Brain Neurorehabil.  2014 Sep;7(2):118-125. 10.12786/bn.2014.7.2.118.

Suprascapular Nerve Block versus Intra-articular Hyaluronic Acid Injection in Hemiplegic Shoulder Pain

Affiliations
  • 1Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Korea. nickel0050@gmail.com

Abstract


OBJECTIVE
To compare the pain and functional improvement of suprascapular nerve block (SSNB) and intra-articular hyaluronic acid (HA) injection in post-stroke patients with hemiplegic shoulder pain. METHOD: In total, 24 stroke patients were randomly assigned in the SSNB group (n = 12) or the HA group (n = 12). Ultrasound (US) guided SSNB with 10 cc of 1% lidocaine and US guided intra-articular injection with 2 cc of HA was done in each group 3 times weekly. Visual analogue scale (VAS), Fugl-Meyer scale (FMS), Wolf motor function test (WMFT), Brunnstrom stage, modified Ashworth scale (MAS), range of motion (ROM) of shoulder joint and brief pain inventory (BPI) concerning the interference of patient's function (activity, mood, walking, work, relationship, sleep and enjoy) were assessed before the injection, one week and four weeks after first injection.
RESULTS
Both groups showed significant improvements in pain assessed by VAS, but the changes between the two groups were not significantly different. There were no significant improvements and did not show any significant differences between the two groups in FMS, WMFT, Brunnstrom stage, MAS and ROM of shoulder joint. On several items of the BPI concerning the interference of patient's function (activity, mood, work, and enjoy), only SSNB group showed significant improvement, even though the differences between the two groups were not significant.
CONCLUSION
Both SSNB and intra-articular HA injection were safe and effective in pain and functional ability in hemiplegic shoulder pain. But comparing the interference of patient's function caused by pain, only SSNB showed significant improvement.

Keyword

hemiplegia; shoulder pain; stroke; nerve block; hyaluronic acid

MeSH Terms

Hemiplegia
Humans
Hyaluronic Acid*
Injections, Intra-Articular
Lidocaine
Nerve Block*
Range of Motion, Articular
Shoulder Joint
Shoulder Pain*
Stroke
Ultrasonography
Walking
Wolves
Hyaluronic Acid
Lidocaine

Figure

  • Fig. 1 Graphs shows change of visual analogue scale parameter at baseline level, 1 week after intervention and 4 weeks after intervention. VAS : Visual analogue scale. *p<0.05 in comparison with baseline level, †p<0.05 in comparison with 1 week after first injection.

  • Fig. 2 Graphs shows change of brief pain inventory parameters at baseline level, 1 week after intervention and 4 weeks after intervention. BPI: Brief pain inventory. *p<0.05 in comparison with baseline level.


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