Efficacy of Suprascapular Radiofrequency Ablation in Hemiplegic Shoulder Pain

Summary

Stroke, one of the most important causes of disability and death in the world, is an acute focal deficit of the central system caused by vascular origin such as cerebral infarction, intracerebral haemorrhage and subarachnoid haemorrhage. Hemiplegic shoulder pain, which is one of the most common complications after stroke, is an important problem affecting extremity rehabilitation. Although there are many factors thought to cause haemiplegic shoulder pain, there is still controversy about its treatment. Although there are many treatment strategies for this complication such as analgesics, antispasmotics, local corticosteroid injections, suprascapular nerve blockade, physical therapy modalities and exercise therapy, sometimes very resistant cases are also seen. For the treatment of persistent haemiplegic shoulder pain unresponsive to conventional treatment modalities, intra-articular injection of corticosteroids into the shoulder joint is commonly used, but its palliative effect has only a relatively short duration.Corticosteroids may also have adverse effects such as allergic reactions, rash, hyperglycaemia, menstrual disorders and adrenal suppression. Suprascapular nerve block is another option to relieve haemiplegic shoulder pain. The suprascapular nerve provides 70% of the sensory innervation of the shoulder joint. Thus, blocking pain transmission through the SS provides effective control of haemiplegic shoulder pain. However, the efficacy of suprascapular nerve block varies according to the study population and depends on the therapeutic modality to which it is compared. In addition, the effect of suprascapular nerve blockade may be limited due to the short duration of action of local anaesthetic agents. Neurolysis may cause permanent paralysis of the supraspinatus and infraspinatus muscles. For this reason, a deconstructive method is not preferred. Pulse RF applications, which is a non-deconstructive, neuromodulatory method, may be preferred in this regard. So far, there are very few studies investigating the efficacy of intra-articular steroid injection, suprascapular block and pulse RF in hemiplegic shoulder pain separately, but there is no study investigating the efficacy of Pulse RF treatment against other treatment methods together. In this study, investigator's aim was to compare the efficacy of suprascapular pulse radiofrequency against USG-guided suprascapular nerve block and intra-articular steroid injections in hemiplegic shoulder pain.

Conditions

• Hemiplegic Shoulder Pain

Interventions

PROCEDURE

Suprascapular nerve pulse radiofrequency ablation

Pulse RF application will be applied to the suprascapular nerve once under US guidance with a TOP-TLG10 STP generator at a maximum temperature of 42 degrees, 2 Hz, 20 ms and 45 V for 2 minutes.

PROCEDURE

Suprascapular Nerve Block Group

Suprascapular block will be applied once with a mixture consisting of 5 ml (1 ml betamethasone, 2% lidocaine 2 ml, 0.9% saline 2 ml).

PROCEDURE

Steroid Group

Intra-articular steroid application will be made with a mixture consisting of 5 ml (2 ml of 2% lidocaine, 2 ml of 0.9% saline and 1 ml of betamethasone 5 mg).

Sponsors & Collaborators

• Yunus Burak Bayır

  lead OTHER_GOV

Principal Investigators

• Damla CANKURTARAN, assoc. prof. · Ankara Etlik City Hospital

• Ebru KARACA UMAY, prof. · Ankara Etlik City Hospital

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-08-01

Primary Completion

2025-07-01

Completion

2025-07-01

Countries

• Turkey (Türkiye)

Study Locations