Effect of Triamcinolone Acetonide Injections on Hemiplegic Shoulder Pain

Abstract

Background and Purpose-Hemiplegic shoulder pain is not uncommon after stroke. Its origin is still unknown, and although many different methods of treatment are applied, none have yet been proved to be effective. We sought to study the efficacy of 3 injections of intra-articular triamcinolone acetonide on pain and arm function in stroke patients with hemiplegic shoulder pain. Methods-In a multicenter, randomized, placebo-controlled clinical trial, patients with hemiplegic shoulder pain received either 3 intra-articular injections of 40 mg triamcinolone acetonide or 1 mL physiological saline solution (placebo). Primary outcomes were pain measured according to 3 visual analogue scales (score range, 0 to 10), and arm function was measured by means of the Action Research Arm test and the Fugl-Meyer assessment scale; secondary outcomes were passive external rotation of the shoulder and general functioning measured according to Barthel Index and the Rehabilitation Activities Profile. Results-In the triamcinolone group (nϭ18), the median decrease in pain, 3 weeks after the last injection, was 2.3 (interquartile range, 0.3 to 4.3) versus 0.2 (interquartile range, Ϫ0.5 to 2.2) in the placebo group. This result was not statistically significant. The change in the other outcome measures did not differ significantly between the 2 treatment groups. Twenty-five patients reported side effects. Conclusions-In the 37 participants included in this study, triamcinolone injections seemed to decrease hemiplegic shoulder pain and to accelerate recovery, but this effect was not statistically significant. Therefore, on the basis of the results of this study, these injections cannot be recommended for the treatment of patients with hemiplegic shoulder pain.

Guidelines for Adult Stroke Rehabilitation and Recovery

“…136 There are only 2 randomized trials of shoulder joint injections for pain. Snels and colleagues 137 showed no significant effect on pain reduction after glenohumeral injection. In contrast, Rah and others 138 showed a significant reduction in pain after corticosteroid injection compared with placebo.…”

Suprascapular Nerve Block for Shoulder Pain in the First Year After Stroke

“…Hemiplegic shoulder pain is associated with reduced functional ability, 15 a higher incidence of depression, 15 interference with rehabilitation, and an increased length of hospitalisation. 16 Despite the high incidence and significant impact of shoulder pain post stroke, there is little robust evidence to inform clinical practice, 17,18 with reviews examining the management of hemiplegic shoulder pain concluding that further efforts are required to examine intervention options. 1,17,18 Published systematic reviews have not included information on the use of suprascapular nerve block (SSNB) as an intervention type because of the emerging nature of this procedure in stroke populations and a lack of robust trials.…”

Blinded and stimulator guided comparison of suprascapular nerve block in hemiplegic shoulder pain: a pilot study

“…[1,2] Hemiplegic shoulder pain (HSP) is correlated with prolonged hospitalization, difficulty in the rehabilitation process and impairment in functional use of the arm. [3] If the patient's pain is reduced, an optimal exercise program may be applied to improve range of motion (ROM) angles. [4] In order to relieve pain; various treatment modalities such as physical therapies, functional electrical stimulation, oral or intra-articular steroid injections, stellate ganglion block and peripheral nerve blocks have been used.…”