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

 Since you did nothing useful in this research, how about this one?

 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 conclusion is the next paragraph;

Conclusions:

The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain.

The latest crapola here:

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

Igor Santos Neto IV • Miguel Guimaraes • Tiago Ribeiro • Ana Gonçalves • Ines Natario • Marta Torres

Published: December 19, 2024

DOI: 10.7759/cureus.76030

Peer-Reviewed

Cite this article as: Neto I, Guimaraes M, Ribeiro T, et al. (December 19, 2024) Retrospective Cohort Study on the Incidence and Management of Hemiplegic Shoulder Pain in Stroke Inpatients. Cureus 16(12): e76030. doi:10.7759/cureus.76030

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Abstract

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(Survivors don't want it 'managed'; they want it prevented! Solve the correct problem; what survivors want! Not your ideas!) of PHS in stroke inpatients, focusing on the effectiveness of various therapeutic interventions.(Whomever approved this objective needs to be fired. The objective should have been to create protocols that cure shoulder pain.)

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.

Introduction

Stroke remains a leading cause of mortality and disability, imposing significant socioeconomic and healthcare burdens on developed countries. Continuous advancements in treatment options have underscored the importance of early rehabilitation programs in enhancing functional independence and improving patient outcomes. However, the rehabilitation process is often hindered by complications, necessitating a comprehensive understanding of strategies to address these challenges [1].

One such complication is painful hemiplegic shoulder (PHS), a condition characterized by shoulder pain following a cerebrovascular accident. Key risk factors for PHS include reduced motor function, type 2 diabetes mellitus (DM2), and a history of prior shoulder pain [2]. Incidence rates of PHS vary widely, from 9% to 73% in earlier reports [3] to more recent findings of 24-64% in inpatient rehabilitation settings [4]. PHS onset varies from two weeks to three months post-stroke, reflecting the heterogeneity of this condition [5]. This condition significantly impairs patients' participation in rehabilitation, resulting in lower Barthel scores at discharge, poorer functional recovery, and extended hospital stays [6].

The multifactorial etiology of PHS includes both musculoskeletal and neurological changes. Common contributors are spasticity, adhesive capsulitis, glenohumeral subluxation, central post-stroke pain, and complex regional pain syndrome [7]. Risk factors such as advanced age, low functional scores, dependence on transfers, neglect, sensory changes, and comorbidities like diabetes mellitus or depression further complicate the clinical picture [8].

Managing PHS is a significant clinical challenge, but effective treatment can enhance patients' participation in rehabilitation, leading to better functional outcomes. Treatment modalities range from conservative approaches, such as physical modalities and slings, to minimally invasive techniques, including intra-articular corticosteroid injections, botulinum toxin injections, nerve blocks, and radiofrequency neuromodulation [9].

Study aim

Given the diverse etiological factors and management strategies for PHS, this retrospective study aimed to determine the prevalence of each identified cause and evaluate the range of treatment options implemented in an inpatient rehabilitation setting.

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