The Relationship between Shoulder Pain and Shoulder Subluxation in Stroke Patients: A Cross-Sectional Study in Sana’a, Yemen

Background: Hemiplegic shoulder pain (HSP) is a common post-stroke complication that hinders upper limb rehabilitation and reduces quality of life. However, the contribution of shoulder subluxation to HSP remains controversial. Objective: To investigate the relationship between shoulder pain and shoulder subluxation in stroke patients in Sana'a, Yemen. Methods: This descriptive cross-sectional study was conducted across nine physiotherapy centers in Sana'a from December 2023 to January 2024. A total of 121 patients with stroke were enrolled. Data were collected using the Visual Analogue Scale (VAS) to assess pain intensity, the Barthel Index (BI) to evaluate functional independence, the Beck Depression Inventory (BDI) to measure depressive symptoms, and the fingerbreadth palpation method to assess shoulder subluxation. Results: Among 121 participants (mean age 55.9 ± 13.9 years), 54.5% had shoulder subluxation. Shoulder pain was more prevalent in females (P=0.002) and was significantly associated with hypertension (P=0.008), previous stroke (P=0.001), obesity (P=0.043), and type of stroke (P=0.048). A significant correlation was found between shoulder subluxation and pain (P=0.044). indicating that patients with subluxation experienced higher levels of shoulder pain. Subluxation is more common in the early post-stroke phase and is associated with increased pain and functional limitation. Conclusion: A positive association was found between shoulder subluxation and shoulder pain among stroke survivors in Sana'a. These findings suggest that shoulder subluxation may contribute to the development or exacerbation of hemiplegic shoulder pain. Early screening and targeted interventions for subluxation could help prevent HSP and improve the rehabilitation outcomes.