Injection in Patients With Chronic Shoulder Pain
Condition: Chronic Shoulder Pain
MeSH terms: Shoulder Pain
Study type: Interventional

Summary: 
      Background: Chronic shoulder pain (CSP) is a musculoskeletal disease characterized by pain
      lasting more than 3 months.

      Purpose: This study aimed to determine whether pre-treatment injection in CSP treatment
      contributes to pain, functionality and quality of life.

      Methods: A total of 110 patients who met the inclusion criteria of the study were divided
      into 2 groups (55 patients in each group).

      A standard 15-session physical therapy program (hot pack, transcutaneous electric nerve
      stimulation(TENS), US and therapeutic exercises) was applied to all patients in both groups.
      Suprascapular Nerve Block was applied to Group I before treatment.

      Assessments were made using VAS-Pain, Shoulder Pain and Disability Index (SPADI) and The
      Nottingham Health Profile (NHP) before and at the end of the treatment and in the
      posttreatment 3th months.
    

Detailed description: 
      INTRODUCTION Chronic pain is a common condition, affecting 20% of people worldwide and
      accounting for 15% to 20% of doctor visits. One of the most common causes of chronic pain and
      disability in the world is musculoskeletal system diseases. Pain and limitations in daily
      living activities and psychological problems that develop due to pain negatively affect the
      quality of life of patients.

      Shoulder pain is the third most common musculoskeletal system disease that causes pain and
      loss of function. Shoulder pain is characterized by chronicity and high recurrence rates due
      to its anatomy and joint structure.

      Chronic and frequently recurring shoulder pain can cause loss of function and not only
      affects the individual's entire life, but also becomes a socio-economic problem with the
      financial burden it brings.

      There are many pharmacological or non-pharmacological treatment approaches in the treatment
      of pain. Many physical therapy methods are used in combination for chronic shoulder pain
      (e.g. Hotpack, TENS, ultrasound, exercise, etc.). Alternative treatments and their
      combinations are gaining importance today in painful shoulder problems that are difficult to
      treat with physiotherapy due to their anatomical and functional structure.

      This study aimed to determine whether pre-treatment injection in CSP treatment contributes to
      pain, functionality and quality of life.

      METHODS The study was designed as a prospective, randomized, controlled, and single-blind
      study. A total of 110 patients who were admitted to the physical therapy and rehabilitation
      outpatient clinic with pain and movement restriction in their shoulder and who signed the
      patient information consent form were included in the study.

      A total of 110 patients who met the inclusion criteria of the study were divided into 2
      groups (55 patients in each group) with simple randomization method by using a table of
      random numbers created on the computer. The researchers who made the assessment measurements
      were unaware of which patient was in which group. Statistical analysis of the results was
      performed by a biostatistician who had no information about the therapies the patient groups
      received.

      All the patients included in the study received a total of 15 sessions of physical therapy
      program 5 times a week for 3 weeks. All the patients received hot pack at 60°C for 20 minutes
      and conventional TENS at 80 Hz for 20 minutes and US at 3 megahertz frequency, and
      1.5watt/cm2 intensity for their involved shoulder. After physical therapy, all the
      participants received therapeutic exercise program (3 sets of 10 reps with 3- minute
      intervals between the sets) consisting of active-assisted range of motion (ROM), passive
      stretching and Codman exercises for their shoulder joint for 30 minutes in accompany with a
      physiotherapist. Suprascapular Nerve Block was applied to Group I before treatment. The
      patients were assessed with the measurements of visual analogue scale (VAS)-pain, Shoulder
      Pain and Disability Index (SPADI) and The Nottingham Health Profile (NHP) before and
      immediately after the intervention and at 12 weeks after the end of the intervention
      (approximately week 15).
    

Intervention name(s): Suprascapular nerve block with physical therapy; Group 2 Physical therapy
Intervention type(s): Other; Other
Intervention description(s): Suprascapular nerve block was applied to the relevant shoulder area of all patients before treatment. Afterwards, a physical therapy program (5 days a week for 3 weeks, a total of 15 sessions) was applied, including 20 minutes of hot pack at 60°C, 20 minutes of conventional TENS at 80 Hz and US at 3 MHz frequency and 1.5 watt/cm2 intensity.
After physical therapy, all the participants received therapeutic exercise program (3 sets of 10 reps with 3- minute intervals between the sets) consisting of active-assisted ROM, passive stretching and Codman exercises for their shoulder joint for 30 minutes in accompany with a physiotherapist.; A physical therapy program (5 days a week for 3 weeks, a total of 15 sessions), including a hot pack at 60 ° C for 20 minutes, conventional TENS at 80 Hz for 20 minutes and US at 3 MHz frequency and an intensity of 1.5 watts / cm2, was applied to the relevant shoulder area of all patients.
After physical therapy, all the participants received therapeutic exercise program (3 sets of 10 reps with 3- minute intervals between the sets) consisting of active-assisted ROM, passive stretching and Codman exercises for their shoulder joint for 30 minutes in accompany with a physiotherapist.
Other intervention name(s): Transcutaneous Electrical Nerve Stimulation (TENS); Hot Pack; Ultrasound(US) Therapy; Therapeutic Exercise Program; Transcutaneous Electrical Nerve Stimulation (TENS); Hot Pack; Ultrasound(US) Therapy; Therapeutic Exercise Program
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: chronic shoulder pain; shoulder injection; suprascapular nerve block; physiotherapy