Deans' stroke musings: Impact of Ultrasound-Guided Suprascapular Nerve Block in Stroke Survivors With Hemiplegic Shoulder Pain Undergoing Neurorehabilitation: A Retrospective Case Series

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, September 18, 2024

Impact of Ultrasound-Guided Suprascapular Nerve Block in Stroke Survivors With Hemiplegic Shoulder Pain Undergoing Neurorehabilitation: A Retrospective Case Series

But is this better? Does your competent? doctor even know about this one?

Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial December 2021

The latest here:

Impact of Ultrasound-Guided Suprascapular Nerve Block in Stroke Survivors With Hemiplegic Shoulder Pain Undergoing Neurorehabilitation: A Retrospective Case Series

Arvind K. Sharma • Satyasheel S. Asthana • Indrajit Deshmukh

Published: September 10, 2024

DOI: 10.7759/cureus.69051

Peer-Reviewed

Cite this article as: Sharma A K, Asthana S S, Deshmukh I (September 10, 2024) Impact of Ultrasound-Guided Suprascapular Nerve Block in Stroke Survivors With Hemiplegic Shoulder Pain Undergoing Neurorehabilitation: A Retrospective Case Series. Cureus 16(9): e69051. doi:10.7759/cureus.69051

Abstract

Background

Hemiplegic shoulder pain (HSP) is one of the most common complications seen in stroke survivors. HSP is an important cause of disability in these patients and may act as a barrier to rehabilitation and functional recovery. Suprascapular nerve block (SSNB) has been shown to be an effective treatment option for managing HSP, and it may also improve overall functional and motor recovery.

Methodology

This is a retrospective case series. Six stroke patients with HSP received an ultrasound-guided SSNB as a part of their inpatient individualized neurorehabilitation program. They were evaluated before the intervention and at 4 and 12 weeks of follow-up. Primary outcome measures were the Shoulder Pain and Disability Index (SPADI) score, active range of motion (AROM), and the visual analog scale (VAS) score of the hemiplegic shoulder. Secondary outcome measures were the passive range of motion (PROM) and manual muscle testing (MMT) of the hemiplegic shoulder.

Results

Of the six patients, four (66.7%) were male, four (66.7%) had hypertension, and two (33.3%) were also suffering from diabetes mellitus. Improvement was seen in the VAS score and the pain subscale of SPADI in all six cases at 12 weeks of follow-up. VAS score improvement was between 40% and 100%, while SPADI pain subscale score improvement ranged from 21.74% to 100%. Total SPADI score improved in all cases, with improvement ranging from 7.94% to 54.55%. No Improvement was seen in four of the six cases in the SPADI disability subscale. AROM showed an improvement in three of the six cases, with the most improvement in flexion (up to 55.56%). PROM improved in all six cases for flexion and abduction and in four cases for external rotation. MMT of only two patients improved by at least two grades.

Conclusions

SSNB is a safe and effective treatment option for patients with HSP. Along with an improvement in pain, the addition of SSNB in neurorehabilitation may play an important role in aiding functional and motor recovery in stroke survivors with HSP.

Introduction

Stroke survivors suffer from various medical complications and hemiplegic shoulder pain (HSP) is one of the most common ones [1]. The incidence of HSP in stroke patients undergoing inpatient rehabilitation ranges between 24% and 64% [2]. HSP contributes to disability in stroke survivors and has also been linked to depression and a decreased quality of life. It may become a major obstacle in rehabilitation participation and the overall recovery of these patients [1].

The etiology of HSP is multifactorial and various pathologies have been linked to its development. These include factors such as impaired motor control and tone changes, soft tissue lesions, and various altered peripheral and central nervous activities [3]. Apart from central causes, nociceptive and peripheral neuropathic pain generation in the hemiplegic shoulder is also postulated as one of the possible mechanisms [4]. The loss of motor control has also been suggested to be an important causative factor in some studies [5]. The presence of severe HSP leads to worse motor outcomes in the affected upper limb [6].

About 70% of the sensory supply of the shoulder joint is provided by the suprascapular nerve. Suprascapular nerve block (SSNB) has proven to be an effective treatment option for shoulder pain in different degenerative shoulder pathologies [7]. A few studies have been conducted over the past two decades studying the efficacy and use of SSNB in HSP patients for pain and motor recovery, with promising results in terms of reduction of pain [8-13].

Pain is an important limiting factor when it comes to active participation in rehabilitation and patient compliance. Pain limits the use of the affected upper limb, thus contributing to the post-stroke limitation in performing activities of daily living. An improvement in pain may also allow better motor and functional recovery in this population of stroke survivors [14]. This case series examines the role of SSNB in improving pain and motor function of the affected upper limb in patients with HSP.