Comparison of the effectiveness of pulsed radiofrequency of the suprascapular nerve and intra-articular corticosteroid injection for hemiplegic shoulder pain management

Abstract

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 (n = 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 (p < 0.001). However, score reduction through time was significantly greater for intra-articular corticosteroid injection for pulsed radiofrequency (p < 0.001). Similarly, a significant post-treatment increase was observed in almost all range of motion measurements in both groups (pulsed radiofrequency group: flexion, p = 0.015; abduction, p = 0.014; external rotation, p = 0.038; internal rotation, p = 0.063; intra-articular corticosteroid injection group: all range of motion, p < 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 (p < 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.

Keywords: Corticosteroid; Hemiplegic shoulder pain; Neurology; Peripheral neurons; Pulsed radiofrequency; Stroke.