Sonographic soft tissue arthritic changes associated with post-stroke hemiplegic knee pain: utility of musculoskeletal ultrasound in a resource-limited setting
More details
Hide details
Department of Radiology, Obafemi Awolowo University, Ile-Ife, Nigeria
Department of Internal Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
Submission date: 2019-09-11
Final revision date: 2020-01-07
Acceptance date: 2020-01-16
Publication date: 2020-01-27
Pol J Radiol, 2020; 85: 45-52
Post-stroke arthritic changes that may compromise rehabilitation have been described in the upper and lower limbs. We aimed at evaluating the soft tissue arthritic changes associated with pain in hemiplegic knees of stroke patients in our environment.

Material and methods:
Hemiplegic and non-hemiplegic knees of 48 stroke patients as well as both knees of 26 apparently healthy controls were evaluated with a 7.5-12 MHz linear ultrasound probe. History of knee pain, and socio-demographic, laboratory, and clinical data were recorded for all study participants. Muscle tone and power as well as functional ambulatory category (FAC) were graded for the stroke patients. Data was analysed using SPSS version 20.

Pain was reported more often in hemiplegic than non-hemiplegic knees (n = 16 vs. n = 6, p = 0.021). The frequencies of soft tissue arthritic changes found, which included reduced lateral and medial femoral cartilage thickness, suprapatellar effusion, and irregular cartilage-bone margin, were similar between hemiplegic and non-hemiplegic knees (p > 0.05). Suprapatellar effusion and reduced lateral femoral cartilage thickness were more prevalent in the hemiplegic knees compared to the healthy control knees (p < 0.05). Stroke patients with pes anserinus tendinosis had greater risk of hemiplegic knee pain (HKP) when compared to stroke patients without this lesion (OR = 10; 95% CI: 1.7-61). FAC, muscle tone, and power showed no association with HKP.

Soft tissue arthritic changes associated with knee pain are comparable between hemiplegic and non-hemiplegic knees of stroke patients. The risk of knee pain in stroke is higher in the presence of pes anserinus tendinosis.

Chen CL, Chen HC, Tang SFT, Wu CY, Cheng PT, Hong WH. Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 2003; 82: 925-935.
Richards JD, Pramanik A, Sykesand L, Pomeroy VM. A comparison of knee kinematic characteristics of stroke patients and age-matched healthy volunteers. Clin Rehabil 2003;17: 565-571.
Yang CP, Lee CL, Chen TW, Lee S, Weng MC, Huang MH. Ultrasonographic findings in hemiplegic knees of stroke patients. Kaohsiung J Med Sci 2005; 21: 70-77.
Caglar NS, Akin T, Aytekin E, et al. Pain syndromes in hemiplegic patients and their effects on rehabilitation results. J Phys Ther Sci 2016; 28: 731-737.
Kong KH, Woon VC, Yang SY. Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors. Arch Phys Med Rehabil 2004; 85: 35-40.
Kumar P. Hemiplegic shoulder pain in people with stroke: present and the future. Pain Manag 2019; 9: 107-110.
Lee CL, Chen TW, Weng MC, Wang YL, Cheng HS, Huang MH. Ultrasonographic findings in hemiplegic shoulders of stroke patients. Kaohsiung J Med Sci 2002; 18: 70-76.
Tunç H, Öken Ö, Kara M, et al. Ultrasonographic measurement of the femoral cartilage thickness in hemiparetic patients after stroke. Int J Rehabil Res 2012; 35: 203-207.
Cho SJ, Yang JR, Yang HS, Yang HE. Effects of extracorporeal shockwave therapy in chronic stroke patients with knee osteoarthritis: a pilot study. Ann Rehabil Med 2016; 40: 862-870.
Park SA, Yang CY, Kim JH, Lee KK, Shin BC, Lee I. Ultrasonographic findings of both knee in hemiplegic ambulators with recent stroke. Korean J Oriental Physiol Pathol 2012; 26: 539-545.
Cook JL, Cook CR, Stannard JP, et al. MRI versus ultrasonography to assess meniscal abnormalities in acute knees. J Knee Surg 2014; 27: 319-324.
Hemke R, Kuijpers TW, van den Berg JM, et al. The diagnostic accuracy of unenhanced MRI in the assessment of joint abnormalities in juvenile idiopathic arthritis. Eur Radiol 2013; 23: 1998-2004.
Sharifah M, Lee C, Suraya A, Johan A, Syed A, Tan S. Accuracy of MRI in the diagnosis of meniscal tears in patients with chronic ACL tears. Knee Surg Sports Traumatol Arthrosc 2015; 23: 826-830.
Karim Z, Wakefield R, Quinn M, et al. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum 2004; 50: 387-394.
Alves TI, Girish G, Kalume Brigido M, Jacobson JA. US of the knee: scanning techniques, pitfalls, and pathologic conditions. Radiographics 2016; 36: 1759-1775.
De Maeseneer M, Marcelis S, Boulet C, et al. Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures. Skeletal Radiol 2014; 43: 1025-1039.
Mureşan S, Mureşan M, Voidăzan S, Neagoe R. The accuracy of musculoskeletal ultrasound examination for the exploration of meniscus injuries in athletes. J Sports Med Phys Fitness 2017; 57: 589-594.
Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L.
Clinical gait assessment in the neurologically impaired: reliability and meaningfulness. Phys Therapy 1984; 64: 35-40.
Uysal F, Akbal A, Gökmen F, Adam G, Reşorlu M. Prevalence of pes anserine bursitis in symptomatic osteoarthritis patients: an ultrasonographic prospective study. Clin Rheumatol 2015; 34: 529-533.
Toktas H, Dundar U, Adar S, Solak O, Ulasli AM. Ultrasonogra­phic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis. Modern Rheumatol 2015; 25: 128-133.
Çarlı AB, Akarsu S, Tekin L, Sağlam M, Kıralp MZ, Özçakar L.
Ultrasonographic assessment of the femoral cartilage in osteoarthritis patients with and without osteoporosis. Aging Clin Exp Res 2014; 26: 411-415.
Li G, Park SE, DeFrate LE, et al. The cartilage thickness distribution in the tibiofemoral joint and its correlation with cartilage-to-cartilage contact. Clin Biomech (Bristol, Avon) 2005; 20: 736-744.
Li G, Lopez O, Rubash H. Variability of a three-dimensional finite element model constructed using magnetic resonance images of a knee for joint contact stress analysis. J Biomech Eng 2001; 123: 341-346.
Marrocco S, Crosby L, Jones IC, Moyer RF, Birmingham TB, Patterson KK. Knee loading patterns of the non-paretic and paretic legs during post-stroke gait. Gait Posture 2016; 49: 297-302.
Zaiton F, Tantawy HI, Elsharkawy KAM, Sanad G. Painful poststroke shoulder: comparison of magnetic resonance imaging and high frequency ultrasonography. Egyptian J Radiol Nucl Med 2011; 42: 47-55.
Sadeghian H, Shekarchi B, Niya MZ, Bagheri H. Ultrasound findings in knee osteoarthritis and rheumatoid arthritis compared to MRI. Bali Med J 2018; 7: 468-471.
Silva-Couto MdA, Lanatovitz Prado-Medeiros Ch, Oliveira AB, et al. Muscle atrophy, voluntary activation disturbances, and low serum concentrations of IGF-1 and IGFBP-3 are associated with weakness in people with chronic stroke. Phys Ther 2014; 94: 957-967.
Hunnicutti JL, Gregory CM. Skeletal muscle changes following stroke: a systematic review and comparison to healthy individuals. Top Stroke Rehabil 2017; 24: 463-471.
Journals System - logo
Scroll to top