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Kumar P, Christodoulou A, Loizou M. Assessment approaches for hemiplegic shoulder pain in people living with stroke - A scoping review. Disabil Rehabil 2024:1-11. [PMID: 39105542 DOI: 10.1080/09638288.2024.2385736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE Hemiplegic shoulder pain (HSP) is reported in up to 40% of people with stroke. Causes of HSP are often multifactorial. To inform appropriate treatment, reliable/valid assessments are critical. The aim of this scoping review was to collate assessment approaches used in studies where the primary outcome was HSP, and to identify how frequently each assessment approach was used. METHODS A systematic search, including studies from 2000-2023 was conducted of the MEDLINE, EMBASE, CINAHL, AMED, Biomed Central, and Cochrane Library databases, with four key terms used: "assess", "stroke", "pain" and "shoulder". All primary studies published in English language fulfilling the reviews inclusion criteria were included. Six reviewers extracted the data. RESULTS A total of 29 assessment methods for HSP were identified from 124 studies. The common assessments were: Visual Analogue Scale (n = 75, 60%), Passive Range of Movement (n = 65, 52%), Fugl-Meyer Assessment (n = 32, 26%), glenohumeral subluxation (n = 30, 24%) and Numerical Rating Scale (n = 27, 22%). CONCLUSION A wide range of assessment approaches was identified for HSP, and some are used more than others. A fully comprehensive assessment that considers different aspects of pain including severity and timing, functioning, and the psychological burden, is needed in this area of practice to be able to guide appropriate treatment.
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Affiliation(s)
- Praveen Kumar
- College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Avgi Christodoulou
- College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Michael Loizou
- Centre for Health Technology, University of Plymouth, Plymouth, UK
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Zheng P, Shi Y, Qu H, Han ML, Wang ZQ, Zeng Q, Zheng M, Fan T. Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial. Trials 2024; 25:418. [PMID: 38937804 PMCID: PMC11212400 DOI: 10.1186/s13063-024-08258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Hemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem. METHODS This study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score. DISCUSSION Ultrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function. TRIAL REGISTRATION Chinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722 .
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Affiliation(s)
- Peng Zheng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu Shi
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hang Qu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Meng Lin Han
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi Qiang Wang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Manxu Zheng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Tao Fan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Zakel J, Chae J, Wilson RD. Innovations in Stroke Recovery and Rehabilitation: Poststroke Pain. Phys Med Rehabil Clin N Am 2024; 35:445-462. [PMID: 38514229 DOI: 10.1016/j.pmr.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Pain can be a significant barrier to a stroke survivors' functional recovery and can also lead to a decreased quality of life. Common pain conditions after stroke include headache, musculoskeletal pain, spasticity-related pain, complex regional pain syndrome, and central poststroke pain. This review investigates the evidence of diagnostic and management guidelines for various pain syndromes after stroke and identifies opportunities for future research to advance the field of poststroke pain.
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Affiliation(s)
- Juliet Zakel
- MetroHealth Rehabilitation Institute, MetroHealth System, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH 44109, USA.
| | - John Chae
- MetroHealth Rehabilitation Institute, MetroHealth System, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH 44109, USA
| | - Richard D Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH 44109, USA
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Lin TY, Shen PC, Chang KV, Wu WT, Özçakar L. Shoulder ultrasound imaging in the post-stroke population: a systematic review and meta-analysis. J Rehabil Med 2023; 55:jrm13432. [PMID: 37615388 PMCID: PMC10461179 DOI: 10.2340/jrm.v55.13432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Post-stroke shoulder pain is a serious challenge for stroke survivors. The aim of this meta-analysis was to review the literature to confirm information on structural changes in post-stroke shoulders detected by ultrasound examination. METHODS PubMed, Embase, Web of Science and ClinicalTrials.gov were searched until 7 December 2022, for studies describing shoulder sonographic findings in stroke patients. Two independent authors selected the studies, extracted the data, and performed the critical appraisal. RESULTS A total of 23 clinical studies were included. The most prevalent pathologies in hemiplegic shoulders pertained to the biceps long head tendon (41.4%), followed by the supraspinatus tendon (33.2%), subdeltoid bursa (29.3%), acromioclavicular joint (15.0%), and subscapularis tendon (9.2%). The common pathological findings encompassed bicipital peritendinous effusion (39.2%), biceps tendinopathy (35.5%), subdeltoid bursitis (29.3%) and supraspinatus tendinopathy (24.6%). Biceps long head tendon and supraspinatus tendon abnormalities were observed significantly more in the hemiplegic (vs contralateral) shoulders, with odds ratios of 3.814 (95% confidence interval 2.044-7.117) and 2.101 (95% confidence interval 1.257-3.512), respectively. No correlation was observed between motor function and shoulder pathology. CONCLUSION Ultrasonography enabled the identification of common shoulder pathologies after stroke. Further research is needed to establish the association between these changes and the clinical course of stroke patients.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Peng-Chieh Shen
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Xiong F, Shen P, Li Z, Huang Z, Liang Y, Chen X, Li Y, Chai X, Feng Z, Li M. Bibliometric Analysis of Post-Stroke Pain Research Published from 2012 to 2021. J Pain Res 2023; 16:1-20. [PMID: 36636268 PMCID: PMC9830001 DOI: 10.2147/jpr.s375063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Background and Purpose Pain is one of the most common symptoms in patients after stroke. It is a distressing experience that affects patients' quality of life, and it is highly prevalent in clinical practice. The pathogenesis mechanisms of PSP are not so clear, and there is currently a lack of effective medical treatments, hence it is necessary to establish a sufficient understanding of this disease. Limited number of studies have applied bibliometric methods to systematically analyze studies on post-stroke pain. This study aimed to systematically analyze scientific studies conducted worldwide on post-stroke pain from 2012 to 2021 to evaluate global trends in this field using a bibliometric analysis. Methods Publications related to post-stroke pain from 2012 to 2021 were obtained from the Web of Science Core Collection database. Bibliometrics Biblioshiny R-package software was used to analyze the relationship of publication year with country, institution, journals, authors, and keywords and to generate variant visual maps to show annual publications, most relevant countries, authors, sources, keywords, and top-cited articles. Results In this study, 5484 papers met the inclusion criteria. The annual growth rate of publications was 5.13%. The USA had the highest number of publications (1381, 25.2%) and citations (36,395), and the University of Toronto had the highest number of papers (156, 2.8%). "Stroke", "management", "pain", "risk", "prevalence", "ischemic stroke", "risk factors", "disease", "diagnosis" and "therapy" are the top 10 keywords. Conclusion The global research interest regarding PSP has maintained growing over the past ten years. Both central post stroke pain and hemiplegic shoulder pain are the hottest research subjects. Further investigations are needed in order to reveal the mystery of the pathophysiologic mechanisms of CPSP, and high-quality well-designed trials of potential treatments of CPSP and HSP are also needed.
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Affiliation(s)
- Feng Xiong
- Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Peng Shen
- Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Zhenhui Li
- Children Health Care Department, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, People’s Republic of China
| | - Ziyi Huang
- Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Ying Liang
- Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Xiwen Chen
- Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Yutong Li
- First School of Clinical Medicine, Nanchang University, Nanchang, People’s Republic of China
| | - Xinping Chai
- First School of Clinical Medicine, Nanchang University, Nanchang, People’s Republic of China
| | - Zhen Feng
- Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China
| | - Moyi Li
- Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, Nanchang, People’s Republic of China,Correspondence: Moyi Li; Zhen Feng, Rehabilitation Medicine Department, The First Affiliated Hospital of Nanchang University, No. 17, Yong Wai Zheng Jie, Nanchang, Jiangxi, 330006, People’s Republic of China, Tel +86 15806031050; +86 13970038111, Email ;
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de Sire A, Moggio L, Marotta N, Fortunato F, Spalek R, Inzitari MT, Paolucci T, Ammendolia A. Ultrasound-Guided Injections and Proprioceptive Neuromuscular Facilitation as Shoulder Rehabilitation for Multiple Sclerosis and Neuropathic Pain. Healthcare (Basel) 2022; 10:healthcare10101869. [PMID: 36292316 PMCID: PMC9601756 DOI: 10.3390/healthcare10101869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple sclerosis (MS) represents a major cause of chronic neurological disability in young adults and can result in upper limb sensorimotor impairment with a huge impact on manual dexterity and activities of daily living. Moreover, pain is common in MS and a large proportion of patients suffer from central neuropathic pain. To date, no rehabilitative treatment has been described as useful for these patients. A 46-year-old woman, affected by relapsing-remittent MS, described a one-year history of right shoulder pain (Visual Analogue Scale = 8) that started gradually and without trauma. The patient also presented balance and gait impairments, upper limb strength deficit, and fatigue (Expanded Disability Status Scale = 5.5). A multidisciplinary treatment was proposed, including three intra-articular corticosteroid injections and one month of manual therapy, three sessions/week, based on proprioceptive neuromuscular facilitation for the upper limb. At the end of the rehabilitative treatment, pain relief and an improvement in the range of motion of the affected shoulder, upper limb muscle strength, and hand dexterity were observed. The present paradigmatic case report with literature review demonstrated that a multidisciplinary approach seems to be effective in pain relief in a patient with central neuropathic shoulder pain and relapsing-remitting MS.
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Affiliation(s)
- Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Lucrezia Moggio
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961369768
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Renata Spalek
- Rehabilitation Unit, ‘Mons. L. Novarese’ Hospital, 13040 Vercelli, Italy
- Department of Geriatrics, Neurosciences, Orthopedics, Center for Geriatric Medicine (CEMI), Institute of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Maria Teresa Inzitari
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Teresa Paolucci
- Physical Medicine and Rehabilitation, Department of Oral, Medical and Biotechnological Sciences, Physical Medicine and Rehabilitation, University G. D’Annunzio, 66100 Chieti, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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Hou Y, Zhang T, Liu W, Lu M, Wang Y. The Effectiveness of Ultrasound-Guided Subacromial-Subdeltoid Bursa Combined With Long Head of the Biceps Tendon Sheath Corticosteroid Injection for Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Front Neurol 2022; 13:899037. [PMID: 35775042 PMCID: PMC9237414 DOI: 10.3389/fneur.2022.899037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Subacromial-subdeltoid (SASD) bursa and long head of the biceps tendon (LHBT) sheath corticosteroid injection are commonly used to treat shoulder pain associated with arthritic shoulder conditions, but effectiveness in the stroke population is unclear. This study aimed to investigate the clinical effectiveness of ultrasound-guided SASD bursa combined with LHBT sheath corticosteroid injection for hemiplegic shoulder pain (HSP) compared with SASD bursa injection alone. Methods 60 patients with HSP were randomly allocated to the dual-target group (n = 30) and single-target group (n = 30). The single-target group received SASD bursa corticosteroid injection alone, and the dual-target group received SASD bursa and LHBT sheath corticosteroid injection. The primary endpoint was pain intensity measured on a visual analog scale (VAS). The secondary endpoint was passive range of motion (PROM) of the shoulder, Upper Extremity Fugl-Meyer assessment (UEFMA) score, and Modified Barthel Index (MBI) score. PROM and pain intensity VAS were assessed at baseline and weeks 1, 4, and 12 post-treatment. UEFMA and MBI were recorded at baseline and weeks 4 and 12 post-treatment. Results A total of 141 patients with HSP were screened, and 60 patients were included. Significant differences in the VAS, PROM, UEFMA and MBI were observed at all follow-ups in both groups. The dual-target group showed a significant difference in VAS score compared with the single-target group (3.3 vs. 3.7, p = 0.01) at week 4 and week 12 (2.5 vs. 3.2, p < 0.001). Moreover, the dual-target group showed statistically significant differences in flexion (p < 0.001) at week 12, extension rotation (p < 0.001) at week 12, and abduction at week 1 (p = 0.003) and weeks 4 and 12 (p < 0.001) compared with the single-target group. There were significant differences in FMA and MBI scores in the two groups before and after treatment (p < 0.001), with a more significant increase in the dual-target group compared with the single-target group (p < 0.001) at week 12. Conclusion The combination of SASD bursa and LHBT sheath corticosteroid injection is superior to SASD bursa injection alone in reducing shoulder pain and improving functional activities in patients with HSP. Clinical Trial Registration www.chictr.org.cn, Unique identifier: ChiCTR2100047125.
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Affiliation(s)
- Yajing Hou
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Wei Liu
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Minjie Lu
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Yong Wang
- Rehabilitation Medicine Center, Fuxing Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Wang
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de Sire A, Moggio L, Demeco A, Fortunato F, Spanò R, Aiello V, Marotta N, Ammendolia A. Efficacy of rehabilitative techniques in reducing hemiplegic shoulder pain in stroke: Systematic review and meta-analysis. Ann Phys Rehabil Med 2021; 65:101602. [PMID: 34757009 DOI: 10.1016/j.rehab.2021.101602] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hemiplegic shoulder pain (HSP) is a disabling complication affecting stroke survivors. In this context, rehabilitation might play a key role in its clinical management. Recent systematic reviews of the impact of rehabilitative approaches on pain reduction in patients with HSP are lacking. OBJECTIVE This systematic review of randomized controlled trials (RCTs) with meta-analysis aimed to investigate the efficacy of rehabilitative techniques in reducing HSP in stroke survivors. METHODS PubMed, Scopus, and Web of Science were searched from inception to March 8, 2021 to identify RCTs of stroke survivors with HSP undergoing specific rehabilitative techniques combined with conventional therapy to reduce pain intensity. A network meta-analysis and meta-analysis of the Bayesian network of random effects were performed. The risk of bias of studies was assessed with Version 2 of the Cochrane Risk of Bias tool for randomized trials. RESULTS Of 1139 articles identified, 12 were included in the final synthesis. We analyzed data for 723 stroke survivors, reporting a significant overall decrease in pain intensity after a rehabilitative approach by the Bayesian meta-analysis (standardized mean difference 2.78, 95% confidence interval 0.89;-4.59; p = 0.003). We report a significant reduction in HSP with botulinum toxin type A injection (p = 0.001), suprascapular nerve pulsed radiofrequency (p = 0.030), suprascapular nerve block (p = 0.020), and trigger-point dry needling (p = 0.005) as compared with conventional rehabilitation. Concerning the effect size, we identified a Bayesian factor10 of 97.2, with very strong evidence of superiority of rehabilitative techniques. CONCLUSIONS The present systematic review and meta-analysis showed that adding other rehabilitative techniques to conventional rehabilitation was significantly more effective than conventional rehabilitation alone in the complex management of patients affected by HSP.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy.
| | - Lucrezia Moggio
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Andrea Demeco
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Francesco Fortunato
- Neurology Institute, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Riccardo Spanò
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Vincenzo Aiello
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Nicola Marotta
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
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Kim M, Kim KY, Huh YG, Ma SH, Jeong KY, Yoon SH. Functional improvement of bilateral frozen shoulder by unilateral intra-articular corticosteroid injection: a retrospective study. J Int Med Res 2021; 49:3000605211050535. [PMID: 34704481 PMCID: PMC8554564 DOI: 10.1177/03000605211050535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Bilateral frozen shoulder (FS) is often treated with intra-articular corticosteroid injection (IACI). No studies have been performed to establish whether IACI must be administered in both shoulders or in only one shoulder to improve function. This study was therefore performed to determine whether unilateral IACI improves shoulder pain and passive range of motion (pROM) in bilateral FS. Methods The medical records of 165 patients with bilateral primary FS who underwent ultrasonography-guided IACI (2 mL of 10-mg/mL triamcinolone acetonide mixed with 5 mL of 1% lidocaine) in one shoulder were retrospectively reviewed. The outcome measures, namely the numeric rating scale (NRS) scores and pROM values (abduction, external rotation, flexion, hyperextension, and internal rotation), were evaluated pre- and post-injection. Results The patients’ mean age was 54.0 ± 8.0 years. The mean symptom duration was 6.5 ± 2.8 months. The mean follow-up period after injection was 6.7 ± 0.8 weeks. The NRS scores and pROM values significantly improved in both the injected and non-injected shoulders. Conclusions This study showed that unilateral IACI in patients with bilateral FS improves the clinical outcome of the non-injected shoulder. We suggest that physicians observe the non-injected shoulder after unilateral injection rather than performing bilateral injections.
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Affiliation(s)
- Minchul Kim
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Ki-Yong Kim
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Yool-Gang Huh
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Sang Hyeok Ma
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Kil-Yong Jeong
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea
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Chiu YH, Chang KV, Wu WT, Hsu PC, Özçakar L. Comparative Effectiveness of Injection Therapies for Hemiplegic Shoulder Pain in Stroke: A Systematic Review and Network Meta-Analysis. Pharmaceuticals (Basel) 2021; 14:ph14080788. [PMID: 34451885 PMCID: PMC8401803 DOI: 10.3390/ph14080788] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 01/13/2023] Open
Abstract
Hemiplegic shoulder pain (HSP) hampers post-stroke functional recovery and is not well managed with conservative treatments. This systematic review aimed to examine the various injection therapies for HSP and investigate their effectiveness at different time points. The protocol of this meta-analysis was registered on INPLASY with a registration number of INPLASY202180010. PubMed, EMBASE, and Scopus were searched from their inception to 4 August 2021 for the clinical studies investigating comparative effectiveness of different injection regimens for treating hemiplegic shoulder pain in patients with stroke. The primary outcome was the weighted mean difference (WMD) on the visual analog scale (VAS) of pain reduction in the fourth-week and between the fourth and twenty-fourth weeks. Ranking probabilities of the WMD for each treatment were obtained using simulations. Seventeen studies with 595 participants were included. The network meta-analysis showed that at the fourth-week, intra-muscular botulinum toxin (BoNT) injections and suprascapular nerve blocks (SSNB) were superior to a placebo, with WMDs of 1.55 (95% CI, 0.09 to 3.01) and 1.44 (95% CI, 0.07 to 2.80), respectively. SSNB possessed the highest probability (53.3%) and appeared to be the best treatment in the fourth-week, followed by intra-muscular BoNT injections (42.6%). Intramuscular BoNT injections were better than the placebo, with a WMD of 1.57 (95% CI, 0.30 to 2.84) between the 4th and 24th weeks. Intramuscular BoNT injections had the highest probability (79.8%) as the best treatment between the 4th and 24th weeks. SSNB was likely to rank first in relieving HSP at the fourth post-treatment week, whereas intra-muscular BoNT injections had the highest probability to achieve the best treatment effectiveness in the post-injection period between the fourth and twenty-fourth weeks. However, as some of the included studies used a non-randomized controlled design, more randomized controlled trials are needed in the future to validate and better understand the short- and long-term efficacy of different injection therapies for management of HSP.
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Affiliation(s)
- Yi-Hsiang Chiu
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (P.-C.H.)
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence:
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (P.-C.H.)
| | - Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (W.-T.W.); (P.-C.H.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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Xie HM, Guo TT, Sun X, Ge HX, Chen XD, Zhao KJ, Zhang LN. Effectiveness of Botulinum Toxin A in Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 102:1775-1787. [PMID: 33454279 DOI: 10.1016/j.apmr.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/06/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of botulinum toxin A (BTX-A) in the treatment of hemiplegic shoulder pain. DATA SOURCES PubMed, EMBASE, Elsevier, Springer, Cochrane Library, Physiotherapy Evidence Database, CNKI, and VIP were researched from the earliest records to September 1, 2020. STUDY SELECTION Randomized controlled trials that compared shoulder BTX-A injections vs a control intervention in patients with a history of hemiplegic shoulder pain after stroke were selected. Among the 620 records screened, 9 trials with 301 eligible patients were included. DATA EXTRACTION Outcome data were pooled according to follow-up intervals (1, 2, 4, and 12 wk). The primary evaluation indices were pain reduction (visual analog scale [VAS] score) and range of motion (ROM) improvement. The second evaluation indices were upper limb functional improvement, spasticity improvement, and incidence of adverse events. Cochrane risk-of-bias was used to assess the methodological quality of studies independently by 2 evaluators. DATA SYNTHESIS Meta-analysis revealed a statistically significant decrease in the VAS score in the BTX group vs the control group at 1, 4, and 12 weeks postinjection (wk 1: standardized mean difference [SMD], 0.91; 95% confidence interval [CI], 0.27 to 1.54; wk 4: SMD, 1.63; 95% CI, 0.76 to 2.51; wk 12: SMD, 1.96; 95% CI, 1.44 to 2.47). Furthermore, the meta-analysis demonstrated a statistically significant increase in abduction at 1, 4, and 12 weeks postinjection (wk 1: SMD, 3.71; 95% CI, 0 to 7.41; wk 4: SMD, 8.8; 95% CI, 2.22 to 15.37; wk 12: SMD, 19.59; 95% CI, 9.05 to 30.13) and external rotation at 1, 2, 4 weeks postinjection (wk 1: SMD, 5.67; 95% CI, 0.88 to 10.47; wk 2: SMD, 9.62; 95% CI, 5.57 to 13; wk 4: SMD, 6.89; 95% CI, 2.45 to 11.33) in the BTX group. CONCLUSIONS BTX-A injection provided greater analgesic effects and increased shoulder abduction and external rotation ROM compared with steroid or placebo injection for the treatment of HSP.
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Affiliation(s)
- Hui-Min Xie
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ting-Ting Guo
- Department of Neurology, the Second Affiliated Hospital of Shanxi Medical University, Shanxi, China
| | - Xuan Sun
- Geriatric Neurological Department, the Second Medical Centre and National Clinical Research Center of Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Han-Xiao Ge
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xue-Dan Chen
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ke-Jia Zhao
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Li-Ning Zhang
- Department of Rehabilitation, Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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12
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Shanthanna H, Busse J, Wang L, Kaushal A, Harsha P, Suzumura EA, Bhardwaj V, Zhou E, Couban R, Paul J, Bhandari M, Thabane L. Addition of corticosteroids to local anaesthetics for chronic non-cancer pain injections: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2020; 125:779-801. [PMID: 32798067 DOI: 10.1016/j.bja.2020.06.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite common use, the benefit of adding steroids to local anaesthetics (SLA) for chronic non-cancer pain (CNCP) injections is uncertain. We performed a systematic review and meta-analysis of English-language RCTs to assess the benefit and safety of adding steroids to local anaesthetics (LA) for CNCP. METHODS We searched MEDLINE, EMBASE, and CENTRAL databases from inception to May 2019. Trial selection and data extraction were performed in duplicate. Outcomes were guided by the Initiative in Methods, Measurements, and Pain Assessment in Clinical Trials (IMMPACT) statement with pain improvement as the primary outcome and pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs). RESULTS Among 5097 abstracts, 73 trials were eligible. Although SLA increased the rate of success (42 trials, 3592 patients; RR=1.14; 95% CI, 1.03-1.25; number needed to treat [NNT], 13), the effect size decreased by nearly 50% (NNT, 22) with the removal of two intrathecal injection studies. The differences in pain scores with SLA were not clinically meaningful (54 trials, 4416 patients, MD=0.44 units; 95% CI, 0.24-0.65). No differences were observed in other outcomes or adverse events. No subgroup effects were detected based on clinical categories. Meta-regression showed no significant association with steroid dose or length of follow-up and pain relief. CONCLUSIONS Addition of cortico steroids to local anaesthetic has only small benefits and a potential for harm. Injection of local anaesthetic alone could be therapeutic, beyond being diagnostic. A shared decision based on patient preferences should be considered. If used, one must avoid high doses and series of steroid injections. CLINICAL TRIAL REGISTRATION PROSPERO #: CRD42015020614.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.
| | - Jason Busse
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Alka Kaushal
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Prathiba Harsha
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Erica A Suzumura
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Varun Bhardwaj
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Edward Zhou
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Abstract
This article summarizes stroke rehabilitation, with a particular focus on rehabilitation from acute diagnosis to chronic impairments of stroke. The emphasis is on both pharmacologic and nonpharmacologic intervention and interdisciplinary collaboration.
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Affiliation(s)
- Leroy R Lindsay
- Department of Rehabilitation Medicine, Weill Cornell Medical College, 525 East 68th Street, Baker 16, New York, NY 10065, USA.
| | - Diane A Thompson
- Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, 180 Fort Washington Avenue, HP1-199, New York, NY 10032, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medical College, 525 East 68th Street, Baker 16, New York, NY 10065, USA
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Wu T, Song HX, Li YZ, Ye Y, Li JH, Hu XY. Clinical effectiveness of ultrasound guided subacromial-subdeltoid bursa injection of botulinum toxin type A in hemiplegic shoulder pain: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e17933. [PMID: 31702679 PMCID: PMC6855603 DOI: 10.1097/md.0000000000017933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Hemiplegic shoulder pain (HSP), which occurs in most patients with hemiplegia, causes considerable distress and worsens outcomes in rehabilitation. Although they have received the treatments such as anti-inflammatory drugs or physical therapy, many of the individuals remain suffering from shoulder pain 6 months after acute stroke event. In this retrospective study, we evaluated the effectiveness of ultrasound guided subacromial-subdeltoid (SASD) bursa injections with botulinum toxin type A (BoNT/A) compared to steroids for refractory HSP.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. In total, 38 patients who received ultrasound guided SASD bursa injection (BoNT/A group, n = 18; corticosteroid group, n = 20) were included. The pain visual analog scale (VAS) score at rest and during arm passive abduction, Fugl-Meyer score of upper limbs (F-M score) were evaluated before, 2, 4, 8, and 12 weeks after injection.Both 2 groups obtained a significant improvement of VAS score at rest or during arms passive abduction compared to baseline score (within group compare, P < .05). There were no significant differences of pain score improvement between two groups at week 2, 4, 8, and 12 after injection either at rest or during passive arm abduction (between 2 groups compare, P > .05). There were also no differences in results of the post treatment F-M score between 2 groups (between 2 groups compare, P > .05). Similarly, during the follow-up period no collateral effects were reported after BoNT/A injection.SASD bursa BoNT/A injection can substantially reduce the pain as corticosteroid in patients with HSP. BoNT/A injection could be a useful strategy for replacing steroids as a treatment for refractory HSP especially in the patients who cannot tolerate the steroids injection.
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Affiliation(s)
- Tao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Hai-Xin Song
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Yang Zheng Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Ye Ye
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Jian-Hua Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University,
| | - Xing Yue Hu
- Department of Neurology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hang Zhou, Zhe Jiang, PR China
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Kim MS, Kim SH, Noh SE, Bang HJ, Lee KM. Robotic-Assisted Shoulder Rehabilitation Therapy Effectively Improved Poststroke Hemiplegic Shoulder Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019; 100:1015-1022. [DOI: 10.1016/j.apmr.2019.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 01/09/2023]
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Sencan S, Celenlioglu AE, Karadag-Saygı E, Midi İ, Gunduz OH. Effects of fluoroscopy-guıded intraartıcular injectıon, suprascapular nerve block, and combınatıon therapy ın hemıplegıc shoulder paın: a prospective double-blınd, randomızed clınıcal study. Neurol Sci 2019; 40:939-946. [PMID: 30690679 DOI: 10.1007/s10072-019-03733-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/18/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect and superiority of fluoroscopy-guided intraarticular shoulder injection (IAI), suprascapular nerve block (SSNB), and combination treatment in hemiplegic shoulder pain (HSP). DESIGN We included 30 patients diagnosed with HSP. Patients were divided into three groups: IAI, SSNB, and combination treatment. Patients were assessed using a visual analogue scale (VAS) prior to the injection and at hour 1, week 2, and month 2 after the injection, with goniometry at two angles at the moment that pain started and maximum passive range of motion (ROM) of the shoulder and Modified Barthel Index prior to the injection, at week 2 and month 2 after the injection. RESULTS Significant decrease in the VAS and increase in shoulder passive ROMs were detected at all follow-ups in groups. In comparison, there was no significant difference in VAS scores. Change in the internal rotation at the moment that pain started was found to be higher in the patients treated with the combined method than the other methods. Change in maximum passive ROMs was similar between treatment groups. CONCLUSION IAI, SSNB, and the combination treatments are reliable and effective treatment modalities that provide pain relief and an increase in shoulder passive ROMs in HSP.
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Affiliation(s)
- Savas Sencan
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, Postal code 34906, Istanbul, Turkey
| | - Alp Eren Celenlioglu
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Erciyes University, Erciyes Üniversitesi Tıp Fakültesi Köşk Mahallesi Dede Efendi Sokağı Melikgazi, Postal code 38030, Kayseri, Turkey.
| | - Evrim Karadag-Saygı
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, Postal code 34906, Istanbul, Turkey
| | - İpek Midi
- Department of Neurology, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, Postal code 34906, Istanbul, Turkey
| | - Osman Hakan Gunduz
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Mimar Sinan Caddesi No:41 Üst Kaynarca Fevzi Çakmak Mahallesi Pendik, Postal code 34906, Istanbul, Turkey
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Huang YC, Leong CP, Tso HH, Chen MJ, Liaw MY, Hsieh HC, Wang LY, Hsu CH. The long-term effects of hyaluronic acid on hemiplegic shoulder pain and injury in stroke patients: A randomized controlled study. Medicine (Baltimore) 2018; 97:e12078. [PMID: 30170424 PMCID: PMC6392532 DOI: 10.1097/md.0000000000012078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hemiplegic shoulder pain (HSP) is one common complication after stroke. The interferes with the functionality of the affected shoulder in patients with stroke during rehabilitation. Hyaluronic acid (HA) could have positive effects on pain relief and shoulder motion in stroke patients with hemiplegic shoulders. We investigated long-term benefits of HA injection in stroke patients with HSP and rotator cuff injury. METHODS A randomized, double-blinded controlled trial was conducted in one medical center. The stroke patients with HSP and rotator cuff injury were randomized and allocated to the control (n = 9) and experimental (n = 18) groups. The control and the experimental groups received ultrasound-guided subacromial 0.9% sodium chloride and HA injections, respectively. All injections were performed once per week for 3 weeks. The associated upper extremity functional assessments, shoulder pain scale, and sonography findings on affected shoulders were measured before interventions and at the 4th and 12th week after local injections. RESULTS The visual analog scale (VAS) scores of HSP were significantly reduced in the control and experimental groups at the 4th week following intervention. Additionally, the VAS score at the 12th week was also significantly reduced in the experimental group. Significant differences were found in the hyperemia occurrence in the subscapularis tendon at the 12th week after intervention (P = .018) and in the severity of hyperemia in the long head of the biceps tendon (P = .042) and the subscapularis tendon after intervention (P = .014). CONCLUSION Subacromial HA injections might provide longer HSP reduction and decrease in hyperemia reactions at the long head of biceps tendon and subscapularis tendon in stroke patients with HSP and tendon injury.
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18
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Efficacy of Injected Corticosteroid Type, Dose, and Volume for Pain in Large Joints: A Narrative Review. PM R 2018; 10:748-757. [DOI: 10.1016/j.pmrj.2018.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 01/31/2023]
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19
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Ahn JH, Lee DH, Kang H, Lee MY, Kang DR, Yoon SH. Early Intra-articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1-Year Retrospective Longitudinal Study. PM R 2017; 10:19-27. [DOI: 10.1016/j.pmrj.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 05/25/2017] [Accepted: 06/03/2017] [Indexed: 11/24/2022]
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20
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Chang MC. The effects of ultrasound-guided corticosteroid injection for the treatment of hemiplegic shoulder pain on depression and anxiety in patients with chronic stroke. Int J Neurosci 2017; 127:958-964. [PMID: 28076692 DOI: 10.1080/00207454.2017.1281274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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21
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1571] [Impact Index Per Article: 196.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE 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 and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Yoon YS, Kim ES, Lee KJ. Musculoskeletal Problems in Upper Extremity after Stroke. BRAIN & NEUROREHABILITATION 2016. [DOI: 10.12786/bn.2016.9.1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yong-Soon Yoon
- Department of Rehabilitation Medicine, Presbyterian Medical Center Jesus Hospital, Seonam University College of Medicine, Korea
| | - Eun-Sil Kim
- Department of Rehabilitation Medicine, Presbyterian Medical Center Jesus Hospital, Seonam University College of Medicine, Korea
| | - Kwang Jae Lee
- Department of Rehabilitation Medicine, Presbyterian Medical Center Jesus Hospital, Seonam University College of Medicine, Korea
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Tao W, Fu Y, Hai-Xin S, Yan D, Jian-Hua L. The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review. J Phys Ther Sci 2015; 27:3007-10. [PMID: 26504346 PMCID: PMC4616147 DOI: 10.1589/jpts.27.3007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/25/2015] [Indexed: 01/12/2023] Open
Abstract
[Purpose] This review article is designed to expose the application of sonography in
shoulder pain after stroke. [Methods] A range of databases was searched to identify
articles that address sonography examination, with or without ultrasound guided
corticosteroid injection for hemiplegic shoulder pain (HSP). The electronic databases of
PubMed, CENTRAL, CINAHL, Cochrane Library, Medline were searched. [Results] According to
the articles identified in our databases research, sonographic technique has potential to
provide objective measurements in patients with HSP. The main sonography finding of HSP
included subacromial subdeltoid (SASD) bursal effusion, tendinosis of the supraspinatus
and subscapularis tendon, long head of biceps tendon sheath effusion, and shoulder
subluxation. Our analysis also revealed significantly decreased pain score (VAS) and
increased passive external rotation degree in the steroid injection group than control
group. [Conclusion] The sonography examination is useful for HSP assessment and ultrasound
guided technique is recommended for HSP injection treatment.
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Affiliation(s)
- Wu Tao
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Yu Fu
- Department of Rehabilitation Medicine, Alxa League Central Hospital, China
| | - Song Hai-Xin
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
| | - Dong Yan
- Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang CAPF, China
| | - Li Jian-Hua
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, China
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Management of shoulder pain after a cerebrovascular accident or traumatic brain injury. J Shoulder Elbow Surg 2015; 24:823-9. [PMID: 25660242 DOI: 10.1016/j.jse.2014.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 11/16/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder pain after a cerebrovascular accident or traumatic brain injury is a common but often under-recognized problem. It is due to a number of causes including inferior subluxation, spasticity, adhesive capsulitis, and heterotopic ossification. Many of these are amenable to surgical intervention. METHODS Literature review of current evidence. RESULTS This article shows that there are multiple treatment options in this group of patients, and it is important to understand these as clinicians in delivering quality care to this complex group of patients. CONCLUSION This review article describes how careful clinical assessment can differentiate between causes of shoulder pain and guide best management.
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Holloway RG, Arnold RM, Creutzfeldt CJ, Lewis EF, Lutz BJ, McCann RM, Rabinstein AA, Saposnik G, Sheth KN, Zahuranec DB, Zipfel GJ, Zorowitz RD. Palliative and End-of-Life Care in Stroke. Stroke 2014; 45:1887-916. [DOI: 10.1161/str.0000000000000015] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kim SH, Kim DS. Suprascapular Nerve Block versus Intra-articular Hyaluronic Acid Injection in Hemiplegic Shoulder Pain. BRAIN & NEUROREHABILITATION 2014. [DOI: 10.12786/bn.2014.7.2.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sang-Hyun Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Korea
| | - Dong Suk Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Korea
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Viana R, Pereira S, Mehta S, Miller T, Teasell R. Evidence for therapeutic interventions for hemiplegic shoulder pain during the chronic stage of stroke: a review. Top Stroke Rehabil 2013. [PMID: 23192716 DOI: 10.1310/tsr1906-514] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the effectiveness of therapeutic interventions targeting hemiplegic shoulder pain (HSP) more than 6 months post stroke. METHODS A literature search of multiple databases (PubMed, CINAHL, Ovid, and EMBASE) was conducted to identify articles published in the English language from 1980 to April 2012. Studies were included if (1) all participants were adults who had sustained a stroke; (2) research design was a randomized controlled trial (RCT) that examined the effectiveness of any treatment for HSP; (3) all participants had experienced stroke at least 6 months previously; and (4) an assessment of pain had been conducted before and after treatment using a standardized method. The following data were extracted: patient characteristics (ie, age, gender, time since stroke), sample size, study design, measurement of pain pre and post treatment, and adverse events. RESULTS Ten RCTs (PEDro scores 4-9) met inclusion criteria and included a total sample size of 388 individuals with a mean age of 53.2 years (range, 43.6-73.2). Mean time post stroke was 18.4 months. Three studies addressed the use of botulinum toxin type A (BTx-A); 2 studies examined electrical stimulation; 3 studies focused on intraarticular glenohumeral corticosteroid injections; 1 studied subacromial corticosteroid injections; and 1 study looked at massage therapy. CONCLUSIONS Positive outcomes were noted with the use of corticosteroid injections and electrical stimulation and conflicting results were seen regarding the use of BTx-A. Overall, these targeted therapies provide benefit in the treatment of HSP in individuals who are more than 6 months post stroke.
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Affiliation(s)
- Ricardo Viana
- St. Joseph's Health Care, Parkwood Hospital, London, Ontario, Canada
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