Abstract
ObjectiveThe aim of the study was to study the effectiveness of suprascapular nerve block (SSNB) in reducing pain and increasing range of motion (ROM) in hemiplegic shoulder pain and to compare them with therapeutic ultrasound (U/S).DesignThe study was designed as a randomized controlled trial.SettingThe study was conducted in the Department of Physical Medicine, Rheumatology and Rehabilitation.Patients and methodsStroke patients with hemiplegic shoulder pain who met the inclusion criteria were included in the present study and allocated to the SSNB or U/S groups. Both groups were given the same standard program of ROM exercise, and visual analog scale score of pain, passive maximum ROM, and Croft Disability Questionnaire at second and fourth weeks were evaluated.ResultsTwenty stroke patients were equally allocated to the SSNB and U/S groups. There was a significant improvement in visual analog scale scores and Croft Disability Questionnaire at the second and fourth weeks in the SSNB group. For ROM outcome of the SSNB group, the increase in flexion at the second and fourth weeks was 18.96 ± 11.73 and 34.93 ± 17.58 and in abduction was 22.26 ± 15.48 and 41.12 ± 22.02, respectively. SSNB produced faster relief of pain and more effective restoration of ROM compared with U/S.ConclusionThe present study suggested that SSNB is a safe and effective treatment for hemiplegic shoulder pain. It was more effective than therapeutic U/S in reducing pain score and improving ROM and upper limb function.
Highlights
There was a significant improvement in visual analog scale scores and Croft Disability Questionnaire at the second and fourth weeks in the suprascapular nerve block (SSNB) group
SSNB produced faster relief of pain and more effective restoration of range of motion (ROM) compared with U/S
The present study suggested that SSNB is a safe and effective treatment for hemiplegic shoulder pain
Summary
Shoulder pain is a distressing complication of hemiplegia and is reported as one of the most common complications of stroke [1].Biomechanical changes result from a combination of paralysis, fluctuation in muscle tone, and prolonged shoulder immobility, which lead to postural malalignment [5].Hemiplegic shoulder pain is associated with reduction in functional use of the upper limb, interference with rehabilitation, and increased length of hospitalization [2].It should be noted that not all shoulder pain is associated with complications of limb flaccidity and may be attributable to spasticity or central pain concepts [1].The prevalence of shoulder pain has been reported to be as high as 70% in the first 12 months following stroke [3].Investigation into the cause of hemiplegic shoulder pain has reported a multifactorial etiology. Shoulder pain is a distressing complication of hemiplegia and is reported as one of the most common complications of stroke [1]. Hemiplegic shoulder pain is associated with reduction in functional use of the upper limb, interference with rehabilitation, and increased length of hospitalization [2]. The prevalence of shoulder pain has been reported to be as high as 70% in the first 12 months following stroke [3]. Investigation into the cause of hemiplegic shoulder pain has reported a multifactorial etiology. The most common noncentral, musculoskeletal etiologies of hemiplegic shoulder pain include adhesive capsulitis, bicipital tendonitis, subacromial bursitis, subluxation, and rotator cuff pathologies, with up to one-third of patients having multiple contributing factors [4]
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