Evolution of Post-Stroke Shoulder Pain With a Capsular Pattern With Physiotherapy Alone Versus Coupled With Mild Arthrographic Distension With Cortisone

• Status: Not yet recruiting
• Trial end date: 2024-05-01
• Target enrollment: 0
• Participant gender: All

Summary

The purpose of this study is to assess the efficacy of mild hydraulic distension with intra-articular corticosteroid injection for the treatment of subacute hemiparetic shoulder pain with a capsular pattern of restricted shoulder motion.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Claire Bourgeois
• Collaborators: Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; Fédération des médecins résidents du Québec
• Treatments: Bupivacaine; Triamcinolone

Criteria

Inclusion Criteria:

• All participants must be enrolled in an inpatient rehabilitation program for post-stroke patients at the Institut de réadaptation Gingras-Lindsay-de-Montréal, which is encompassed by the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal. Participants must be 18 years old or older and apt to give consent and able to reliably express themselves (either verbally, written or other) to participate in the study. Aptitude and ability to express themselves will be clinically assessed by their attending physician. Participants with a score of 3 or less out of 5 on the memory section of the Montreal Cognitive Assessment will receive special attention to ensure that the information obtained is accurate through communication with their treatment team, their medical file or their family and caregivers.

The shoulder pain must be significant, as defined by a pain that is bothersome to the patient (limits sleep, limits time spent in wheelchair, limits ADL functioning, discomfort impacting their rehabilitation, or associated with Complex Regional Pain Syndrome), as well as a score of 3/10 on the visual analog scale during rest, at night or during ADLs, despite adequate positioning of the arm. The pain must be present for at least 2 weeks and unresolved by physiotherapy alone. Their current symptoms of shoulder pain must have started after their most recent episode of stroke. There must also be a capsular pattern of reduced ROM of the shoulder, defined by a loss of 10 degrees or more of either external rotation, abduction or internal rotation ROM compared to the non painful shoulder.

Exclusion Criteria:

• Patients below the age of 18 years will be excluded. Patients with pain duration of more than 6 months will be excluded. Patients inapt to give consent to participate in the study will be excluded.

Patients who have had multiple strokes will not be excluded. Non-verbal patients or those with cognitive difficulties will have the option of participating with assistance in answering questionnaires by their primary caregiver, a healthcare worker or information recorded in the medical file. Previous shoulder ailments are not a cause for exclusion from participation but their data may be analysed separately. Patients who refuse intra-articular corticosteroid injection but accept to participate in all other aspects of the study will not be excluded as their long-term evolution undergoing physiotherapy alone may be used as a separate cohort if the sample size is large enough.