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Suprascapular nerve block in hemiplegic shoulder pain: comparison of the effectiveness of placebo, local anesthetic, and corticosteroid injections—a randomized controlled study

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Abstract

Background

Shoulder pain is a common complication of hemiplegic patients that can interrupt their rehabilitation program and is associated with poorer outcomes. The usefulness of the suprascapular nerve block. (SSNB) in the stroke population has been suggested, but some concerns still remain.

Objectives

To investigate the effect of SSNB on pain intensity and passive range ofmotion (PROM) in patients with hemiplegic shoulder pain (HSP).Study Design: A prospective, double blind, randomized controlled trial was conductedin 34 stroke patients with HSP. They were randomly divided into three groups: Localanesthetic (LA) injection into the trapezius muscle (placebo group), LA injection into thesuprascapular notch, and LA and corticosteroid (CS) injections into the suprascapularnotch.The main outcome was visual analog scale (VAS) scores evaluated before andafter administration of the injection at 1 hour, 1 week, and 1 month.

Results

There were significant decreases in the VAS scores with all three injections at all follow-up time points (p: 0.001 for the placebo group, p <0.001 for the LA group, and p <0.001 for the LA+CS group). When changes in VAS scores were compared between the groups, the LA+CS group demonstrated a higher decrease in VAS than the placebo group. Improvement in the PROM was seen only in the LA and LA+CS groups.

Conclusions

The findings of this study support the use of an SSNB with or without CS, to increase the range of motion in the affected shoulder, especially during the rehabilitation period.

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References

  1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, O’Donnell M (2014) Global and regional burden of stroke during 1990–2010. Lancet 383:245–254

    Article  Google Scholar 

  2. Bhakta BB, Cozens JA, Chamberlain MA, Bamford J (2000) Impact of botulinum toxin type a on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. J Neurol Neurosurg Psychiatry 69:217–221

    Article  CAS  Google Scholar 

  3. Wang L, Tao Y, Chen Y, Wang H, Zhou H, Fu X (2016) Association of post stroke depression with social factors, insomnia and neurological status in Chinese elderly population. Neurol Sci 37:1305–1310

    Article  Google Scholar 

  4. Adey-Wakeling Z, Arima H, Crotty M, Leyden J, Kleinig T, Anderson CS, Study Collaborative SEARCH (2015) Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study. Arch Phys Med Rehabil 96:241–247

    Article  Google Scholar 

  5. Lindgren I, Gard G, Brogårdh C (2017) Shoulder pain after stroke - experiences, consequences in daily life and effects of interventions: a qualitative study. Disabil Rehabil 40(10):1176–1182

    Article  Google Scholar 

  6. Benlidayi IC, Basaran S (2014) Hemiplegic shoulder pain: a common clinical consequence of stroke. Pract Neurol 14(2):88–91

    Article  Google Scholar 

  7. Lo SF, Chen SY, Lin HC, Jim YF, Meng NH, Kao MJ (2003) Arthrographic and clinical findings in patients with hemiplegic shoulder pain. Arch Phys Med Rehabil 84(12):1786–1791

    Article  Google Scholar 

  8. Dromerick AW, Edwards DF, Kumar A (2008) Hemiplegic shoulder pain syndrome: frequency and characteristics during inpatient stroke rehabilitation. Arch Phys Med Rehabil 89(8):1589–1593

    Article  Google Scholar 

  9. Yasar E, Vural D, Safaz I, Balaban B, Yilmaz B, Goktepe AS, Alaca R (2011) Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehab 25(1):60–68

    Article  Google Scholar 

  10. Shanahan EM, Ahern M, Smith M, Wetherall M, Bresnihan B, Fitzgerald O (2003) Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis 62(5):400–406

    Article  CAS  Google Scholar 

  11. Dahan TH, Fortin L, Pelletier M, Petit M, Vadeboncoeur R, Suissa S (2000) Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol 27(6):1464–1469

    CAS  PubMed  Google Scholar 

  12. Graven-Nielsen TA, McArdle J, Phoenix L, Arendt-Nielsen TS, Jensen MJ, Jackson RHT (1997) Edwards: in vivo model of muscle pain: quantification of intramuscular chemical, electrical, and pressure changes associated with saline-induced muscle pain in humans. Pain 69:137–143

    Article  CAS  Google Scholar 

  13. Svendsen O, Edwards CN, Lauritzen B, Rasmussen AD (2005) Intramuscular injection of hypertonic saline: in vitro and in vivo muscle tissue toxicity and spinal neurone c-fos expression. Bas Clin Pharmacol Toxicol 97(1):52–57

    Article  CAS  Google Scholar 

  14. Dangoisse MJ, Wilson DJ, Glynn CJ (1994) MRI and clinical study of an easy and safe technique of suprascapular nerve blockade. Acta Anaesthesiol Belg 45(2):49–54

    CAS  PubMed  Google Scholar 

  15. Vorster W, Lange CP, Briët RJ, Labuschagne BC, du Toit DF, Muller C (2008) The sensory branch distribution of the suprascapular nerve: an anatomic study. J Shoulder Elb Surg 17(3):500–502

    Article  Google Scholar 

  16. Borstad J, Woeste C (2015) The role of sensitization in musculoskeletal shoulder pain. Braz J Phys Ther 19(4):251–257

    Article  Google Scholar 

  17. Chang KV, Wu WT, Hung CY, Han DS, Yang RS, Chang CH, Lin CP. Comparative Effectiveness of Suprascapular Nerve Block in the Relief of Acute Post-Operative Shoulder Pain: A Systematic Review and Meta-analysis. 2016;19(7):445–456

  18. Lee KH, Khunadorn F (1986) Painful shoulder in hemiplegic patients: a study of the suprascapular nerve. Arch Phys Med Rehabil 67(11):818–820

    CAS  PubMed  Google Scholar 

  19. Boonsong P, Jarernpornwattana A, Boonhong J (2009) Preliminary study of suprascapular nerve block (SSNB) in hemiplegic shoulder pain. Med J Med Ass Thai 92(12):1669

    Google Scholar 

  20. Adey-Wakeling Z, Crotty M, Shanahan EM (2013) Suprascapular nerve block for shoulder pain in the first year after stroke: a randomized controlled trial. Stroke 44(11):3136–3141

    Article  Google Scholar 

  21. Tang L, Li Y, Huang QM, Yang Y (2018) Dry needling at myofascial trigger points mitigates chronic post-stroke shoulder spasticity. Neural Reg Res 13(4):673

    Article  Google Scholar 

  22. Bennett DL, Cronin AM, Palmer WE, Kattapuram SV, Huang AJ (2014) Optimization and standardization of technique for fluoroscopically guided suprascapular nerve blocks. AJR Am J Roentgenol 202(3):576–5834

    Article  Google Scholar 

  23. Chang KV, Hung CY, Wu WT, Han DS, Yang RS, Lin CP (2016) Comparison of the effectiveness of suprascapular nerve block with physical therapy, placebo, and intra-articular injection in management of chronic shoulder pain: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 97(8):1366–1380

    Article  Google Scholar 

  24. Lee JH, Kim SB, Lee KW, Joe YL, Kim YD (2009) Comparison of blind and Ultasonography guided approach of Suprascapular nerve block. J Korean Acad Rehab Med 33(2):219–224

    Google Scholar 

  25. Picelli A, Bonazza S, Lobba D, Parolini M, Martini A, Chemello E, Schweiger V (2017) Suprascapular nerve block for the treatment of hemiplegic shoulder pain in patients with long-term chronic stroke: a pilot study. Neurol Sci 38(9):1697–1701

    Article  Google Scholar 

  26. Aydın T, Şen Eİ, Yardımcı MY, Kesiktaş FN, Öneş K, Paker N (2019) Efficacy of ultrasound-guided suprascapular nerve block treatment in patients with painful hemiplegic shoulder. Neurol Sci 40:985–991

    Article  Google Scholar 

  27. Picelli A, Lobba D, Vendramin P, Castellano G, Chemello E, Schweiger V, Smania N (2018) A retrospective case series of ultrasound-guided suprascapular nerve pulsed radiofrequency treatment for hemiplegic shoulder pain in patients with chronic stroke. J Pain Res 11:1115–1120

    Article  Google Scholar 

  28. Jeon WH, Park GW, Jeong HJ, Sim YJ (2014) The comparison of effects of suprascapular nerve block, intra-articular steroid injection and a combination therapy on hemiplegic shoulder pain: pilot study. Ann Rehabil Med 38:167–173

    Article  Google Scholar 

  29. Sencan S, Celenlioglu AE, Karadag-Saygı E, Midi İ, Gunduz OH (2019) Effects of fluoroscopy-guıded intraartıcular injectıon, suprascapular nerve block, and combınatıon therapy ın hemıplegıc shoulder paın: a prospective double-blınd, randomızed clınıcal study. Neurol Sci 40:939–946

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey

    Rana Terlemez, Selda Çiftçi, Beril Dogu, Figen Yilmaz & Banu Kuran

  2. Department of Physical Medicine and Rehabilitation, Mahir Topaloglu; MD. Koc University Hospital, Istanbul, Turkey

    Mahir Topaloglu

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  1. Rana Terlemez
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  2. Selda Çiftçi
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  3. Mahir Topaloglu
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Correspondence to Rana Terlemez.

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Terlemez, R., Çiftçi, S., Topaloglu, M. et al. Suprascapular nerve block in hemiplegic shoulder pain: comparison of the effectiveness of placebo, local anesthetic, and corticosteroid injections—a randomized controlled study. Neurol Sci 41, 3243–3247 (2020). https://doi.org/10.1007/s10072-020-04362-0

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  • DOI: https://doi.org/10.1007/s10072-020-04362-0

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