The purpose of this prospective randomized controlled clinical trial is to evaluate the effect of suprascapular nerve block on shoulder joint proprioception in stroke patients with hemiplegic shoulder pain.
Fourteen patients aged 18-80 years with hemiplegic shoulder pain will be randomized into two groups. One group will receive suprascapular nerve block followed by a standardized physical therapy program, while the control group will receive the same physical therapy program alone.
The primary outcome is shoulder joint proprioception. Secondary outcomes include pain intensity, shoulder range of motion, motor recovery, stroke-specific quality of life, and upper extremity functional outcomes.
The results of this study are expected to clarify the role of suprascapular nerve block on proprioception and rehabilitation outcomes in patients with hemiplegic shoulder pain.
Age between 18 and 80 years
Presence of shoulder pain on the hemiplegic side with a Numeric Rating Scale (NRS) score > 3
At least 1 month since the cerebrovascular event (subacute and chronic stroke patients)
Active shoulder flexion range of motion > 90 degrees (required for the application of the laser pointer-assisted joint position sense test)
Mini-Mental State Examination score < 24 indicating cognitive impairment
Presence of aphasia
Shoulder spasticity with a Modified Ashworth Scale score > 2
Brunnstrom upper extremity motor stage < 3
Parallel
suprascapular nerve block
Procedure/SurgeryAn ultrasound-guided suprascapular nerve block will be performed by injecting 5 mL of 2% lidocaine (Lidon 100 mg/5 mL solution for injection) into the suprascapular fossa.
physical therapy
Other interventionAccepted routine physical therapy modalities for hemiplegic shoulder pain, including cold pack application, transcutaneous electrical nerve stimulation, assisted shoulder range of motion exercises, and posterior capsule stretching exercises, will be administered five days per week for three weeks, in 45-minute sessions, for a total of 15 sessions
Laser pointer-assisted joint position sense test
The validity and reliability of the laser pointer-assisted joint position sense test in patients with shoulder instability were established by Amir K. Vafadar et al., with inter-observer and intra-observer correlation coefficients of 0.78 and 0.86, respectively. In this test, a laser pointer is secured to the patient's arm using a Velcro strap positioned 5 cm proximal to the elbow. With eyes open, the patient is asked to raise the hemiplegic arm to 90 degrees. The laser point is marked on millimeter paper fixed 1 meter in front of the shoulder joint. The patient is then asked, with eyes open, to relocate the same point to learn the joint position. Subsequently, with eyes closed, the patient is asked to identify the same point again. This second point is marked, and the distance from the initial point is measured along the x- and y-axes. The angular deviation of the shoulder joint position is calculated using the tangent formula.
Thumb localization test
For the assessment of proprioception, the thumb localization test will be performed. The validity and reliability of this test in patients with hemiplegia were established by Otaka et al., with a weighted kappa value of 0.84 for inter-observer measurements, indicating high agreement. With the patient's eyes closed, the patient is asked to locate and grasp the thumb of the affected hand using the fingers of the unaffected hand
Numeric Rating Scale (NRS)
A 0-10 numeric rating scale will be used to assess pain severity.
Goniometric measurement
Shoulder range of motion will be assessed using a standard goniometer, which provides an objective measurement of joint angles in degrees. The goniometer is aligned with anatomical landmarks of the shoulder, and active or passive movements (flexion, abduction, and rotation) are measured according to standardized positioning.
Goal Attainment Scale (GAS)
Goal Attainment Scale (GAS) is a goal-oriented functional outcome measure based on the International Classification of Functioning, Disability and Health (ICF) framework and is used to assess the extent to which individuals achieve predefined goals. It quantifies the success or failure of set goals and can be applied in rehabilitation settings. According to this scale, pain during upper extremity dressing was evaluated as follows: -2 = severe pain, -1 = moderate pain, 0 = mild pain, +1 = pain at the end of movement, and +2 = pain-free movement."
Fugl-Meyer Assessment - Upper Extremity
Fugl-Meyer Assessment - Upper Extremity: The Fugl-Meyer Upper Extremity Scale is a standardized measure used to evaluate upper extremity motor function after stroke. It is designed to assess movement impairments and loss of muscle control in the upper extremity following stroke. The scale evaluates a range of functions, including shoulder, elbow, wrist, and hand movements, as well as hand use and functional abilities. Each movement is scored on a 0-2 scale, with a maximum total score of 66 points. This scale is widely used in post-stroke rehabilitation programs to assess treatment effectiveness and to monitor motor recovery over time.
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