Departamento de Biomecanica, Medicina e Reabilitacao do Aparelho Locomotor, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR.
Clinics (Sao Paulo). 2019;74:e905. doi: 10.6061/clinics/2019/e905. Epub 2019 Apr 29.
Poststroke shoulder pain occurs very frequently and compromises function and quality of life. Because treatment depends on a multidisciplinary approach, it is desirable to optimize effectiveness. Myofascial pain syndrome is defined by the presence of trigger points that can also be found in spastic stroke patients. The aim of this study was to evaluate the frequency of myofascial pain in the shoulder girdle muscles in patients with poststroke shoulder pain and to document the clinical and functional results obtained with specific treatment for this condition.
Spastic stroke hemiplegic patients undergoing rehabilitation at the Rehabilitation Center of the Hospital das Clínicas of the Ribeirão Preto Medical School of the University of São Paulo were evaluated regarding the intensity and characteristics of shoulder pain, previous therapeutic interventions, shoulder goniometry and the presence of trigger points. Patients underwent trigger point blockade by intramuscular infiltration of 1% lidocaine. The evaluation and treatment procedures were repeated in the subsequent 3 weeks as long as the pain intensity was greater than 5 on a visual analog scale (VAS). In the fourth week, the evaluation procedures were repeated. Patients who were in a multiprofessional rehabilitation program were instructed to continue the treatment, and the others received complementary therapeutic advice if necessary to initiate it. The evaluations were performed at 0, 1, and 3 weeks and after 4 months.
Twenty-one patients (13 men; age=67.8±10.2 years; right hemiparesis: 11) participated in the study, and there was a reduction in pain assessed by VAS from baseline (7.6±2.7) to the first week (5.8±3.6; p<0.05) through the end of the third week (5.2±3.5; p<0.05), but not at the end of four months (6.6±2.9; p=0.11). Good responders had significantly lower pain levels after the third week and presented with a larger range of motion for passive abduction by the end of 4 months. These results demonstrate that the myofascial component of pain should be considered in poststroke shoulder pain and that its treatment may be a pathway for the rapid and long-lasting relief of symptoms.
Trigger point blockade with lidocaine can reduce pain perception in spastic hemiplegic shoulder in as much as 50% of stroke survivors for four months.
脑卒中后肩痛非常常见，会影响功能和生活质量。由于治疗需要多学科方法，因此优化疗效是很有必要的。肌筋膜疼痛综合征的定义是存在触发点，这些触发点也可以在痉挛性脑卒中患者中找到。本研究的目的是评估脑卒中后肩痛患者肩带肌肉中肌筋膜疼痛的频率，并记录针对这种情况的特定治疗获得的临床和功能结果。
对在圣保罗大学里贝朗普雷图医学院附属医院康复中心接受康复治疗的痉挛性脑卒中偏瘫患者进行评估，评估内容包括肩痛的强度和特征、既往治疗干预、肩关活动度和触发点的存在。患者接受肌肉内浸润 1%利多卡因的触发点阻滞。在接下来的 3 周内，只要视觉模拟量表（VAS）上的疼痛强度大于 5，就会重复评估和治疗过程。在第 4 周，会重复评估过程。如果患者正在接受多专业康复计划，则指导其继续治疗，否则，如果有必要开始治疗，则为其提供补充治疗建议。评估在 0、1 和 3 周以及 4 个月后进行。
21 名患者（13 名男性；年龄=67.8±10.2 岁；右侧偏瘫：11 名）参与了这项研究，VAS 评估的疼痛从基线（7.6±2.7）减少到第 1 周（5.8±3.6；p<0.05），一直持续到第 3 周（5.2±3.5；p<0.05），但在第 4 个月时没有减少（6.6±2.9；p=0.11）。在第 3 周后，治疗反应良好的患者疼痛程度显著降低，在第 4 个月时，被动外展的活动范围更大。这些结果表明，脑卒中后肩痛应考虑肌筋膜疼痛成分，其治疗可能是缓解症状的快速且持久的途径。
利多卡因触发点阻滞可使 50%的脑卒中幸存者的痉挛性偏瘫肩部疼痛在 4 个月内减轻 50%。
