Effectiveness of repeated ultrasound-guided suprascapular nerve blocks in hemiplegic shoulder pain: a randomized controlled trial

Abstract

Background: Hemiplegic shoulder pain (HSP) is a common complication after stroke, significantly impairing rehabilitation. While suprascapular nerve block (SSNB) has shown promise in pain management, its long-term efficacy, especially with repeated applications, remains unclear. Objective: This study aimed to evaluate the effectiveness of ultrasound-guided repeated SSNB in reducing pain, improving range of motion (ROM), and enhancing motor function in patients with HSP. Methods: This double-blind, randomized controlled trial included 42 patients with HSP, allocated to either the SSNB group or the control group in a 1:1 ratio. The SSNB group received ultrasound-guided injections of levobupivacaine and triamcinolone at baseline, 3 weeks, and 6 weeks, while the control group received sham injections. All participants followed a standardized physiotherapy program. Pain was assessed using the visual analog scale, ROM with a goniometer, spasticity with the Ashworth scale, and motor recovery with the Brunnstrom scale. Assessments were conducted at baseline, 1, 4, and 7 weeks. Results: Thirty-nine patients completed the study. The SSNB group showed significant reductions in visual analog scale scores at 1, 4, and 7 weeks compared to the control group (P < .05). ROM for abduction and flexion significantly improved in the SSNB group at 7 weeks (P < .05). However, there were no significant differences between groups in Ashworth or Brunnstrom scores at any time point. Conclusion: Repeated SSNB effectively reduces pain and improves ROM in patients with HSP when combined with physiotherapy. However, it does not significantly impact spasticity or motor function. Further research with longer follow-ups and active comparators is needed to determine its long-term benefits.