Comparison of the effectiveness of pulsed radiofrequency of the suprascapular nerve and intra-articular corticosteroid injection for hemiplegic shoulder pain management

Assessment approaches for hemiplegic shoulder pain in people living with stroke - A scoping review

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.

Retrospective Cohort Study on the Incidence and Management of Hemiplegic Shoulder Pain in Stroke Inpatients

BACKGROUND

Painful hemiplegic shoulder (PHS) is a prevalent and challenging complication following a stroke and can significantly impair a patient's engagement in rehabilitation, leading to poorer functional outcomes and extended hospital stays. This retrospective cohort study aims to investigate the incidence, etiology, and management of PHS in stroke inpatients, focusing on the effectiveness of various therapeutic interventions.

METHODS

We conducted a retrospective analysis of subacute stroke inpatients who developed PHS during rehabilitation at a single center. Medical records were reviewed to assess the incidence of PHS, underlying causes, and treatment modalities. Primary outcome measures included the prevalence of PHS, the distribution of identified etiologies, and therapeutic outcomes associated with different management strategies.

RESULTS

Our findings revealed a significant prevalence of PHS among stroke inpatients, consistent with existing literature. The multifactorial etiology included spasticity, adhesive capsulitis, glenohumeral subluxation, central post-stroke pain, and complex regional pain syndrome, with advanced age, low functional scores, motor and sensory impairments, and comorbidities such as diabetes mellitus identified as key risk factors. Management strategies ranged from conservative approaches, such as physical modalities and slings, to advanced interventions, including intra-articular corticosteroid injections, botulinum toxin type A applications, nerve blocks, and radiofrequency neuromodulation. Corticosteroid injections and electrical stimulation were particularly effective in alleviating pain and improving functional outcomes. Notably, pulsed radiofrequency modulation targeting the suprascapular and axillary nerves showed superior efficacy in enhancing the passive range of motion compared to conventional nerve blocks, although the effectiveness of botulinum toxin type A was inconsistent.

CONCLUSIONS

This study emphasizes the multifaceted nature of PHS in stroke inpatients, underlining the importance of individualized and comprehensive treatment strategies. While several therapeutic interventions, particularly corticosteroid injections and pulsed radiofrequency, demonstrated effectiveness, the variability in treatment outcomes highlights the need for further investigation. Future research should focus on larger patient cohorts with extended follow-up periods to better elucidate the progression of PHS and refine management approaches. Despite limitations, including the retrospective study design and a short follow-up period, these findings provide valuable insights into the prevalence, progression, and treatment of PHS in stroke rehabilitation.

Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain

BACKGROUND

Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP.

OBJECTIVE

This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP.

METHODS

In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire.

RESULTS

The pain scores of the SSNB group decreased more significantly (p< 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment (p< 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups.

CONCLUSION

TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.

The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review

Pain from nervous or musculoskeletal disorders is one of the most common complaints in clinical practice. Corticosteroids have a high pain-reducing effect, and their injection is generally used to control various types of pain. However, they have various adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression. Pulsed radiofrequency (PRF) is known to have a pain-reducing effect similar to that of corticosteroid injection, with nearly no major side effects. Therefore, it has been widely used to treat various types of pain, such as neuropathic, joint, discogenic, and muscle pain. In the current review, we outlined the pain-reducing mechanisms of PRF by reviewing previous studies. When PRF was first introduced, it was supposed to reduce pain by long-term depression of pain signaling from the peripheral nerve to the central nervous system. In addition, deactivation of microglia at the level of the spinal dorsal horn, reduction of proinflammatory cytokines, increased endogenous opioid precursor messenger ribonucleic acid, enhancement of noradrenergic and serotonergic descending pain inhibitory pathways, suppression of excitation of C-afferent fibers, and microscopic damage of nociceptive C- and A-delta fibers have been found to contribute to pain reduction after PRF application. However, the pain-reducing mechanism of PRF has not been clearly and definitely elucidated. Further studies are warranted to clarify the pain-reducing mechanism of PRF.