Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial

Yaşar, Evren; Vural, Dilek; Safaz, İsmail; Balaban, Birol; Yılmaz, Bilge; Göktepe, Ahmet Salim; Alaca, Rıdvan

doi:10.1177/0269215510380827

Cited by 45 publications

(33 citation statements)

References 23 publications

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“…145,146 In another small, comparison study of patients with nonneuropathic hemiplegic shoulder pain, suprascapular nerve blocks were as effective as glenohumeral triamcinolone injections. 147 Surgical tenotomy of the pectoralis major, lattisimus dorsi, teres major, and subscapularis muscles may reduce pain in patients with severe hemiplegia and restrictions in shoulder range of motion. 148 In patients with clinical evidence of a central pain component associated with sensory changes, allodynia, and hyperpathia, medication management with neuromodulating medications may be considered.…”

Section: Assessment Prevention and Treatment Of Hemiplegic Shouldermentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,110

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Assessment Prevention and Treatment Of Hemiplegic Shouldermentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,110

840

View full text Add to dashboard Cite

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“…The mechanism of initial pain reduction is attributed to blocking these sensory fibers 23 and reducing nociceptive input to the central nervous system. 20 Lack of degradation of treatment effect by 3 months suggests an additional potential mechanism in this population. It has been postulated 22 that there may be a reduction in central sensitisation secondary to diminished nociceptive stimulus as a potential effect of SSNB.…”

Section: Strokementioning

confidence: 95%

“…Since commencement of this trial, 2 small trials have been published in this field. 19,20 Comparison of SSNB with intra-articular steroid injection 20 did not demonstrate either treatment to be superior, although in a preliminary study 19 of 10 people, comparison of SSNB with ultrasound treatment trended toward greater improvement in the SSNB group. Conclusions regarding the efficacy of SSNB are unable to be drawn from these studies because of small numbers, absence of power analysis, and absence of placebo control.…”

mentioning

confidence: 97%

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

Adey‐Wakeling

Crotty

Shanahan

2013

Stroke

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Background and Purpose-Shoulder pain is a common complication after stroke that can impede participation in rehabilitation and has been associated with poorer outcomes. Evidence-based treatments for hemiplegic shoulder pain are limited. Suprascapular nerve block (SSNB) is a safe and effective treatment of shoulder pain associated with arthritic shoulder conditions, but its usefulness in a stroke population is unclear. Methods-We undertook a randomized controlled trial assessing the effectiveness of SSNB in a population of 64 stroke patients (onset < 1 year) with hemiplegic shoulder pain. The primary outcome was pain measured on a visual analogue scale (VAS). Secondary outcomes were disability (Modified Rankin Scale, Croft Disability Index) and quality of life (EuroQol Health Questionnaire). All participants were assessed before randomization, and at 1, 4, and 12 weeks postintervention. Both groups continued with routine therapy. Results-Although both intervention and control groups demonstrated reduction in pain score, participants who received SSNB consistently demonstrated superior, statistically significant pain reduction compared with placebo. Mean VAS reduction in the SSNB group was >18 mm greater than participants receiving placebo injection. The number needed to treat with SSNB to reduce 1 stroke survivor's pain by 50% at 4 weeks is 4. No significant differences in function or quality of life were observed. No adverse events were reported. Conclusions-Suprascapular

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“…[6] Although the blinded method of SSNB by the help of anatomical and bony landmarks has been found to be effective and safe, it can be difficult to reach the suprascapular notch in hemiplegic patients because of anatomical changes. [7,8] In this study, we aimed to investigate the efficacy of blinded SSNB in HSP by comparing it with stimulator guided SSNB.…”

mentioning

confidence: 99%

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

Külcü¹,

Taraktaş²,

Badur³

et al. 2017

Turk J Phys Med Rehab

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Objectives: This study aims to compare the superiority of different suprascapular nerve block (SSNB) application methods on hemiplegic shoulder pain (HSP), in a blinded and stimulator guided manner. Patients and methods:Twenty-six stroke patients (19 males, 7 females; mean age 61.0±9.4 years; range 53 to 76 years) meeting the enrollment criteria, were included in this study between September 2014 and November 2014. Patients were randomly divided into two equal groups. Patients in group A received blinded SSNB and patients in group B received stimulator guided SSNB. Range of motion (ROM) (by goniometer) and pain levels (by visual analog scale-VAS) were assessed. Evaluations were made before, one hour after and one week after SSNBs. Results:In each group, VAS pain scores significantly decreased over time (p<0.0001) and a significant increase in terms of flexion and abduction ROM angles (group A: p=0.002 and p=0.010; group B: p=0.004 and p=0.012, respectively) was observed. In addition, internal rotation ROM angles were found to have increased in group B (p=0.036). There were no significant differences in ROM and VAS one hour and one-week change scores between the two groups (p>0.05). Conclusion:Both blinded or stimulator guided suprascapular nerve block techniques were safe and effective for pain relief in hemiplegic shoulder pain management. None of the injection techniques was superior to the other.Keywords: Blinded; hemiplegic shoulder pain; stimulator guided; suprascapular nerve block.Hemiplejik omuz ağrısında kör ve stimülatör kılavuzluğunda supraskapular sinir blokajının karşılaştırılması: Pilot çalışma ÖZ Amaç: Bu çalışmada hemiplejik omuz ağrısında (HOA) kör ve stimülatör kılavuzluğunda, farklı supraskapular sinir blokajı (SSSB) uygulama yöntemlerinin birbirlerine üstünlüğü araştırıldı. Hastalar ve yöntemler:Eylül 2014 -Kasım 2014 tarihleri arasında yapılan bu çalışmaya katılma kriterlerini karşılayan 26 inme hastası (19 erkek, 7 kadın; ort. yaş 61.0±9.4 yıl; dağılım 53-76 yıl) dahil edildi. Hastalar randomize olarak iki eşit gruba ayrıldı. Grup A'daki hastalara kör SSSB, grup B'deki hastalara ise stimülatör kılavuzluğunda SSSB verildi. Eklem hareket açıklığı (EHA) (gonyometre ile) ve ağrı düzeyleri (görsel analog ölçeği-GAÖ ile) değerlendirildi. Ölçümler SSSB öncesinde, bir saat sonrasında ve bir hafta sonrasında yapıldı. Bulgular:Her iki grupta GAÖ ağrı skorlarında zamanla anlamlı olarak azalma (p<0.0001); fleksiyon ve abdüksiyon EHA açılarında (sırasıyla grup A: p=0.002 ve p=0.010; grup B: p=0.004 ve p=0.012) ise anlamlı artış gözlendi. Ek olarak grup B internal rotasyon EHA açılarında artış saptandı (p=0.036). Gruplar arasında, GAÖ ve EHA açıları bir saatlik ve bir haftalık değişim skorlarında anlamlı bir farklılık yoktu (p>0.05).Sonuç: Kör ya da stimülatör kılavuzluğunda yapılan supraskapular sinir blokajı tekniklerinin her ikisi de güvenli ve hemiplejik omuz ağrısı tedavisinde ağrının giderilmesinde etkilidir. Hiçbir enjeksiyon tekniği diğerinden üstün değildir.Anahtar sözcükler: Kör; hemiple...

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Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial

Abstract: Our results showed that neither injection technique was superior to the other. Both injection procedures are safe and have a similar effect in stroke patients with hemiplegic shoulder pain.

Cited by 45 publications

References 23 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

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

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

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