Treatment of hemiplegic shoulder pain in the Netherlands: results of a national survey

Abstract

Objective:To describe the methods of treatment applied by physiotherapists, occupational therapists, rehabilitation physicians, nursing-home physicians and neurologists for hemiplegic shoulder pain, and to investigate their beliefs about the effectiveness of triamcinolone acetonide injections for this diagnosis. Design: Postal questionnaire with structured and open-ended questions. If necessary, a written reminder was sent after 2-3 weeks. Subjects: One hundred physiotherapists, 100 occupational therapists, 100 rehabilitation physicians, 100 nursing-home physicians and 100 neurologists in the Netherlands. These healthcare workers were all active in the rehabilitation of stroke patients. Results: The response was 351 (70.2%), ranging from 58% (neurologists) to 83% (physiotherapists). Fifty-four different (combinations of) treatments were mentioned and were classified into eight treatment groups. The frequency of the first choice of treatment was: physiotherapy (32%), prevention/ instruction/education (22%), oral medication (8%), local injection (7%), sling (4%), referral (3%), other therapies (4%), and different combinations (20%).In total, 86 respondents had applied local injections: 70 rehabilitation physicians, 10 nursing-home physicians and 6 neurologists. The injections used were: corticosteroids alone (51.2%), in combination with a local anaesthetic (37.2%) or a local anaesthetic only (9.3%). Belief in the effectiveness of triamcinolone injections, measured on a 0-100 point scale, was: physiotherapists median 62. Conclusions:As preventive measures and physiotherapy, or a combination of both, were found to be the favourite methods of treatment for hemiplegic shoulder pain in this survey, it seems that most physicians and therapists rely on a mechanical approach to hemiplegic shoulder pain. Rehabilitation physicians used additional local (anti-inflammatory) injections.at Vrije Universiteit 34820 on

Intramuscular Botulinum Toxin-A Reduces Hemiplegic Shoulder Pain

“…In this study, we selected intraarticular steroid injection as a control therapy, because this therapy is frequently applied in the clinical setting and one survey showed that clinicians believed in its effectiveness. 56 We believe that the possible mechanisms of improved hemiplegic shoulder pain after BoNT-A injection could be associated with the antinociceptive effect of BoNT-A. Although no direct association between BoNT-A and spasticity was found during the present study, the muscle relaxing or tone reducing effects of BoNT-A might also have contributed to pain reduction.…”

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“…Além disso, resulta em grande impacto negativo sobre a recuperação funcional de pacientes que sobrevivem a um AVE [4][5][6][7] . Devido à importância e à necessidade de medidas profiláticas precoces, apontadas por vários autores 1,15,16 , o tratamento fisioterapêutico proposto para esse estudo foi iniciado nas primeiras 48 horas pois, em cerca de 20% dos pacientes, a dor no ombro H/ P pode surgir já na 1 a e 2 a semana pós ictal [8][9][10] .…”

“…Apesar das causas, fatores de risco e tratamento serem desconhecidos, há consenso quanto a importância e a necessidade de profilaxia 1,15,16 . Tanto a eletro-estimulação, quanto o uso de tipóias mostraram resultados pouco favoráveis [17][18][19] .…”

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“…2 Clinicians use a wide variety of approaches to treat poststroke shoulder pain. 3,4 However, the large number of interventions and a lack of consensus as to which are effective suggest that both the etiology and rationale for the treatment of poststroke shoulder pain are poorly understood.…”