Subacromial Corticosteroid Injection on Poststroke Hemiplegic Shoulder Pain: A Randomized, Triple-Blind, Placebo-Controlled Trial

Abstract Rah UW, Yoon S-H, Moon DJ, Kwack K-S, Hong JY, Lim YC, Joen B. Subacromial corticosteroid injection on poststroke hemiplegic shoulder pain: a randomized, triple-blind, placebo-controlled trial. Objective To evaluate the effect of subacromial corticosteroid injection on hemiplegic shoulder pain (HSP). Design Multicenter, randomized, triple-blind, placebo-controlled trial. Setting Three primary and 1 university-affiliated tertiary-care hospitals. Participants Poststroke HSP patients (N=58) with evidence of rotator cuff disorder. Interventions Participants were randomly assigned to receive ultrasound-guided subacromial injection with triamcinolone 40mg (treatment group, n=29), or lidocaine (placebo group, n=29). After a single injection, participants were followed up for 8 weeks. Main Outcome Measures Visual analog scale (VAS) of the average shoulder pain level at day and night (VAS-day/night, the primary outcome measures), Modified Barthel Index, Shoulder Disability Questionnaire (SDQ), and angles of shoulder active range of motion (flexion, abduction, external rotation, and internal rotation) at pretreatment and weeks 2, 4, and 8 posttreatment. Results There was no significant difference between the 2 groups in the main outcome measures at pretreatment. Compared with the placebo group, VAS-day/night, SDQ, flexion, external rotation, and internal rotation showed significant improvement in the treatment group. Conclusions To our knowledge, this is the first randomized, placebo-controlled study to assess the efficacy of subacromial injection in HSP patients with evidence of rotator cuff disorder. Subacromial corticosteroid injection showed improvement in pain, disability, and active range of motion, and the duration of its efficacy continued up to 8 weeks.