MTPr With Shockwave on Pain & Function of SHS in Stroke

Study Overview
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Brief Summary
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Background: shoulder-hand syndrome is considered a significant reason for the reduction of upper limb functions after stroke. Purpose: To investigate the influence of Myofascial Trigger Points (MTrPs) release and shockwave therapy on pain and functions of the upper extremity in stroke patients with diabetic neuropathy.

Detailed Description
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Methods: two equal groups of thirty stroke patients, divided into, study group: which treated with MTrPs release combined with shockwave therapy and conventional program, while control group: treated with a conventional selected exercise program.

Official Title
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Myofascial Trigger Points Release With Shockwave Therapy on Pain and Function of Shoulder Hand Syndrome in Stroke Patients With Diabetic Neuropathy

Conditions
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Stroke

Intervention / Treatment
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* Other: Myofascial trigger points pressure (MTrP) release
* Other: Shockwave therapy application
* Other: conventional therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: stroke from 4:8 months age ranging from 45:60 years All the patients were identified with SHS as diagnosed by the Diagnostic criteria for SHS post-stroke 18 and were in stage I of syndrome evolution Exclusion Criteria: any other causes of shoulder pain in the hemiplegic side of the body a cognitive impairment structured joint deformity in the painful shoulder or hand other musculoskeletal disorders of UE.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: study group: which treated with MTrPs release combined with shockwave therapy and conventional program, while control group: treated with a conventional selected exercise program
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: study group<br>which treated with MTrPs release combined with shockwave therapy and conventional program | Other: Myofascial trigger points pressure (MTrP) release<br>* Myofascial trigger points pressure (MTrP) release technique, the initial step was to recognize and find the trigger points (TP) , and The second step after TP palpation was the MTrP release technique, as follow, by one or both hands, the thumbs or four fingers of the therapist applied a maintained pressure, pushing internal toward the middle<br>Other: Shockwave therapy application<br>* The JEST-2000 (JOEUN Medical, Dae-Jeon, South Korea) was used for the ESWT. The application of pressure pulses of ESWT was centered around the flexor muscles with hypertonia<br>Other: conventional therapy<br>* Passive ROM exercises performed by the therapist and Bobath Neurodevelopmental Approach (prolonged stretch): The Intervention methods for Bobath involved the activation of key points of control for the reduction of tone<br>|
| Experimental: control group<br>which treated with conventional physical therapy program | Other: conventional therapy<br>* Passive ROM exercises performed by the therapist and Bobath Neurodevelopmental Approach (prolonged stretch): The Intervention methods for Bobath involved the activation of key points of control for the reduction of tone<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| - Complex Regional Pain Syndrome (CRPS) severity score | It is a quantitative index and valid instrument to score and monitor the severity of CRPS and SHS. | 4 weeks | 
| - Figure-of-Eight Method of Measuring Hand Size for hand swelling | The figure-of-eight technique utilizing tape measurement for hand size | 4 weeks | 
| - Visual analogue scale for pain (VAS-P) for pain assessment | The VAS for pain is a valid and reliable assessment of pain intensity, as a straight horizontal line of fixed length (10 cm) considered the simplest VAS. | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stroke, Diabetic Neuropathy, Shoulder hand syndrome