Subacromial Corticosteroid Injection for Poststroke Shoulder Pain: An Exploratory Prospective Case Series

Abstract

Chae J, Jedlicka L. Subacromial corticosteroid injection for poststroke shoulder pain: an exploratory prospective case series. Objective To assess the effectiveness of subacromial corticosteroid injections for poststroke shoulder pain. Design Exploratory, prospective case series. Setting Ambulatory setting, university-affiliated hospital. Participants Stroke survivors (N=10) with pain in the hemiparetic shoulder. Intervention Consecutive stroke survivors with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis received subacromial corticosteroid injections. Main Outcome Measures The primary outcome measure was the Brief Pain Inventory (BPI) question 12 (BPI 12), which assesses “worst pain” in the previous 7 days. Secondary measures included BPI question 15, which assesses present pain and BPI question 23 (BPI 23), which assesses pain interference with 7 daily activities. Outcomes were assessed at baseline, weekly for the first 4 weeks and then at 8 and 12 weeks postinjection. Results Repeated measure analysis of variance revealed significant within group time effect for BPI 12 (F=7.7, P<.001). Based on absolute means, the largest therapeutic benefit was seen by the second week postinjection with partial loss of effect thereafter. There were significant within group time effects for the general activity (F=3.2, P=.009), sleep (F=3.9, P=.003), and enjoyment of life (F=2.3, P=.044) domains of BPI 23. Conclusions Subacromial corticosteroid injection is associated with significant reduction in poststroke shoulder pain in patients with evidence of supraspinatus impingement, supraspinatus tendonitis, or subacromial bursitis. However, there is a gradual loss of effect with time. Controlled trials are needed to show a cause and effect relationship.