The Importance of Pectoralis Minor Syndrome in Hemiplegic Shoulder Pain

Istanbul University - Cerrahpasa

Status: Completed

Conditions: Pectoralis Minor Syndrome; Hemiplegic Shoulder Pain

Treatments: Procedure: Ultrasound-guided injection of the subacromial bursa and pectoralis minor; Drug: Lidocaine (drug)

Study type: Interventional

Funder types: Other

Identifiers

NCT06613646

IstanbulUC-BCetin-01

Details and patient eligibility

About

Hemiplegic shoulder pain, common in stroke patients, often arises from muscle weakness, imbalance, or joint and nerve issues. Previous case reports in literature suggest that pectoralis minor syndrome may play a significant role in this pain. In current study, the investigators aimed to evaluate the role of the pectoralis minor muscle in patients with hemiplegic shoulder pain and to reveal the contribution of pectoralis minor syndrome to hemiplegic shoulder pain. Additionally, this study may provide fundamental information to improve clinical practice in determining rehabilitation and treatment strategies, contribute to the development of new approaches in managing hemiplegic shoulder pain, and assist in optimizing rehabilitation programs.

Full description

Hemiplegic shoulder pain is a common complication following a stroke, with a prevalence ranging from 22% to 47%, typically occurring two to three months post-stroke. This pain can lead to withdrawal from rehabilitation programs, longer hospital stays, reduced joint mobility, and impaired quality of life. Various factors contribute to its development, including decreased muscle tone, shoulder subluxation, increased muscle tone, impingement syndrome, frozen shoulder, brachial plexus injury, and thalamic syndrome. Among these, subacromial/subdeltoid bursitis is the most frequently reported cause of pain, and significant pain relief following local anesthetic injections into the subacromial/subdeltoid bursa is diagnostic of subacromial impingement syndrome.

Treatment goals for hemiplegic shoulder pain include pain reduction, restoring shoulder mobility, improving functional activities, and preventing degenerative changes. Treatment options range from conservative methods like shoulder slings, range-of-motion exercises, pain relievers, physical therapy, and various injection therapies, to surgical interventions for cases unresponsive to conservative measures.

Pectoralis minor syndrome, associated with hemiplegic shoulder pain, can occur in stroke patients. The pectoralis minor muscle plays a crucial role in shoulder stability and movement. Compression or irritation of neurovascular structures in the retropectoral space by this muscle leads to pectoralis minor syndrome, often diagnosed through clinical evaluation rather than specific radiological or electrophysiological tests. Ultrasound-guided pectoralis minor muscle blocks have become significant in both diagnosis and treatment, demonstrating marked pain reduction in affected patients. Research on pectoralis minor syndrome aims to enhance understanding of its causes, effects, and treatment strategies, contributing to the development of more effective and specific approaches for managing hemiplegic shoulder pain.

Enrollment: 19 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Development of spastic hemiplegia due to stroke
• Presence of shoulder pain on the hemiplegic side

Exclusion criteria

• Lack of medical stability
• Inability to communicate verbally
• History of severe sensitivity to lidocaine injections
• Surgical history related to the hemiplegic shoulder
• Presence of a prosthesis in the hemiplegic shoulder
• Malignancy in the hemiplegic shoulder
• Severe psychiatric illness
• History of injections to the hemiplegic shoulder within the last 6 months
• Pregnancy
• History of inflammatory rheumatic disease

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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19 participants in 1 patient group

Intervention Arm

Experimental group

Description:

Patients presenting to the outpatient clinic with shoulder pain on the hemiplegic side will first undergo a diagnostic subacromial bursa injection, followed by a pectoralis minor muscle block.

Treatment:

Drug: Lidocaine (drug)

Procedure: Ultrasound-guided injection of the subacromial bursa and pectoralis minor