# Perineural Injection Therapy for Hemiplegic Shoulder Pain: A Novel Management Approach

## TL;DR

A new therapy using dextrose injections reduced pain and improved movement in stroke patients with shoulder pain, helping them participate better in rehabilitation.

## Contribution

This study introduces perineural injection therapy as a novel, effective, and accessible treatment for hemiplegic shoulder pain in stroke patients.

## Key findings

- Pain levels dropped significantly, with NRS scores decreasing from 7.3 to 1.0.
- Shoulder range of motion improved by 40 degrees in flexion and 37 degrees in abduction.
- FMA-UE scores increased by an average of 25.3, showing meaningful functional improvement.

## Abstract

Hemiplegic shoulder pain (HSP) significantly interferes with upper limb rehabilitation and reduces the function and quality of life in stroke patients. Perineural injection therapy (PIT) offers a regenerative approach by targeting potential pain-generating nerves utilizing dextrose. The effectiveness of PIT in HSP remains underexplored.

This case series involved five stroke patients diagnosed with HSP during post-stroke inpatient rehabilitation. Their pain was not responding to analgesics and physical modalities, causing poor rehabilitation participation. All patients received the same PIT regime, whereby 1-5 ml of buffered 5% dextrose was administered subcutaneously to the lateral and intermediate supraclavicular nerve exiting point, quadrangular space, and triangular space. Pain levels, shoulder passive range of motion (PROM), and Fugl-Meyer Assessment for upper extremity (FMA-UE) scores were measured pre- and post-treatment. Standard rehabilitation care continued post-treatment.

All patients reported significant pain reduction, with numerical rating scale (NRS) scores decreasing from an average of 7.3 to 1.0. Shoulder PROM improved by an average of 40 degrees in flexion and 37 degrees in abduction. FMA-UE scores increased from an average of 32.0 to 57.3, with all patients achieving the minimal clinically important difference of 12.4. No adverse effects were reported.

In conclusion, a single-session PIT demonstrated effectiveness in reducing pain and improving function in patients with HSP, facilitating engagement in rehabilitation. This approach may be particularly valuable in facilities lacking ultrasound equipment.