Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain

Abstract

BACKGROUND:

Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP.

OBJECTIVE:

This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP.

METHODS:

In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire.

RESULTS:

The pain scores of the SSNB group decreased more significantly ( $p<$ 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment ( $p<$ 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups.

CONCLUSION:

TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.

Keywords

Hemiplegia shoulder pain nerve block electric stimulation therapy

1. Introduction

Stroke is one of the leading causes of disability worldwide. Various complications are seen in hemiplegia due to stroke. Hemiplegic shoulder pain (HSP) is one such complication, with an incidence of 30–70% [1, 2]. HSP is a very common disorder and has various mechanical and neurogenic causes [3, 4, 5]. Mechanical causes include injuries to the surrounding tissues, motor loss, and muscle tone changes due to misalignment in the shoulder. In addition, neurogenic factors such as central pain, spasticity, or loss of sensation, also play a role in HSP [5].

The rehabilitation team plays a role in protecting the hemiplegic upper limb. Proper positioning of the upper extremities is required in hemiplegic patients. Despite training the patients’ families in this situation, HSP can develop very frequently. HSP causes deterioration in functional status and reduces quality of life; therefore, its treatment is important. The first-line treatment for HSP is usually via conservative methods [3]. Proper positioning of the upper limb, the use of shoulder braces while standing, physiotherapy, and exercises are beneficial treatments for HSP. Medications to reduce inflammation such as NSAIDs and other analgesics can help to alleviate the pain. Transcutaneus electrical nerve stimulation (TENS) is a commonly used treatment for painful conditions in clinical practice. TENS is thought to be beneficial for pain control in patients with HSP [6].

Intra-articular steroid injections or steroid injections into the subacromial bursa may also be helpful for pain control. Considering that 70% of the shoulder’s sensation is provided by the suprascapular nerve [7], suprascapular nerve block (SSNB) has been found to be beneficial in chronic shoulder pain and in patients with HSP [8, 9].

Nevertheless, in the literature there are conservative options for treating shoulder pain and these options are supported by the evidences. Although various treatment methods are used to control pain in patients with HSP, information on the clinical outcomes of these treatments is limited [10]. The treatment of HSP is based on a multidisciplinary approach, which aims to use different therapies optimizing the results and limiting the possible side effects [11].

Rehabilitation and physiotherapy are not always sufficient to achieve satisfactory pain relief. Pain may lead to decrease in shoulder range of motion (ROM), activities of daily living (ADL), and quality of life (Qol) in patients. The primary aim of this study is to compare the effects of TENS and SSNB on HSP. Secondly, we aimed to investigate the effects of these two treatment modalities on shoulder ROM, ADL, and Qol in patients with HSP.

2. Methods

2.1 Design

This comparative research study was conducted in our stroke rehabilitation unit.

2.2 Participants

The inclusion criteria for the study were an age of at least 18 years, a stroke duration $<$ 12 months before the beginning of our study, and an HSP duration of $\geqslant$ 3 months. Patients with an infected skin lesion in the shoulder area, uncontrolled hypertension or diabetes mellitus, severe cooperation disorder (Mini Mental State Examination (MMSE) test score $<$ 24), aphasia, dysphasia, cardiac pacemaker, a botulinum toxin injection in the shoulder adductor or internal rotators within the last 3 months, or an intra-articular steroid injection into the subacromial bursa or shoulder were excluded from the study. We did not make changes to the anti-spasticity drug doses during the study. Analgesic medication was not given to the patients. Eighty-four hemiplegic patients who applied to the stroke rehabilitation unit were screened for eligibility for the study. HSP was not detected in 48 of these patients. Four patients were excluded from the study because botulinum toxin was administered within the last 3 months, 5 were excluded because of unregulated diabetes, and 2 for other reasons. Subsequently, 25 patients with HSP who met the criteria were included in this clinical research study.

2.3 Interventions

Patients were randomized into 2 treatment groups, TENS ( $n=$ 13) and SSNB ( $n=$ 12). TENS and SSNB were administered by the same two physical medicine and rehabilitation specialist Conventional TENS was applied to the hemiplegic shoulders of the patients in the first group for 30 minutes 5 times a week for 3 weeks for a total of 15 sessions. The TENS application parameters consisted of a 100 Hz symmetrical waveform and a 300 microsecond wave duration. The amplitude was applied within the limits of the pain threshold that the patient could tolerate (range 0–100 mA) while taking into account the sensory threshold value of between 5 and 9 mA. Ultrasound-guided SSNB was administered to the second group. It has been shown that the treatment efficiency of ultrasound-guided SSNB is better [8]. For SSNB, a 10 mL syringe and a 22-gauge 80 mm needle with 1 mL of 40 mg/mL methylprednisolone and 8 mL of 0.5% bupivacaine hydrochloride were used. All patients participated in a conventional rehabilitation program consisting of gentle ROM exercises. Bobath and Proprioceptive Neuromuscular Facilitation (PNF) exercises were conducted throughout the study. The patients continued to take their antispasticity medication. One patient in the TENS group was diagnosed with coronavirus disease 2019 (COVID-19) in the second week with a fever and cough. This patient was excluded from the study. A total of 24 patients completed the study.

2.4 Outcome measures

The patients were evaluated with the following outcome measures at the beginning of the study, at the first week of treatment, and at the end of the third week.

•
Visual Analogue Scale (VAS): A 100 mm VAS was used to assess the severity of pain.
•
Shoulder ROM: Passive abduction, flexion, and external rotation ROM of the shoulder were measured with a goniometer.
•
The modified Ashworth scale (MAS): MAS was used to evaluate spasticity around the shoulder adductor and elbow. MAS has been applied in clinical practice and research as a measure of spasticity. The modified Ashworth scale purpose is to grade muscle spasticity. MAS is evaluated between 1–5. A scale of 1 indicates no resistance and five indicates rigidity [11].
•
Modified Barthel scale: A modified Barthel scale was used to assess the activities of daily living (ADL). Modified Barthel scale is used to assess physical independence in activities of daily living. (Assesses the patient’s independence in mobility and personal care in ten items.) It consists of ten items (nutrition, bathing, self-care, dressing, bowel care, bladder care, toilet use, transfer, ambulation or wheelchair use, and stair climbing) and each item are scored separately. The total score is between 0–100. The higher the score, the higher the patient’s level of independence [12].
•
Stroke-Specific Quality of Life Scale (SS-Qol): Quality of life was measured using the SS-QoL. The patients were evaluated at the beginning of the study, at the first week of treatment, and at the end of the third week. SS-Qol is a disease-specific quality of life scale and consists of 49 items that assess 12 domains: social role (5 items), mobility (6 items), energy (3 items), language (5 items), self-care (5 items), mood (5 items), personality (3 items), thinking (3 items), upper extremity function (5 items), family roles (3 items), vision (3 items), and work/productivity (3 items). The scores of these 12 domains are summed to obtain a total score of 49–245. Higher scores indicate a better quality of life [13].

2.5 Statistical analysis

In the descriptive statistics of the data, mean, standard deviation, median, lowest, highest, frequency, and ratio values were used. The distribution of variables was assessed using the Kolmogorov-Smirnov test. The independent sample $t$ -test and Kruskal-Wallis test were used in the analysis of quantitative independent data, while the Wilcoxon test was used in the analysis of dependent quantitative data. The chi-squared test was used in the analysis of independent qualitative data, and the Fischer test was used when chi-squared test conditions were not met. McNemar’s test was used to analyze dependent qualitative data. The Statistical Package for the Social Sciences (SPSS) version 27.0 was used for the analyses.

3. Results

The demographic and clinical characteristics of the study groups are summarized in Table 1. The ratio of female patients in the SSNB group and the ratio of male patients in the TENS group were significantly higher ( $p<$ 0.05). The rate of left hemiplegia in the SSNB group and the rate of right hemiplegia in the TENS group were significantly higher ( $p<$ 0.05, Table 1). There were no significant differences between the groups in terms of other parameters ( $p>$ 0.05).

Table 1
The demographic and clinical characteristics of the study groups

	TENS group				SSNB group				$p$
	Ave. $\pm$ s.d/n-%			Median	Ave. $\pm$ s.d/n-%			Median
Age	62.3	$\pm$	11.2	64.0	69.3	$\pm$	8.5	70.5	0.105	m
Gender
Female	2		16.7%		9		75.0%		0.004	X ${}^{2}$
Male	10		83.3%		3		25.0%
Height	167.4	$\pm$	7.4	169.0	165.4	$\pm$	3.8	165.0	0.271	m
Weight	76.8	$\pm$	9.6	77.5	68.8	$\pm$	9.2	70.0	0.050	t
BMI	27.5	$\pm$	4.0	28.2	25.3	$\pm$	3.9	26.0	0.175	t
Marital status
Married	10		83.3%		8		66.7%		0.346	X ${}^{2}$
Single	2		16.7%		4		33.3%
Stroke duration	9.5	$\pm$	8.0	8.3	11.6	$\pm$	14.6	8.0	0.954	m
Number of strokes
One	10		83.3%		10		83.3%		1.000	X ${}^{2}$
Recurrent	2		16.7%		2		16.7%
Hemiplegic shoulder pain duration	56.1	$\pm$	30.5	50.0	144.2	$\pm$	135.6	105.0	0.068	m
Modified barthel	55.4	$\pm$	28.2	55.0	52.1	$\pm$	17.5	52.5	0.732	t
Stroke side
Right hemiplegia	8		66.7%		3		25.0%		0.041	X ${}^{2}$
Left hemiplegia	4		33.3%		9		75.0%
Etiology
Ischemic	11		91.7%		12		100%		1.000	X ${}^{2}$
Hemorogic	1		8.3%		0		0.0%
Arm sling
( $+$ )	3		25.0%		3		25.0%		1.000	X ${}^{2}$
( $-$ )	9		75.0%		9		75.0%
Subluxation
( $-$ )	3		25.0%		0		0.0%		0.217	X ${}^{2}$
( $+$ )	9		75.0%		12		100%
Pain type
Mechanical	9		75.0%		6		50.0%		0.206	X ${}^{2}$
Mixed (neuropathic and mechanical)	3		25.0%		6		50.0%
Brunnstrom upper	3.2	$\pm$	1.3	3.0	1.9	$\pm$	0.9	2.0	0.011	m
Brunnstrom lower	3.6	$\pm$	1.3	3.0	2.8	$\pm$	0.7	3.0	0.119	m

${}^{\text{t}}$ Independent sample $t$ test; ${}^{\text{m}}$ Mann-whitney $u$ test; ${}^{\text{X}^{2}}$ Chi-square test (Fischer test); Ave: Average.

Table 2

The difference in the follow-up parameters of the TENS and SSNB groups

		TENS GROUP				SSNB GROUP				$p$
		Ave. $\pm$ s.d/n-%			Median	Ave. $\pm$ s.d/n-%			Median
Pain
Before treatment		62.5	$\pm$	26.7	50.0	72.1	$\pm$	24.6	70.0	0.318	m
1st week		42.1	$\pm$	23.0	40.0	31.7	$\pm$	10.9	30.0	0.410	m
3rd week		32.5	$\pm$	30.2	30.0	16.3	$\pm$	11.7	10.0	0.231	m
BT/1st week difference		$-$ 20.4	$\pm$	11.6	$-$ 22.5	$-$ 40.4	$\pm$	19.9	$-$ 30.0	0.012	m
In-group difference p		0.003			W	0.002			W
BT/3rd week difference		$-$ 30.0	$\pm$	35.2	$-$ 30.0	$-$ 55.8	$\pm$	24.9	$-$ 45.0	0.029	m
In-group difference p		0.025			W	0.002			W
Abduction
Before treatment		108.8	$\pm$	33.2	110.0	104.2	$\pm$	26.7	92.5	0.537	m
3rd week		125.4	$\pm$	28.7	120.0	131.3	$\pm$	20.7	130.0	0.336	m
BT/3rd week difference		16.7	$\pm$	14.4	10.0	27.1	$\pm$	26.2	30.0	0.280	m
In-group difference		0.004			W	0.007			W
Flexion
Before treatment		112.9	$\pm$	41.5	100.0	92.8	$\pm$	33.5	90.0	0.266	m
3rd week		131.7	$\pm$	34.4	135.0	120.4	$\pm$	29.6	115.0	0.367	m
BT/3rd week difference		18.8	$\pm$	22.0	20.0	27.7	$\pm$	37.5	25.0	0.599	m
In-group difference p		0.023			W	0.012			W
External Rotation
Before treatment		71.9	$\pm$	21.8	77.5	79.6	$\pm$	9.6	80.0	0.516	m
3rd week		80.4	$\pm$	10.8	80.0	82.5	$\pm$	7.5	80.0	0.760	m
BT/3rd week difference		8.5	$\pm$	19.9	2.5	2.9	$\pm$	5.4	0.0	0.539	m
In-group difference p		0.041			W	0.102			W
SS-QOL
Before treatment		28.6	$\pm$	8.7	29.0	27.4	$\pm$	3.9	27.0	0.817	m
3rd week		33.8	$\pm$	9.9	36.0	29.5	$\pm$	4.2	29.5	0.156	m
BT/3rd week difference		5.3	$\pm$	5.0	3.5	2.1	$\pm$	2.2	2.0	0.040	m
In-group difference p		0.003			W	0.007			W
Spasticity
Before treatment	( $+$ )	9		75.0%		9		75.0%		1.000	X ${}^{2}$
	( $-$ )	3		25.0%		3		25.0%
3rd week	( $+$ )	10		83.3%		10		83.3%		1.000	X ${}^{2}$
	( $-$ )	2		16.7%		2		16.7%
In-group difference p		1.000			N	1.000			N

${}^{\text{m}}$ Mann-whitney $u$ test; ${}^{\text{w}}$ Wilcoxon test; ${}^{\text{X}^{2}}$ Chi-square test (Fischer test); ${}^{\text{N}}$ MC Nemar test; BT: before treatment; Ave: Average.

Figure 1.

The difference in the follow-up parameters of the TENS and SSNB groups.

The differences in the follow-up parameters of the TENS and SSNB groups are shown in Table 2 and Fig. 1. In both groups, pain scores measured by VAS at the 1st and 3rd weeks showed a significant ( $p<$ 0.05) decrease when compared to the pre-treatment period. The decrease in pain scores in the SSNB group was significantly higher ( $p<$ 0.05) than in the TENS group at both the 1st and 3rd weeks when compared to the pre-treatment group.

At week 3, the shoulder passive abduction and flexion ROM in both groups increased significantly ( $p<$ 0.05) relative to the pre-treatment period. However, the magnitude of the change in shoulder passive abduction and flexion ROM did not differ between the groups ( $p>$ 0.05, Table 2).

The shoulder passive external rotation ROM increased significantly ( $p<$ 0.05) in the TENS group at the 3rd week when compared to the pre-treatment period. Conversely, this did not change significantly in the SSNB group ( $p>$ 0.05) compared to the pre-treatment period.

SS-QOL scores measured at the 3rd week in both groups were significantly higher than before treatment ( $p<$ 0.05). This increase in SS-QOL scores was significantly higher in the TENS group than in the SSNB group ( $p<$ 0.05, Table 2).

Spasticity scores as measured after treatment with the MAS and Modified Barthel Scores did not differ significantly compared to pre-treatment values in both groups ( $p>$ 0.05).

4. Discussion

HSP is associated with upper extremity weakness, right hemispheric lesions, sensory impairment, spasticity. It tends to begin in the subacute and chronic poststroke periods, and can be related to glenohumeral subluxation. Physical therapy with passive ROM exercises and prevention of shoulder injury are important to reduce the developing hemiplegic shoulder pain.

TENS is a physical therapy agent that stimulates small diameter, high threshold cutaneous afferents to block transmission of nociceptive information in peripheral nerves and activates extrasegmental analgesic mechanism. Although it is uncertain, TENS may help reducing most types of chronic pain and may be used as an adjunct to other more active treatments.

The suprascapular nerve is a mixed motor and sensory peripheral nerve. The nerve innervates shoulder muscles and sends sensory branches to the shoulder area. SSNB is a safe and effective method to treat pain in chronic pain of the shoulder.

In this study, both TENS and SSNB were found to be beneficial in terms of pain, shoulder ROM, daily living activities, and quality of life in patients with HSP. SSNB was better than TENS in terms of its rapid effects in reducing pain. Pain relief and improved ROM over a shorter period enable faster and more effective rehabilitation for HSP patients. This can lead to better functional results.

If there is increased muscle tone around the shoulder, antispasmodics and botulinum toxin injections could also be helpful for reducing the HSP. In the study by Mera et al. 30 subjects with post stroke spasticity were divided into two groups. One of the groups received botulinum toxin injection and physiotherapy while the other group received botulinum toxin injection, rESWT and physiotherapy. Assessments were performed before treatment and first, second and third months after treatment. Using MAS, VAS for pain and MyotonPro ${}^{\@setsize{\scriptsize}{8pt}{\viipt}{\@viipt}\textregistered}$ device to assessed myometric evaluation of muscles tone and stiffness. Muscles tone and stiffness statistically decreased until 3 months in the both groups. They found that rESWT could be an effective physical treatment for decreasing the upper and lower limbs spasticity and could lead to the improvement of trophic conditions of the spastic muscles in post-stroke patients [14]. In this study which the patients continued to their regular anti-spasticity drugs, the spasticity severity as measured by MAS did not show any significant difference, ADL also did not change significantly after treatment.

In the study by Aydin et al., there was a more significant improvement in pain, shoulder ROM, and quality of life in the SSNB group at the 1st and 3rd months compared to those who only performed a home exercise program [15]. Moreover, in the SSNB group, there was an improvement in pain 1 week after the injection, and this situation continued for the 1st and 3rd months. Conversely, there was no improvement in pain in the home exercise group. In the same study, the quality of life as measured by EQ-5D also improved in the 1st week in the SSNB group. There was no difference between the baseline values in either group in shoulder spasticity, as measured by the MAS and Brunnstrom Motor Stages after treatment.

In a placebo-controlled study in patients with HSP conducted by Adey-Wakeling et al., the decrease in pain severity measured by VAS at the 1st and 4th weeks was greater in the SSNB group than in the control [16]. The same study also reported no differences between the groups in terms of disability and quality of life.

In a study conducted by Picelli et al. in stroke patients with chronic HSP with a stroke duration of $>$ 2 years, there was a significant decrease in pain severity as measured by VAS at 1 hour, 1 week, and 1 month after SSNB administration [17]. There was also a decrease in spasticity and an increase in passive shoulder flexion, abduction, and external rotation openings 1 hour after SSNB [14]. Quality of life also improved after 1 month ( $p<$ 0.05).

In a 4-week study by Boonsong et al., the efficacy of SSNB and ultrasound were compared in patients with HSP. The reduction in shoulder pain was faster in the SSNB group than in the ultrasound group [18], but there were no differences between the groups in terms of shoulder ROM. No complications were reported during the treatment.

Farì et al. investigated the efficacy of radiofrequency in treating various musculoskeletal pain.They reported that radiofrequency was more effective in reducing pain than control treatments in adhesive capsulitis. In our study we used SSNB instead of radiofrequency for treating the HSP to reduce the pain [19].

In a study in patients with HSP by Ekim et al., TENS application for 20 minutes, 5 days a week, for a total of 15 sessions, was superior to placebo in terms of pain and improvement in ADL, as assessed by the Barthel Index [6]. In another placebo-controlled study by Leandri et al. involving 60 patients with HSP, the patients were divided into 3 groups and received a total of 12 sessions of TENS over 4 weeks. At the end of the treatment and 1 month later, high-intensity TENS increased the passive flexion, abduction, and extension openings of the shoulder, but there was no significant effect in the low-intensity TENS group [20]. In this study, because of its better tolerability, the TENS intensity was adjusted to be within the limits of the pain threshold. In a previous study conducted on patients with chronic pain, there was no difference in pain between different TENS applications [21]. TENS applied at the pain threshold has been found to be useful in the treatment of acute and chronic painful conditions [22].

Kim and Chang compared the effectiveness of pulsed radiofrequency stimulation of the suprascapular nerve with intra-articular corticosteroid injection for chronic hemiplegic shoulder pain following stroke. This study included 20 patients with hemiplegic shoulder pain after stroke, randomly assigned to the pulsed radiofrequency and intra-articular corticosteroid injection treatment groups ( $n=$ 10 in each). They found that 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 [23].

In our study, in both groups, pain scores measured by VAS at the 1st and 3rd weeks showed a significant decrease when compared to the pre-treatment period. The decrease in pain scores in the SSNB group was significantly higher than in the TENS group at both the 1st and 3rd weeks when compared to the pre-treatment group. The reduction in shoulder pain was faster in the SSNB group than in the TENS group. Spasticity scores as measured after treatment with the MAS and Modified Barthel Scores did not differ significantly compared to pre-treatment values in both groups.

In our study, no complications were observed in either group. Both TENS and SSNB were found to be safe. One patient in the TENS group diagnosed with COVID-19 was excluded from the study. All remaining patients completed 15 sessions of TENS treatment.

This study has strengths and some limitations. Its strength is that, to the best of our knowledge, this is the first study comparing TENS and SSNB in the treatment of HSP. SSNB can be used as an additional treatment when conventional treatments are insufficient in pain control in HSP. Its limitations are that the sample size was relatively small, the follow-up period was relatively short, and there was no long-term follow-up. Another limitation is that the person making the evaluations was not blinded to the treatments.

5. Conclusion

Both TENS and SSNB have been deemed beneficial in relieving pain and increasing passive shoulder ROM and ADL in patients with HSP. It was observed that pain control was achieved more quickly with SSNB in the first week. Although, the clinical trials with big sample sizes are needed, SSNB is advantageous to enable the patients to participate in rehabilitation programs actively in a short time.

Ethical approval

The study was performed in accordance with the Declaration of Helsinki and was approved by the Bakırköy Dr Sadi Konuk Research and Training Hospital Ethics Committee (Approval number 2020-25-04). Written informed consent was obtained from all subjects.

Funding

This study was not supported by any foundation.

Author contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript.

Footnotes

Acknowledgments

The authors are grateful to the patients and hospital staff who contributed to this study, Istatistik Akademisi for analyzing the data and Scribendi for proofreading and editing.

Conflict of interest

The authors do not have commercial or other associations that might pose a conflict of interest.

References

Adey-Wakeling

Arima

Crotty

, et al. Incidence and associations of hemiplegic shoulder pain poststroke: Prospective population-based study. Arch Phys Med Rehabil. 2015; 96(2): 241-247.e1.

Van Ouwenaller

Laplace

Chantraine

. Painful shoulder in hemiplegia. Arch Phys Med Rehabil. 1986 Jan; 67(1): 23-6. PMID: 3942479.

Wilson

Chae

. Hemiplegic shoulder pain. Phys Med Rehabil Clin N Am. 2015; 26(4): 641-655. doi: 10.1016/j.pmr.2015.06.007.

Walsh

. Management of shoulder pain in patients with stroke. Postgrad Med J. 2001; 77(912): 645-649. doi: 10.1136/pmj.77.912.645.

Vasudevan

Browne

. Hemiplegic shoulder pain: An approach to diagnosis and management. Phys Med Rehabil Clin N Am. 2014; 25(2): 411-437.

Ekim

Armağan

Oner

. Hemiplejik omuz ağrisinda TENS tedavisinin etkileri: Plasebo kontrollü bir çalişma [Efficiency of TENS treatment in hemiplegic shoulder pain: A placebo controlled study]. Agri. 2008 Jan; 20(1): 41-6. Turkish. PMID: 18338278.

Ritchie

Tong

Chung

Norris

Miniaci

Vairavanathan

. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality? Anesth Analg. 1997 Jun; 84(6): 1306-12. doi: 10.1097/00000539-199706000-00024. PMID: 9174311.

Chang

Hung

Han

Yang

Lin

. Comparison of the effectiveness of suprascapular nerve block with physical therapy, placebo, and intra-articular injection in management of chronic shoulder pain: A meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2016 Aug; 97(8): 1366-80. doi: 10.1016/j.apmr.2015.11.009. Epub 2015 Dec 14. PMID: 26701762.

Yasar

Vural

Safaz

Balaban

Yilmaz

Goktepe

Alaca

. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: Intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehabil. 2011 Jan; 25(1): 60-8. doi: 10.1177/0269215510380827. Epub 2010 Oct 13. PMID: 20943716.

10.

Dyer

Mordaunt

Adey-Wakeling

. Interventions for post-stroke shoulder pain: An overview of systematic reviews. Int J Gen Med. 2020 Dec 7; 13: 1411-1426. doi: 10.2147/IJGM.S200929. PMID: 33324087; PMCID: PMC7732168.

11.

Harb

Kishner

. Modified Ashworth Scale. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32119459.

12.

Küçükdeveci

Yavuzer

Tennant

Süldür

Sonel

Arasil

. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000 Jun; 32(2): 87-92. PMID: 10853723.

13.

Mahmoodi

Safari

Vossoughi

, et al. Stroke specific quality of life questionnaire: Test of reliability and validity of the Persian version. Iran J Neurol. 2015; 14(2): 94-100. PMID: 26056554.

14.

Megna

Marvulli

Farì

Gallo

Dicuonzo

Fiore

Ianieri

. Pain and Muscles Properties Modifications After Botulinum Toxin Type A (BTX-A) and Radial Extracorporeal Shock Wave (rESWT) Combined Treatment. Endocr Metab Immune Disord Drug Targets. 2019; 19(8): 1127-1133. doi: 10.2174/1871530319666190306101322. PMID: 30843498.

15.

Aydın

Şen

Eİ

Yardımcı

Kesiktaş

Öneş

Paker

. Efficacy of ultrasound guided suprascapular nerve block treatment in patients with painful hemiplegic shoulder. Neurol Sci. 2019; 40(5): 985-91.

16.

Adey-Wakeling

Crotty

Shanahan

. Suprascapular nerve block for shoulder pain in the first year after stroke: A randomized controlled trial. Stroke. 2013 Nov; 44(11): 3136-41. doi: 10.1161/STROKEAHA.113.002471. Epub 2013 Aug 22. PMID: 23970790.

17.

Picelli

Bonazza

Lobba

Parolini

Martini

Chemello

, et al. Suprascapular nerve block for the treatment of hemiplegic shoulder pain in patients with long-term chronic stroke: A pilot study. Neurological Sciences. 2017; 38(9): 1697-1701. doi: 10.1007/s10072-017-3057-8.

18.

Boonsong

Jaroenarpornwatana

Boonhong

. Preliminary study of suprascapular nerve block (SSNB) in hemiplegic shoulder pain. J Med Assoc Thai. 2009 Dec; 92(12): 1669-74. PMID: 20043571.

19.

Farì

de Sire

Fallea

Albano

Grossi

Bettoni

Di Paolo

Agostini

Bernetti

Puntillo

Mariconda

. Efficacy of radiofrequency as therapy and diagnostic support in the management of musculoskeletal pain: A systematic review and meta-analysis. Diagnostics (Basel). 2022 Feb 26; 12(3): 600. doi: 10.3390/diagnostics12030600. PMID: 35328153; PMCID: PMC8947614.

20.

Leandri

Parodi

Corrieri

Rigardo

. Comparison of TENS treatments in hemiplegic shoulder pain. Scand J Rehabil Med. 1990; 22(2): 69-71. PMID: 2363027.

21.

Köke

Schouten

Lamerichs-Geelen

Lipsch

Waltje

van Kleef

Patijn

. Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: A randomized crossover trial. Pain. 2004 Mar; 108(1–2): 36-42. doi: 10.1016/j.pain.2003.11.013. PMID: 15109505.

22.

Johnson

Paley

Jones

Mulvey

Wittkopf

. Efficacy and Safety of Transcutaneous Electrical Nerve Stimulation (TENS) for Acute and Chronic Pain: A Systematic Review and Meta-Analysis (Meta-TENS). Available at SSRN: https://ssrn.com/abstract=3756796 or doi: 10.2139/ssrn.3756796.

23.

Kim

Chang

. Comparison of the effectiveness of pulsed radiofrequency of the suprascapular nerve and intra-articular corticosteroid injection for hemiplegic shoulder pain management. J Integr Neurosci. 2021 Sep 30; 20(3): 687-693. doi: 10.31083/j.jin2003073. PMID: 34645102.

Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Methods

2.1 Design

2.2 Participants

2.3 Interventions

2.4 Outcome measures

3. Results

Table 1 The demographic and clinical characteristics of the study groups

5. Conclusion

Ethical approval

Funding

Author contributions

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
The demographic and clinical characteristics of the study groups