SHOULDER SHRUG - A PROGNOSTIC SIGN FOR RECOVERY OF HAND MOVEMENT AFTER STROKE

A new clinical sign with prognostic significance for recovery of hand movements after stroke is described. Thirty-two patients with hemispheric cerebrovascular accident were assessed to determine whether the ability to shrug the hemiplegic shoulder at initial assessment correlated with the recovery of hand movements. The results of 29 of these patients with poor hand movements at initial assessment were analysed. Of 18 patients with absent shoulder shrug, only two patients (11%) showed return of good active movements in the involved hand at final evaluation, whereas eight (73%) of 11 patients who could shurg the hemiplegic shoulder at initial assessment went on to recover good movements in the hand (P = 0.00). In a subgroup of patients who demonstrated only synergistic flexion of fingers in the hemiplegic hand, one of five patients with absent shoulder shrug showed good hand movements at the final assessment in contrast to six to seven patients who initially could shrug the hemiplegic shoulder. Only one of 15 patients who showed total absence of hand movements at the initial assessment had a return of good hand movements. The data suggest that clinical assessment of shoulder shrug is a good prognostic indicator for recovery of voluntary movements in the hemiplegic hand especially when any hand movement, even if it is only synergistic finger flexion, is present at initial assessment. Total absence of hand movements at initial assessment is a poor prognostic sign.