Suprascapular nerve block to improve shoulder proprioception and pain after stroke

Effects of Suprascapular Nerve Block on Proprioception in Hemiplegic Shoulder Pain: A Randomized Controlled Trial

This trial will test whether adding a suprascapular nerve block to standard physical therapy helps adults with hemiplegic shoulder pain after stroke feel their shoulder better and have less pain.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 40 (estimated)
• Ages: 18 Years to 80 Years
• Sex: All
• Sponsor: Fatih Sultan Mehmet Training and Research Hospital (other)
• Locations: 1 site (Istanbul, Istanbul)
• Trial ID: NCT07346755 on ClinicalTrials.gov

What this trial studies

This is a prospective, randomized, investigator-blinded, parallel-group trial enrolling 14 adults with hemiplegic shoulder pain after stroke. Participants are randomized to receive a suprascapular nerve block plus a standardized physical therapy program or the same physical therapy program alone. The primary outcome is shoulder joint proprioception measured with a laser pointer-assisted joint position sense test; secondary outcomes include pain intensity, shoulder range of motion, motor recovery, stroke-specific quality of life, and upper-extremity function. The study limits enrollment to first-ever unilateral hemiplegia patients aged 18–80 who are at least one month post-stroke and able to perform active shoulder flexion >90°.

Who should consider this trial

Good fit: Adults aged 18–80 with first-ever unilateral hemiplegia at least one month after stroke who have hemiplegic shoulder pain (NRS > 3), active shoulder flexion > 90°, intact cognition, and no major spasticity, aphasia, recent botulinum toxin to shoulder muscles, or pre-existing shoulder pathology.

Not a fit: Patients with severe cognitive impairment or aphasia, very limited shoulder range of motion, high spasticity (Modified Ashworth Scale >2), recent botulinum toxin injections affecting the shoulder, bilateral involvement, or pre-existing shoulder disease are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, the intervention could reduce shoulder pain, improve joint proprioception, and enhance rehabilitation outcomes for people with hemiplegic shoulder pain.

How similar studies have performed: Suprascapular nerve block has been commonly used to reduce shoulder pain and improve range of motion in hemiplegic patients, but its specific effects on shoulder proprioception and downstream rehabilitation outcomes have not been previously studied.

Eligibility criteria

Inclusion Criteria:

* 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)
* First-ever, unilateral hemiplegia

Exclusion Criteria:

* 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
* Botulinum toxin type A injection within the last 3 months to muscles affecting shoulder joint movement (trapezius, levator scapulae, pectoralis major, deltoid, serratus anterior, latissimus dorsi, rhomboids, teres major, biceps, coracobrachialis, triceps, supraspinatus, subscapularis, infraspinatus, and teres minor)
* Pre-existing shoulder pathology causing pain in the hemiplegic shoulder
* Presence of neglect syndrome
* Complex regional pain syndrome, central pain, traumatic brachial plexus injury
* Change in pain medication during the study period
* Hypersensitivity to the medication used for suprascapular nerve block (lidocaine)
* Adhesive capsulitis (frozen shoulder)
* Other shoulder pathologies such as fractures or joint replacement

Where this trial is running

Istanbul, Istanbul

• Fatih Sultan Mehmet Training and Research Hospital Istanbul, İstanbul, Turkey — Istanbul, Istanbul, Turkey (Türkiye) (RECRUITING)

Study contacts

• Study coordinator: Merve Kocibar, MD

Conditions: Hemiplegic Shoulder Pain, Proprioception, Suprascapular Nerve Block, Suprascapular nerve block, Hemiplegia