Sharma Arvind K, Asthana Satyasheel S, Deshmukh Indrajit
Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Raebareli, Raebareli, IND.
Cureus. 2024 Sep 10;16(9):e69051. doi: 10.7759/cureus.69051. eCollection 2024 Sep.
Background Hemiplegic shoulder pain (HSP) is one of the most common complications seen in stroke survivors. HSP is an important cause of disability in these patients and may act as a barrier to rehabilitation and functional recovery. Suprascapular nerve block (SSNB) has been shown to be an effective treatment option for managing HSP, and it may also improve overall functional and motor recovery. Methodology This is a retrospective case series. Six stroke patients with HSP received an ultrasound-guided SSNB as a part of their inpatient individualized neurorehabilitation program. They were evaluated before the intervention and at 4 and 12 weeks of follow-up. Primary outcome measures were the Shoulder Pain and Disability Index (SPADI) score, active range of motion (AROM), and the visual analog scale (VAS) score of the hemiplegic shoulder. Secondary outcome measures were the passive range of motion (PROM) and manual muscle testing (MMT) of the hemiplegic shoulder. Results Of the six patients, four (66.7%) were male, four (66.7%) had hypertension, and two (33.3%) were also suffering from diabetes mellitus. Improvement was seen in the VAS score and the pain subscale of SPADI in all six cases at 12 weeks of follow-up. VAS score improvement was between 40% and 100%, while SPADI pain subscale score improvement ranged from 21.74% to 100%. Total SPADI score improved in all cases, with improvement ranging from 7.94% to 54.55%. No Improvement was seen in four of the six cases in the SPADI disability subscale. AROM showed an improvement in three of the six cases, with the most improvement in flexion (up to 55.56%). PROM improved in all six cases for flexion and abduction and in four cases for external rotation. MMT of only two patients improved by at least two grades. Conclusions SSNB is a safe and effective treatment option for patients with HSP. Along with an improvement in pain, the addition of SSNB in neurorehabilitation may play an important role in aiding functional and motor recovery in stroke survivors with HSP.
偏瘫肩痛（HSP）是中风幸存者中最常见的并发症之一。HSP是这些患者残疾的重要原因，可能成为康复和功能恢复的障碍。肩胛上神经阻滞（SSNB）已被证明是治疗HSP的有效方法，它还可能改善整体功能和运动恢复。
这是一项回顾性病例系列研究。6例患有HSP的中风患者接受了超声引导下的SSNB，作为其住院个体化神经康复计划的一部分。在干预前以及随访4周和12周时对他们进行评估。主要结局指标为肩痛与残疾指数（SPADI）评分、主动活动范围（AROM）以及偏瘫肩的视觉模拟量表（VAS）评分。次要结局指标为偏瘫肩的被动活动范围（PROM）和徒手肌力测试（MMT）。
6例患者中，4例（66.7%）为男性，4例（66.7%）患有高血压，2例（33.3%）还患有糖尿病。在随访12周时，所有6例患者的VAS评分以及SPADI的疼痛子量表均有改善。VAS评分改善幅度在40%至100%之间，而SPADI疼痛子量表评分改善幅度为21.74%至100%。所有病例的SPADI总分均有改善，改善幅度为7.94%至54.55%。6例中有4例的SPADI残疾子量表未见改善。6例中有3例的AROM有所改善，其中屈曲改善最为明显（高达55.56%）。所有6例患者的屈曲和外展PROM均有改善，4例患者的外旋PROM有改善。只有2例患者的MMT至少提高了两个等级。
SSNB对于HSP患者是一种安全有效的治疗选择。除了疼痛改善外，在神经康复中加入SSNB可能在帮助患有HSP的中风幸存者进行功能和运动恢复方面发挥重要作用。
