Department of Physical Medicine and Rehabilitation, Seoul Songdo Hospital, 04597 Seoul, Republic of Korea.
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 705-717 Daegu, Republic of Korea.
J Integr Neurosci. 2021 Sep 30;20(3):687-693. doi: 10.31083/j.jin2003073.
Many patients complain of hemiplegic shoulder pain following stroke. Here, the effectiveness of pulsed radiofrequency stimulation of the suprascapular nerve is compared with intra-articular corticosteroid injection for chronic hemiplegic shoulder pain following stroke. This single-center, prospective, randomized controlled study included 20 patients with hemiplegic shoulder pain after stroke, randomly assigned to the pulsed radiofrequency and intra-articular corticosteroid injection treatment groups ( = 10 in each). Hemiplegic shoulder pain severity was measured by numeric rating scale and passive shoulder range motion was assessed at baseline and one and two months after each procedure. Compared to the baseline numeric rating scale scores, post-treatment scores decreased significantly in both groups ( < 0.001). However, score reduction through time was significantly greater for intra-articular corticosteroid injection for pulsed radiofrequency ( < 0.001). Similarly, a significant post-treatment increase was observed in almost all range of motion measurements in both groups (pulsed radiofrequency group: flexion, = 0.015; abduction, = 0.014; external rotation, = 0.038; internal rotation, = 0.063; intra-articular corticosteroid injection group: all range of motion, < 0.001). Moreover, the measurements for all ranges of motion in the intra-articular corticosteroid injection group were significantly higher than those in the pulsed radiofrequency group ( < 0.001). Thus, intra-articular corticosteroid injection appears more effective than pulsed radiofrequency for control of hemiplegic shoulder pain, whereas, pulsed radiofrequency of the suprascapular nerve has minimal effect. However, in patients at risk for developing complications following corticosteroid injections, pulsed radiofrequency of the suprascapular nerve may be an option in management of hemiplegic shoulder pain.
许多脑卒中患者会出现偏瘫后肩痛。本研究旨在对比经皮高频脉冲射频术与关节内注射皮质类固醇治疗脑卒中后慢性偏瘫肩痛的疗效。这是一项单中心前瞻性随机对照研究，共纳入 20 例脑卒中后偏瘫肩痛患者，随机分为经皮高频脉冲射频术组和关节内注射皮质类固醇组（每组 10 例）。采用数字评分法评估偏瘫肩痛严重程度，于治疗前、治疗后 1 个月和 2 个月评估被动肩关节活动范围。与治疗前相比，两组患者的数字评分法评分均显著降低（ < 0.001），但关节内注射皮质类固醇组的评分降低更显著（ < 0.001）。两组患者的各项肩关节活动范围测量值在治疗后均显著增加（经皮高频脉冲射频术组：前屈， = 0.015；外展， = 0.014；外旋， = 0.038；内旋， = 0.063；关节内注射皮质类固醇组：所有运动范围， < 0.001），且关节内注射皮质类固醇组的测量值显著高于经皮高频脉冲射频术组（ < 0.001）。因此，与经皮高频脉冲射频术相比，关节内注射皮质类固醇更能有效控制偏瘫肩痛，而高频脉冲射频术对偏瘫肩痛的疗效甚微。然而，对于那些存在皮质类固醇注射相关并发症风险的患者，高频脉冲射频术可能是治疗偏瘫肩痛的一种选择。
