The Importance of Pectoralis Minor Syndrome in Hemiplegic Shoulder Pain: A Prospective, Interventional Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 19
- 试验地点
- 1
- 主要终点
- Pain Relief
研究概览
简要总结
Hemiplegic shoulder pain, common in stroke patients, often arises from muscle weakness, imbalance, or joint and nerve issues. Previous case reports in literature suggest that pectoralis minor syndrome may play a significant role in this pain. In current study, the investigators aimed to evaluate the role of the pectoralis minor muscle in patients with hemiplegic shoulder pain and to reveal the contribution of pectoralis minor syndrome to hemiplegic shoulder pain. Additionally, this study may provide fundamental information to improve clinical practice in determining rehabilitation and treatment strategies, contribute to the development of new approaches in managing hemiplegic shoulder pain, and assist in optimizing rehabilitation programs.
详细描述
Hemiplegic shoulder pain is a common complication following a stroke, with a prevalence ranging from 22% to 47%, typically occurring two to three months post-stroke. This pain can lead to withdrawal from rehabilitation programs, longer hospital stays, reduced joint mobility, and impaired quality of life. Various factors contribute to its development, including decreased muscle tone, shoulder subluxation, increased muscle tone, impingement syndrome, frozen shoulder, brachial plexus injury, and thalamic syndrome. Among these, subacromial/subdeltoid bursitis is the most frequently reported cause of pain, and significant pain relief following local anesthetic injections into the subacromial/subdeltoid bursa is diagnostic of subacromial impingement syndrome.
Treatment goals for hemiplegic shoulder pain include pain reduction, restoring shoulder mobility, improving functional activities, and preventing degenerative changes. Treatment options range from conservative methods like shoulder slings, range-of-motion exercises, pain relievers, physical therapy, and various injection therapies, to surgical interventions for cases unresponsive to conservative measures.
Pectoralis minor syndrome, associated with hemiplegic shoulder pain, can occur in stroke patients. The pectoralis minor muscle plays a crucial role in shoulder stability and movement. Compression or irritation of neurovascular structures in the retropectoral space by this muscle leads to pectoralis minor syndrome, often diagnosed through clinical evaluation rather than specific radiological or electrophysiological tests. Ultrasound-guided pectoralis minor muscle blocks have become significant in both diagnosis and treatment, demonstrating marked pain reduction in affected patients. Research on pectoralis minor syndrome aims to enhance understanding of its causes, effects, and treatment strategies, contributing to the development of more effective and specific approaches for managing hemiplegic shoulder pain.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Development of spastic hemiplegia due to stroke
- •Presence of shoulder pain on the hemiplegic side
排除标准
- •Lack of medical stability
- •Inability to communicate verbally
- •History of severe sensitivity to lidocaine injections
- •Surgical history related to the hemiplegic shoulder
- •Presence of a prosthesis in the hemiplegic shoulder
- •Malignancy in the hemiplegic shoulder
- •Severe psychiatric illness
- •History of injections to the hemiplegic shoulder within the last 6 months
- •Pregnancy
- •History of inflammatory rheumatic disease
研究组 & 干预措施
Intervention Arm
Patients presenting to the outpatient clinic with shoulder pain on the hemiplegic side will first undergo a diagnostic subacromial bursa injection, followed by a pectoralis minor muscle block.
干预措施: Ultrasound-guided injection of the subacromial bursa and pectoralis minor (Procedure)
Intervention Arm
Patients presenting to the outpatient clinic with shoulder pain on the hemiplegic side will first undergo a diagnostic subacromial bursa injection, followed by a pectoralis minor muscle block.
干预措施: Lidocaine (drug) (Drug)
结局指标
主要结局
Pain Relief
时间窗: Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month
Pain will be assessed using the Numerical Rating Scale (NRS), which ranges from 0 (no pain) to 10 (worst pain imaginable), at rest, during movement, at night, and overall, both before and after injections into the subacromial bursa and the pectoralis minor muscle. Higher scores indicate worse pain outcomes.
Passive Range of Motion of Shoulder
时间窗: Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month
Passive shoulder flexion, abduction, and external rotation will be measured with a goniometer. Flexion and abduction will be measured from 0° (no range of motion) to 180° (full range of motion), while external rotation will be measured from 0° to 90°. Higher scores indicate better outcomes in terms of range of motion.
次要结局
- Modified Ashworth Scale(Baseline)
- Brunnstrom Stages of Recovery for Upper Extremity Motor Function and Hand Function(Baseline)
- Functional Ambulation Scale(Baseline)
- Subluxation in the glenohumeral joint(Baseline)
- Overall Improvement(One hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, one month)
研究者
Burak Ugur Cetin
Medical Doctor
Istanbul University - Cerrahpasa