The Comparison of Effects of Suprascapular Nerve Block, Intra-articular Steroid Injection, and a Combination Therapy on Hemiplegic Shoulder Pain: Pilot Study

Abstract

ObjectiveTo assess the relative effectiveness of three injections methods suprascapular nerve block (SSNB) alone, intra-articular steroid injection (IAI) alone, or both-on relief of hemiplegic shoulder pain.MethodsWe recruited 30 patients with hemiplegic shoulder pain after stroke. SSNB was performed in 10 patients, IAI in 10 patients, and a combination of two injections in 10 patients. All were ultrasonography guided. Each patient's maximum passive range of motion (ROM) in the shoulder was measured, and the pain intensity level was assessed with a visual analogue scale (VAS). Repeated measures were performed on pre-injection, and after injection at 1 hour, 1 week, and 1 month. Data were analyzed by Kruskal-Wallis and Friedman tests.ResultsAll variables that were repeatedly measured showed significant differences in shoulder ROM with time (p<0.05), but there was no difference according injection method. In addition, VAS was statistically significantly different with time, but there was no difference by injection method. Pain significantly decreased until a week after injection, but pain after a month was relatively increased. However, pain was decreased compared to pre-injection.ConclusionThe three injection methods significantly improved shoulder ROM and pain with time, but no statistically significant difference was found between them.

The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review

“…Subacromial injection with corticosteroid is known to improve pain and function in non-stroke patients with rotator cuff disorder. Jeon et al 18 ) reported that US-guided suprascapular nerve block, intra-articular steroid injection, and a combination therapy on HSP significantly improved shoulder ROM and pain with time, but no statistically significant difference was found between them. Suprascapular nerve block is a safe and efficacious treatment of HSP 36 ) .…”

“…Ultrasound (US)-guided injections are widely used because of the advances in image quality, decreased cost of use, portability and lack of radiation exposure 16 ) . Recently US-guided injections showed greater accuracy than landmark technology for all shoulder pain treatment, with the exception of the target space 17 , 18 , 19 ) .…”

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

“…Jeon et al [5] compared the effects of intra-articular steroid injection, SSNB and combined administration of both approaches in patients with HSP. They reported that all the injection regimens, which were performed under USG guidance, had similar beneficial effect in the management of poststroke patients with shoulder pain.…”

“…[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. [5] Recently, suprascapular nerve block (SSNB) has been commonly preferred for the treatment of shoulder disorders. The suprascapular nerve supplies 70% of sensorial fibers to the shoulder.…”

Suprascapular Nerve Block Followed by Codman s Manipulation and Home Exercises An Effective Combined Approach in the Rehabilitation of Idiopathic Frozen Shoulder : A Review

“…This technique has previously been demonstrated to be safe, and it effectively blocks the articular branches of the suprascapular nerve [63]. For treatment of chronic shoulder conditions, injectable steroids usually are added to the local anaesthetic solution (10 ml solution of 0.5% bupivacaine hydrochloride and 40 mg of methyl prednisolone acetate) [65][66][67][68][69][70]. Local steroid injection blocks transmission through nociceptive C fibers, thus prolonging the effect of the local anaesthetic through alteration of the function of K channel on the excitable tissue [71,72].…”