The Effectiveness of Pulsed Radiofrequency of the Suprascapular Nerve and Shoulder Joint Compared to Intra-articular Corticosteroid Injection for Hemiplegic Shoulder Pain Management and Functional Improvement.

Introduction Post-stroke shoulder pain is a common condition, with various etiology and outcome. The incidence is 10-22% according to a recent meta-analysis and 12 month prevalence is estimated to be 39% (1). Shoulder pain is most commonly developing within the 2-3 months after diagnosis (2), and often resolves spontaneously in 6 months period. The background of shoulder pain condition is complicated phenomenon encompassing both nociceptive and neuropathic pain etiologies (3-5). Specific musculoskeletal etiologies are associated with HSP, including rotator cuff tendinitis, adhesive capsulitis, and bicipital tendinitis, subacromial bursitis (6) while other causes are more complex like glenohumeral subluxation, spasticity, central pain (6, 7) and the causes are often overlapping (3,4).

HSP has been demonstrated to be a predictor of poor motor and functional recovery, lower quality of life and can lead to emotional problems such as depression and anxiety (8,9,10).

Generally, clinicians employ range of motion (ROM) exercises, oral medications and other modalities of therapy to control HSP (11).

Some research have showed significant benefits in terms of pain reduction for many interventions including orthoses, botulinum toxin injection, electrical stimulation, aromatherapy and acupuncture (3).

In different national guidelines and systematic reviews intra-articular corticosteroid injection (ICI) into the shoulder joint is suggested as a choice of treatment, but its effect has only a relatively short duration (12). CSI has been reported to lead adverse events such as tendon degeneration, cutaneous atrophy or infection (13-15). In addition, CSI can cause systemic side effects including changes in the hypothalamic-pituitary-adrenal (HPA) axis function and elevated blood glucose levels (16).