asymmetry (_0.5 cm) and has the potential advantage over the fingerbreadth palpation method of identifying patients with minor subluxation.