THE PAINFUL HEMIPLEGIC SHOULDER

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Abstract
Effects of intra-articular triamcinolone acetonide on pain and passive range of motion (ROM) in the painful hemiplegic shoulder were studied. A Multiple baseline (or AB) design across seven subjects was used. The length of the baseline condition (or A phase) was either 2 or 3 wk, and randomized across subjects. Subsequently, a treatment condition (or B phase) of 4 wk was applied during which three intra-articular injections of triamcinolone acetonide were administered at day 1, 8, and 22. Pain and ROM were the primary outcome parameters and were measured three times each week by means of a visual analogue scale (VAS) and a fluid-filled goniometer, respectively. In addition, a number of secondary outcome parameters were assessed, i.e., spastic muscle activity (Ashworth scale), motor function (Fugl-Meyer index), upper limb function (action research arm test) and signs and symptoms of a shoulder hand syndrome (clinical scoring list). Statistical analysis of the combined time series showed significant effects on pain (P = 0.025). Analysis of the individual time series revealed that five out of seven patients had significant reduction of pain. ROM improved significantly in four out of seven patients. However, improvement of ROM did not reach significance at the group level (P = 0.13). None of the secondary parameters showed significant changes. The correlation coefficient between upper limb function (ARA) at intake and size of treatment effect approached a level of significance (P = 0.09). The results indicate that intra-articular triamcinolone may be of benefit in reducing hemiplegic shoulder pain.