POST-STROKE ARTHROPATHIES: PHENOMENOLOGY AND STRUCTURAL JOINT ABNORMALITIES

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.