Suprascapular Nerve Block versus Intra-articular Steroid Injection for Hemiplegic Shoulder Pain: A Preliminary Double-Blind Randomized Controlled Trial
Keywords:hemiplegia, shoulder pain, stroke, scapular nerve block, intra-articular steroid injection
Objectives: To compare the analgesic efficacy of two alternative injections in improving passive shoulder range of motion and shoulder function in patients with hemiplegic shoulder pain.
Study design: A double-blind randomized controlled trial.
Setting: Rehabilitation Medicine Clinic, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Subjects: Patients with hemiplegic shoulder pain of at least two weeks duration were recruited into this study
Methods: Either a suprascapular nerve block or an intra-articular steroid injection were administered to all patients. Maximal tolerable passive range of motion and the corresponding numerical rating scale pain score were documented at pre-injection and at one hour, one month and three months post-injection. The Shoulder Pain and Disability Index questionnaire was completed by the participants at pre-injection and at one month and three months post-injection. All outcome measures were analysed using repeated measures ANOVA.
Results: Thirty-one patients were enrolled in this study. The mean age was 57.7 years (SD 8.1). Mean stroke duration was 16.9 months (SD 24.2). Twenty-six of the strokes (83.9%) were of ischaemic aetiology. Significant pain reduction, passive range of motion and shoulder pain and disability index over time were evaluated in both groups. The intra-articular steroid group had an analgesic effect earlier (at one month) than the suprascapular nerve block group (at three months). No significant differences in pain, shoulder passive range of motion or shoulder pain and disability index between the two groups were observed at any point in this study.
Conclusions: Neither injection technique was found to be superior in terms of pain reduction, passive range of motion increase or reduction in Shoulder Pain and Disability Index score. However, this result could be due to the small sample size. The intra-articu-lar steroid group evidenced an analgesic effect at one month, earlier than the suprascapular nerve block group.
Keywords: hemiplegia, shoulder pain, stroke, scapular nerve block, intra-articular steroid injection
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