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HSP Injection Therapies in Stroke
Hemiplegic shoulder pain (HSP) is one of the most debilitating complications after stroke . Hemiplegic shoulder pain (HSP) hampers post-stroke functional recovery and is not well managed with conservative treatments.
Hemiplegic shoulder pain (HSP) is one of the most debilitating complications after stroke . Its reported incidence varies from 30% to 72% at one-year follow-up across different studies . HSP is mostly graded as ranging from moderate to severe intensity  and rarely resolves spontaneously . Stroke patients with poor upper extremity function have an increased risk of HSP . Various theories have been proposed for the development of HSP, including deficiency in pain adaption , central sensitization to normal or subthreshold sensory stimuli , and impaired neuromuscular control of the scapula . Spasticity over the hemiplegic limbs, shoulder subluxation, concomitant rotator cuff pathology, and prolonged immobilization of the affected limbs are also reported to be associated with HSP . Without adequate management, HSP further worsens the function of the upper extremities and can prolong the hospital stay .
Shoulder slings, passive range of motion exercises, analgesics, and electrical stimulation have been commonly applied for treating HSP, although their effects are usually limited . In recent years, various injection therapies have been proposed in its management. For instance, suprascapular nerve block (SSNB) using local anesthetics can be performed to decrease nociception from the glenohumeral joint . Intramuscular botulinum toxin (BoNT) injections are also effective in reducing spasticity of the hemiplegic limbs and the associated pain . On the other hand, BoNT injections are beneficial for decreasing chronic shoulder pain, possibly through inhibition of the release of pain mediators . Corticosteroid injections have long been used to treat painful shoulders owing to their anti-inflammatory potential, while intra-articular hyaluronic acid (HA) injections might prevent adhesions and reduce synovitis inside the glenohumeral joint .
2. Injection Therapies for Hemiplegic Shoulder Pain in Stroke
This entry is adapted from 10.3390/ph14080788
- McLean, D.E. Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Arch. Phys. Med. Rehabil. 2004, 85, 466–469.
- Roy, C.W.; Sands, M.R.; Hill, L.D. Shoulder pain in acutely admitted hemiplegics. Clin. Rehabil. 1994, 8, 334–340.
- Adey-Wakeling, Z.; Arima, H.; Crotty, M.; Leyden, J.; Kleinig, T.; Anderson, C.S.; Newbury, J.; Collaborative, S.S. Incidence and associations of hemiplegic shoulder pain poststroke: Prospective population-based study. Arch. Phys. Med. Rehabil. 2015, 96, 241–247.e1.
- Lindgren, I.; Jonsson, A.-C.; Norrving, B.; Lindgren, A. Shoulder pain after stroke: A prospective population-based study. Stroke 2007, 38, 343–348.
- Kim, Y.H.; Jung, S.J.; Yang, E.J.; Paik, N.J. Clinical and sonographic risk factors for hemiplegic shoulder pain: A longitudinal observational study. J. Rehabil. Med. 2014, 46, 81–87.
- Kashi, Y.; Ratmansky, M.; Defrin, R. Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain. Pain Pract. 2018, 18, 716–728.
- Klit, H.; Finnerup, N.B.; Jensen, T.S. Central post-stroke pain: Clinical characteristics, pathophysiology, and management. Lancet Neurol. 2009, 8, 857–868.
- De Baets, L.; Jaspers, E.; Janssens, L.; Van Deun, S. Characteristics of neuromuscular control of the scapula after stroke: A first exploration. Front. Hum. Neurosci. 2014, 8, 933.
- Murie-Fernández, M.; Iragui, M.C.; Gnanakumar, V.; Meyer, M.; Foley, N.; Teasell, R. Painful hemiplegic shoulder in stroke patients: Causes and management. Neurología 2012, 27, 234–244.
- Benlidayi, I.C.; Basaran, S. Hemiplegic shoulder pain: A common clinical consequence of stroke. Pract. Neurol. 2014, 14, 88–91.
- Aydın, T.; Şen, E.İ.; Yardımcı, M.Y.; Kesiktaş, F.N.; Öneş, K.; Paker, N. Efficacy of ultrasound-guided suprascapular nerve block treatment in patients with painful hemiplegic shoulder. Neurol. Sci. 2019, 40, 985–991.
- Marciniak, C.M.; Harvey, R.L.; Gagnon, C.M.; Duraski, S.A.; Denby, F.A.; McCarty, S.; Bravi, L.A.; Polo, K.M.; Fierstein, K.M. Does botulinum toxin type A decrease pain and lessen disability in hemiplegic survivors of stroke with shoulder pain and spasticity?: A randomized, double-blind, placebo-controlled trial. Am. J. Phys. Med. Rehabil. 2012, 91, 1007–1019.
- Hsu, P.-C.; Wu, W.-T.; Han, D.-S.; Chang, K.-V. Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials. Toxins 2020, 12, 251.
- Huang, Y.-C.; Leong, C.-P.; Tso, H.-H.; Chen, M.-J.; Liaw, M.-Y.; Hsieh, H.-C.; Wang, L.-Y.; Hsu, C.-H. The long-term effects of hyaluronic acid on hemiplegic shoulder pain and injury in stroke patients: A randomized controlled study. Medicine 2018, 97, e12078.
- Wu, T.; Song, H.-X.; Li, Y.Z.; Ye, Y.; Li, J.-H.; Hu, X.Y. Clinical effectiveness of ultrasound guided subacromial-subdeltoid bursa injection of botulinum toxin type A in hemiplegic shoulder pain: A retrospective cohort study. Medicine 2019, 98, e17933.
- Kasapoğlu-Aksoy, M.; Aykurt-Karlıbel, İ.; Altan, L. Comparison of the efficacy of intramuscular botulinum toxin type-A injection into the pectoralis major and the teres major muscles and suprascapular nerve block for hemiplegic shoulder pain: A prospective, double-blind, randomized, controlled trial. Neurol. Sci. 2020, 41, 2225–2230.
- Terlemez, R.; Ciftci, S.; Topaloglu, M.; Dogu, B.; Yilmaz, F.; Kuran, B. Suprascapular nerve block in hemiplegic shoulder pain: Comparison of the effectiveness of placebo, local anesthetic, and corticosteroid injections-a randomized controlled study. Neurol. Sci. 2020, 41, 3243–3247.
- Adey-Wakeling, Z.; Crotty, M.; Shanahan, E.M. Suprascapular nerve block for shoulder pain in the first year after stroke: A randomized controlled trial. Stroke 2013, 44, 3136–3141.
- Sencan, S.; Celenlioglu, A.E.; Karadag-Saygı, E.; Midi, İ.; Gunduz, O.H. Effects of fluoroscopy-guıded intraartıcular injectıon, suprascapular nerve block, and combınatıon therapy ın hemıplegıc shoulder paın: A prospective double-blınd, randomızed clınıcal study. Neurol. Sci. 2019, 40, 939–946.
- Achar, S.; Kundu, S. Principles of office anesthesia: Part I. Infiltrative anesthesia. Am. Fam. Phys. 2002, 66, 91.
- Barnes, P.J.; Adcock, I.; Spedding, M.; Vanhoutte, P.M. Anti-inflammatory actions of steroids: Molecular mechanisms. Trends Pharmacol. Sci. 1993, 14, 436–441.
- Jankovic, J. Botulinum toxin in clinical practice. J. Neurol. Neurosurg. Psychiatry 2004, 75, 951–957.
- Wissel, J.; Ward, A.B.; Erztgaard, P.; Bensmail, D.; Hecht, M.J.; Lejeune, T.M.; Schnider, P. European consensus table on the use of botulinum toxin type A in adult spasticity. J. Rehabil. Med. 2009, 41, 13–25.
- Flynn, T.C. Botulinum toxin. Am. J. Clin. Dermatol. 2010, 11, 183–199.
- Hou, Y.-P.; Zhang, Y.-P.; Song, Y.-F.; Zhu, C.-M.; Wang, Y.-C.; Xie, G.-L. Botulinum toxin type A inhibits rat pyloric myoelectrical activity and substance P release in vivo. Can. J. Physiol. Pharmacol. 2007, 85, 209–214.
- Matak, I.; Tékus, V.; Bölcskei, K.; Lacković, Z.; Helyes, Z. Involvement of substance P in the antinociceptive effect of botulinum toxin type A: Evidence from knockout mice. Neuroscience 2017, 358, 137–145.
- Stephens, M.B.; Beutler, A.; O’Connor, F.G. Musculoskeletal injections: A review of the evidence. Am. Fam. Phys. 2008, 78, 971–976.
- Lee, L.-C.; Lieu, F.-K.; Lee, H.-L.; Tung, T.-H. Effectiveness of hyaluronic acid administration in treating adhesive capsulitis of the shoulder: A systematic review of randomized controlled trials. BioMed Res. Int. 2015, 2015, 314120.
- Shanthanna, H.; Busse, J.; Wang, L.; Kaushal, A.; Harsha, P.; Suzumura, E.A.; Bhardwaj, V.; Zhou, E.; Couban, R.; Paul, J.; et al. Addition of corticosteroids to local anaesthetics for chronic non-cancer pain injections: A systematic review and meta-analysis of randomised controlled trials. Br. J. Anaesth. 2020, 125, 779–801.