Evidence-Based Algorithm for Interventional Management of Post-Stroke Shoulder Pain: An International Consensus
Abstract
Shoulder pain is a common complaint over the paralytic side of stroke patients. We suggest that ultrasound examination should be arranged for hemiplegic shoulders in the presence of pain unresponsive to medication and physical therapy.
Ultrasound-guided dual target corticosteroid injection can be introduced over the rotator cuff interval and subdeltoid bursa in case of rotator cuff pathologies. Otherwise, suprascapular nerve block can be performed under ultrasound guidance.
Furthermore, the physician should examine whether there is pain associated with increased spasticity, which can be managed by shock wave therapy or botulinum toxin intra-muscular injection. Finally, if the patients have developed symptoms of complex regional pain syndrome, ultrasound-guided cervical sympathetic ganglion block should be taken into consideration.