Jebmh.com Original Research Article J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 5/Issue 46/Nov. 12, 2018 Page 3228 ULTRA-SOUND GUIDED SUPRASCAPULAR NERVE BLOCK IN HEMIPLEGIC SHOULDER PAIN Swapnil Pramod Sonune 1 , Anil Kumar Gaur 2 , Shefali Gupta 3 1 Senior Resident, Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, Maharashtra. 2 HOD, Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, Maharashtra. 3 Consultant, Department of Radiodiagnosis, All India Institute of Physical Medicine and Rehabilitation, Mumbai, Maharashtra. ABSTRACT BACKGROUND Hemiplegic shoulder pain is associated with reduced functional improvement, a higher incidence of depression, interference with rehabilitation, and an increased length of hospitalisation. Supra- Scapular Nerve Block (SSNB) has shown efficacy in various chronic shoulder pain management but lacks clinical evidence in case of hemiplegic shoulder pain management. MATERIALS AND METHODS A prospective randomised controlled trial was done to look for the efficacy of suprascapular nerve block in hemiplegic shoulder pain which included 60 patients divided in to two groups. Group A received ultra-sound guided suprascapular nerve block and exercise therapy (n=30); Group B received exercise therapy alone (n=30). Pain outcome was measured using Visual Analogue Scale (VAS) at rest and at movement of affected shoulder at 1 st week, 4 th week and 12 th week. RESULTS The VAS score, both at rest and at movement, improved significantly in group A with p-value 0.000 which was evident at 1st week post injection. The improvement in VAS score at rest is from 4.67 ± 1.42 to 1.53 ± 1.93 and in VAS score at movement is from 7.53 ± 1.50 to 2.37 ± 1.97 in group A. CONCLUSION Therefore, we conclude that SSNB is a safe and effective treatment option for patients with hemiplegic shoulder pain in the first year after stroke. The intervention can be easily performed using ultra-sound guidance in clinical settings, offering a practical and important advancement for shoulder pain management in this patient population. KEYWORDS Shoulder Pain; Post Stroke Pain; Suprascapular Nerve Block; Hemiplegic Shoulder Pain. HOW TO CITE THIS ARTICLE: Sonune SP, Gaur AK, Gupta S. Ultra-sound guided suprascapular nerve block in hemiplegic shoulder pain. J. Evid. Based Med. Healthc. 2018; 5(46), 3228-3232. DOI: 10.18410/jebmh/2018/657 BACKGROUND Shoulder pain and stiffness are unfortunately, frequent complications in hemiplegia after stroke. It is reported as one of the four most common medical complications of stroke. 1 Approximately a 16% to 72% of stroke patients develop hemiplegic shoulder pain. 2,3,4 It may occur in up to 80% of stroke patients who have little or no voluntary movement of the affected upper limb. 5 Hemiplegic shoulder pain (HSP) has been shown to affect stroke outcome in a negative way. 6 It interferes with recovery after a stroke, it can cause considerable distress and reduced activity and can markedly hinder rehabilitation. 7,8,9 Good shoulder function is a prerequisite for effective hand function, as well as for performing multiple tasks involving mobility, ambulation, and activities of daily living (ADL). Hemiplegic shoulder pain can begin as early as 2 weeks post-stroke but typically occurs within 2-3 months poststroke. 10 The causes of hemiplegic shoulder pain are multifactorial. Some of the most frequently suspected factors contributing to shoulder pain include Subluxation, Capsulitis, Contractures, Complex regional pain syndrome (CRPS) type-1, Rotator cuff injury, Impingement syndrome, and Spastic muscle imbalance of the glenohumeral joint, peripheral nerve entrapment, neglect, sensory impairment, central pain, central sensitization. 11,12,13,14 However, identifying the exact mechanism(s) of shoulder pain can be difficult. Hanger and colleagues suggested it to be highly probable that the cause is multifactorial, with different factors contributing at different stages of recovery (i.e. flaccidity contributing to subluxation and subsequent capsular stretch, abnormal tonal and synergy patterns contributing to rotator cuff or scapular instability, etc). 15 Therefore, early intervention in the shoulder pain is not only Financial or Other, Competing Interest: None. Submission 27-10-2018, Peer Review 30-10-2018, Acceptance 10-11-2018, Published 12-11-2018. Corresponding Author: Dr. Swapnil Pramod Sonune, All India Institute of Physical Medicine and Rehabilitation, K. Khadye Road, Haji Ali, Mahalaxmi, Mumbai- 400034, Maharashtra. E-mail: drspsonune@gmail.com DOI: 10.18410/jebmh/2018/657