Therapeutics
Gabrielle T I Sigaki, MD
Researcher
Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade da Universidade de São Paulo, São Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil
Pericles T. Otani, MD, PhD
Professor
Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao, Faculdade de Medicina FMUSP, Universidade de Sao Paulo
São Paulo, Sao Paulo, Brazil
Linamara R. Battistella, MD, PhD
Full Professor
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil
Levent Özçakar, N/A, MD
MD, Professor
Hacettepe University Faculty of Medicine, Department of Physical and Rehabilitation Medicine
Ankara, Ankara, Turkey
Marta Imamura, MD, PhD (she/her/hers)
Associate Professor
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Sao Paulo / Sao Paulo, Sao Paulo, Brazil
Hemiplegic shoulder pain (HSP affects up to 72% of patients within the first year after stroke and is associated with poorer rehabilitation outcomes, reduced quality of life, and increased mortality. Pharmacological and physiotherapeutic treatments frequently provide insufficient pain relief. This study aimed to evaluate the effectiveness and clinical relevance of suprascapular nerve block (SNB) in the management of HSP.
Design:
A structured review of randomized controlled trials was conducted using PubMed and the Cochrane Library. Predefined search terms related to stroke, shoulder pain, and suprascapular nerve block were applied. Eligible studies compared SNB with placebo, superficial techniques, intra-articular injections, pulsed radiofrequency, or other interventions. Methodological quality, heterogeneity, and risk of bias were qualitatively assessed.
Results:
Eight randomized controlled trials met inclusion criteria. SNB consistently demonstrated superiority over placebo, subcutaneous saline injection, therapeutic ultrasound, and intramuscular anesthetic injections for pain reduction. Comparable efficacy was observed when SNB was contrasted with intra-articular injections and botulinum toxin A, though effects were generally less durable. SNB was not consistently superior to pulsed radiofrequency. Interpretation of results is limited by small sample sizes, geographic concentration of studies, heterogeneous protocols, and high risk of bias, resulting in very low certainty of evidence.
Conclusion:
Although the quality of available evidence is limited, suprascapular nerve block appears to provide clinically meaningful pain relief in patients with hemiplegic shoulder pain after stroke. Given its low cost, minimally invasive nature, ease of administration, and favorable safety profile, SNB may be considered a useful adjunct to rehabilitation, particularly when no specific shoulder pathology is identified. Further high-quality, adequately powered trials are required to clarify its long-term efficacy, comparative effectiveness, and impact on functional outcomes.
