Evaluation of the Effectiveness of Pericapsular Nerve Group Block in Hemiplegic Shoulder Pain
Overview
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Marmara University
- Enrollment
- 15
- Locations
- 1
- Primary Endpoint
- Change in Pain Intensity (Numeric Rating Scale, NRS):
Overview
Brief Summary
Hemiplegic shoulder pain (HSP) is a common and clinically significant complication after stroke that negatively affects rehabilitation outcomes. It is associated with shoulder subluxation, capsular contracture, spasticity, and central pain mechanisms, leading to pain, limited range of motion, and reduced quality of life. The suprascapular nerve (SSN) block has been shown to be effective for shoulder pain management; however, the glenohumeral joint (GHJ) receives innervation from multiple nerves including the axillary, subscapular, and lateral pectoral nerves. The recently described pericapsular/periarticular nerve group (PENG) block targets these articular branches and may provide analgesia with minimal motor impairment.
This study aims to evaluate the effects of adding an ultrasound-guided PENG block to conventional physical therapy in patients with post-stroke hemiplegic shoulder pain, focusing on pain intensity, range of motion, and quality of life outcomes.
Detailed Description
Pericapsular/Periarticular Nerve Group (PENG) Block Procedure:
The procedure is performed with the patient in the supine position, the affected arm externally rotated and abducted approximately 45 degrees. A high-frequency linear ultrasound probe is placed longitudinally between the coracoid process and the humeral head. After identifying the humeral head, the subscapularis muscle tendon, and the overlying deltoid muscle, an in-plane approach is used to advance a 100-mm needle between the deltoid muscle and the subscapularis tendon under real-time ultrasound guidance.
After confirming the needle tip position, a total of 10 mL of 0.25% bupivacaine hydrochloride combined with 4 mg of dexamethasone is injected slowly, ensuring appropriate spread within the targeted pericapsular space. The goal of the block is to provide analgesia for the glenohumeral joint by targeting the articular branches of the axillary, subscapular, and lateral pectoral nerves with minimal motor impairment.
No major complications have been reported for this technique in the literature. However, minor complications such as local bleeding, infection, or transient vasovagal reactions may occur.
Study Design
- Study Type
- Observational
- Observational Model
- Case Only
- Time Perspective
- Prospective
Eligibility Criteria
- Ages
- 18 Years to 85 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age between 18 and 85 years
- •Stroke onset less than 1 year
- •Presence of hemiplegic shoulder pain with limited shoulder range of motion confirmed by clinical examination
- •Numeric Rating Scale (NRS) pain score ≥ 4
Exclusion Criteria
- •Severe deformity or pathology of the shoulder region
- •Complex regional pain syndrome type I
- •Modified Ashworth Scale score ≥ 3
- •Presence of neglect syndrome
- •Grade 4 glenohumeral joint degeneration
- •Coagulopathy or bleeding disorders
- •Fracture on the affected side
- •Secondary pathology on MRI (malignancy or infection)
- •Presence of pacemaker
- •History of allergic reaction to local anesthetic agents or dexamethasone
Outcomes
Primary Outcomes
Change in Pain Intensity (Numeric Rating Scale, NRS):
Time Frame: Baseline, 1 hour, 2 weeks, and 2 months post-intervention. Numeric Rating Scale
NRS is a scale in which the patient gives points between "0" and "10" for the low back and leg pain felt by the patient, "0" = No pain, "10" = The most severe, unbearable pain
Secondary Outcomes
- Fugl-Meyer Assessment for Upper Extremity (FMA-UE)(Baseline, 2 weeks, and 2 months)
- Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) Questionnaire(Baseline, 2 weeks, and 2 months)
- Modified Ashworth Scale (MAS)(Baseline, 2 weeks, and 2 months)
- Stroke-Specific Quality of Life Scale (SS-QOL)(Baseline, 2 weeks, and 2 months)
- Modified Barthel Index (MBI)(Baseline, 2 weeks, and 2 months)
- Shoulder Range of Motion (ROM)(Baseline, 2 weeks, and 2 months)