medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-242medsovet-9303Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYПостинсультная боль в плече на этапе медицинской реабилитации (пилотное исследование)Post-stroke shoulder pain in the medical rehabilitation phase (pilot study)https://orcid.org/0000-0002-7465-0677ПизоваН. В.PizovaN. V.

Пизова Наталия Вячеславовна - д.м.н., профессор кафедры нервных болезней с медицинской генетикой и нейрохирургией.

150000, Ярославль, ул. Революционная, д. 5

Nataliia V. Pizova - Dr. Sci. (Med.), Professor of the Department of Nervous Diseases with Medical Genetics and Neurosurgery.

5, Revolutsionnaya St., Yaroslavl, 150000

pizova@yandex.ruhttps://orcid.org/0009-0006-2838-2313ЛебедеваО. С.LebedevaO. S.

Лебедева Ольга Сергеевна - ординатор кафедры нервных болезней с медицинской генетикой и нейрохирургией.

150000, Ярославль, ул. Революционная, д. 5

Olga S. Lebedeva - Resident of the Department of Nervous Diseases with Medical Genetics and Neurosurgery.

5, Revolutsionnaya St., Yaroslavl, 150000

olialebedeva@mail.ruhttps://orcid.org/0000-0002-3009-3020ПизовН. А.PizovN. A.

Пизов Николай Александрович - заведующий отделением медицинской реабилитации пациентов с нарушениями функции центральной нервной системы.

Nikolai А. Pizov - Head of the Department of Medical Rehabilitation of Patients with Central Nervous System Disorders.

39, Suzdalskoe Shosse, Yaroslavl, 150030

nikolai@pizov.ruЯрославский государственный медицинский университетРоссияYaroslavl State Medical UniversityRussian FederationКлиническая больница № 2РоссияClinical Hospital No. 2Russian Federation2025080820250123843Copyright © Пизова Н.В., Лебедева О.С., Пизов Н.А., 20252025Пизова Н.В., Лебедева О.С., Пизов Н.А.Pizova N.V., Lebedeva O.S., Pizov N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9303Введение

Введение. Боль в плече после инсульта часто возникает в первые 2–3 мес., препятствует восстановлению двигательной функции, увеличивает время пребывания в больнице, связана с депрессией, ограничивает повседневную жизнедеятельность и надлежащее участие в реабилитационных программах.

Цель

Цель. Выявить особенности постинсультной боли в плече до и после курса реабилитации с учетом использованных методов реабилитации.

Материалы и методы

Материалы и методы. Наблюдались 37 пациентов (средний возраст – 63 года, 17 мужчин и 13 женщин), из которых в раннем восстановительном периоде ОНМК было 32 пациента и 5 пациентов – в позднем восстановительном периоде. В ходе исследования оценивались вид постинсультного болевого синдрома, характеристики болевого синдрома при постинсультной артропатии и неврологический статус пациентов до проведения реабилитационных мероприятий и по окончании.

Результаты

Результаты. Из 37 обследованных у 30 пациентов была выявлена постинсультная артропатия (81,1%); у 4 пациентов (10,8%) – центральный постинсультный болевой синдром и у 3 пациентов (8,1%) – болевой синдром, связанный с болезненным спазмом спастичных мышц паретичных конечностей. Постинсультная боль в плече чаще развивалась у пациентов с грубым и выраженным парезом руки. У пациентов вследствие болевого синдрома имелось существенное ограничение объема движений в плечевом суставе. Амплитуда движений в плечевом суставе при измерении с помощью гониометра до проведения реабилитационных мероприятий при пассивном сгибании в среднем составила 1100, при пассивном отведении – в среднем 880. На момент выписки пациенты, которым проводились традиционные реабилитационные мероприятия в сочетании с применением ботулотоксина типа А, имели лучшие результаты по сравнению с пациентами без ботулинотерапии.

Выводы

Выводы. Необходимы ранняя диагностика развития постинсультной боли в плече, тщательный подход к реабилитационным мероприятиям, поскольку отдельные механизмы могут потребовать специально подобранных терапевтических вмешательств.

Introduction

Introduction. Post-stoke shoulder pain (PSSP) commonly occurs within the first 2-3 months after stroke, interferes with the recovery of motor function, prolongs hospital stay, is associated with depression, and limits daily activities and proper participation in rehabilitation programs.

Aim

Aim. To identify the features of post-stroke shoulder pain before and after the rehabilitation course, taking into account the rehabilitation methods used.

Materials and methods

Materials and methods. The study observed 37 patients (average age of 63 years, 17 men and 13 women), of which 32 patients were in the early recovery period after acute cerebrovascular event (ACVE) and 5 patients were in the late recovery period. The study evaluated the type of post-stroke pain syndrome, characteristics of pain syndrome in post-stroke arthropathy and neurological status of patients before and after rehabilitation activities.

Results

Results. Of the 37 patients examined, 30 patients had post-stroke arthropathy (81.1%); 4 patients (10.8%) had central post-stroke pain syndrome and 3 patients (8.1%) had pain syndrome associated with a painful spasm in the spastic muscles of paretic limbs. Stroke patients with severe and pronounced arm paresis more often developed post-stroke shoulder pain. Patients had significantly limited range of motion within the shoulder joint due to pain syndrome. The shoulder’s range of motion in the shoulder joint when measured with a goniometer before rehabilitation activities averaged 1100 with the arm in fixed flexion, and 880 with the arm in passive abduction. At the time of discharge, patients who underwent traditional rehabilitation activities combined with the use of botulinum toxin type A showed better results compared to patients without botulinum therapy.

Conclusions

Conclusions. Early diagnosis of post-stroke shoulder pain and a thorough approach to rehabilitation activities are needed, as specific mechanisms may require personalized therapeutic interventions.

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The authors declare that there are no conflicts of interest present.