Effect of extracorporeal shock wave therapy on hemiplegic shoulder pain_West China Medical Journal

Authors：

JIN Xiaoxuan ^1,2 , DING Jianwei ² ,  ZHENG Jiejiao ^1,2

1. School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China;
2. Department of Rehabilitation Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

ZHENG Jiejiao, Email: zjjcss@163.com

Keywords：

Extracorporeal shock wave therapy; hemiplegic shoulder pain; stroke

DOI：

10.7507/1002-0179.202303023

Video：

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Objective To observe the effect of extracorporeal shock wave therapy combined with conventional rehabilitation in the treatment of hemiplegic shoulder pain (HSP). Methods HSP patients admitted to Huadong Hospital Affiliated to Fudan University between January and October 2022 were selected. The enrolled patients were randomized into a control group and an experimental group in a 1∶1 ratio using SPSS 26.0 statistical software. The control group was given conventional rehabilitation training, and the experimental group was given extracorporeal shock wave treatment on this basis. Both groups were treated for 4 weeks. Primary outcome measure was Visual Analogue Scale (VAS) for pain. Secondary outcome measures were passive range of motion (PROM) of the shoulder joint, Fugl-Meyer Assessment of Upper Extremity (FMA-UE), and the activities of daily living were assessed by Modified Barthel Index (MBI). Results A total of 39 patients were included. Among them, there were 19 cases in the experimental group and 20 cases in the control group. Before treatment, there was no statistically significant difference in VAS, FMA-UE, MBI scores, and the PROM of flexion, extension, abduction, external rotation and internal rotation between the two groups (P>0.05). After treatment, there was no statistically significant difference in MBI score and the PROM of extension, abduction, external rotation, internal rotation between the two groups (P>0.05). After treatment, intra group comparisons showed that the VAS, FMA-UE, MBI scores, and the PROM of flexion, extension, abduction, external rotation, and internal rotation of the two groups were better than before treatment (P<0.001). After treatment, inter group comparison showed that the the VAS score in the experimental group was lower than that in the control group (t=5.291, P<0.05), while the FMA-UE score and the PROM of flexion in the experimental group were higher than those in the control group (t=−4.008, 3.164, P<0.05). Conclusion Extracorporeal shock wave therapy can significantly reduce the pain degree of patients with HSP and improve upper limb function and activities of daily living.

Citation： JIN Xiaoxuan, DING Jianwei, ZHENG Jiejiao. Effect of extracorporeal shock wave therapy on hemiplegic shoulder pain. West China Medical Journal, 2023, 38(6): 859-863. doi: 10.7507/1002-0179.202303023 Copy

1.	Vasudevan JM, Browne BJ. Hemiplegic shoulder pain: an approach to diagnosis and management. Phys Med Rehabil Clin N Am, 2014, 25(2): 411-437.
2.	Kumar P. Hemiplegic shoulder pain in people with stroke: present and the future. Pain Manag, 2019, 9(2): 107-110.
3.	Duray M, Baskan E. The effects of hemiplegic shoulder pain on upper extremity motor function and proprioception. NeuroRehabilitation, 2020, 46(4): 561-567.
4.	Yi Y, Shim JS, Kim K, et al. Prevalence of the rotator cuff tear increases with weakness in hemiplegic shoulder. Ann Rehabil Med, 2013, 37(4): 471-478.
5.	Dyer S, Mordaunt DA, Adey-Wakeling Z. Interventions for post-stroke shoulder pain: an overview of systematic reviews. Int J Gen Med, 2020, 13: 1411-1426.
6.	Tsur A, Ring H. Axillary nerve conduction changes in hemiplegia. J Brachial Plex Peripher Nerve Inj, 2008, 3: 26.
7.	Sanchis MN, Lluch E, Nijs J, et al. The role of central sensitization in shoulder pain: a systematic literature review. Semin Arthritis Rheum, 2015, 44(6): 710-716.
8.	朱明跃, 徐俊峰, 杨丽华. 脑卒中偏瘫后肩痛发病机制分析和治疗进展. 中国疼痛医学杂志, 2014, 20(10): 745-747, 751.
9.	Tan B, Jia L. Ultrasound-guided BoNT-A (botulinum toxin A) injection into the subscapularis for hemiplegic shoulder pain: a randomized, double-blind, placebo-controlled trial. Stroke, 2021, 52(12): 3759-3767.
10.	苏建康, 汪杰, 王丛笑, 等. Mulligan 动态关节松动术对脑卒中偏瘫肩痛的疗效观察. 中国康复医学杂志, 2020, 35(11): 1363-1365.
11.	张红霞. 经皮神经电刺激治疗卒中后偏瘫侧肩痛. 中国疼痛医学杂志, 2020, 26(8): 630-631, 634.
12.	Zhou M, Li F, Lu W, et al. Efficiency of neuromuscular electrical stimulation and transcutaneous nerve stimulation on hemiplegic shoulder pain: a randomized controlled trial. Arch Phys Med Rehabil, 2018, 99(9): 1730-1739.
13.	Deng P, Zhao Z, Zhang S, et al. Effect of kinesio taping on hemiplegic shoulder pain: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2021, 35(3): 317-331.
14.	Nadler M, Pauls M. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clin Rehabil, 2017, 31(4): 444-453.
15.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019. 中华神经科杂志, 2019, 52(9) : 710-715.
16.	朱美丽, 胡江飚, 陈海挺, 等. 气弹式体外冲击波治疗偏瘫后肩痛的疗效观察. 心脑血管病防治, 2017, 17(1): 59-60.
17.	张浩冲, 邢更彦. 冲击波在医学中的应用进展. 中国医学前沿杂志(电子版), 2014, 6(1): 29-33.
18.	邢更彦, 张浩冲, 刘水涛, 等. 中国骨肌疾病体外冲击波疗法指南(2019 年版). 中国医学前沿杂志(电子版), 2019, 11(4): 1-10.
19.	王江山, 何明伟, 倪家骧. 体外冲击波疼痛治疗的进展. 中国康复医学杂志, 2011, 26(8): 788-791.
20.	周迪远, 陶惠红, 杨耀琴, 等. 体外冲击波对肌肉骨骼痛症的抗炎镇痛机制. 实用骨科杂志, 2017, 23(7): 618-621, 625.
21.	Wess O. Extracorporeal shock waves for pain relief-hypothesis of a neural working mechanism. J Endourol, 2009, 23(A15/A16): 239-241.
22.	赵景春, 咸春静, 于家傲, 等. 体外冲击波疗法对促进创面血管生成及愈合作用的研究进展. 中华损伤与修复杂志(电子版), 2014, 9(1): 71-75.
23.	陈庆梅, 杨卫新. 放散状体外冲击波治疗脑卒中后肩痛 38 例. 交通医学, 2011, 25(3): 266-267.
24.	阚秀丽, 冀磊磊, 周云, 等. 体外冲击波联合肩肱节律训练对卒中后肩痛的疗效观察. 颈腰痛杂志, 2022, 43(3): 358-361.
25.	Zhang T, Zhang C. Extracorporeal shock wave therapy for shoulder pain after stroke: a systematic review and meta-analysis. Clin Rehabil, 2023, 37(6): 774-790.

1. Vasudevan JM, Browne BJ. Hemiplegic shoulder pain: an approach to diagnosis and management. Phys Med Rehabil Clin N Am, 2014, 25(2): 411-437.
2. Kumar P. Hemiplegic shoulder pain in people with stroke: present and the future. Pain Manag, 2019, 9(2): 107-110.
3. Duray M, Baskan E. The effects of hemiplegic shoulder pain on upper extremity motor function and proprioception. NeuroRehabilitation, 2020, 46(4): 561-567.
4. Yi Y, Shim JS, Kim K, et al. Prevalence of the rotator cuff tear increases with weakness in hemiplegic shoulder. Ann Rehabil Med, 2013, 37(4): 471-478.
5. Dyer S, Mordaunt DA, Adey-Wakeling Z. Interventions for post-stroke shoulder pain: an overview of systematic reviews. Int J Gen Med, 2020, 13: 1411-1426.
6. Tsur A, Ring H. Axillary nerve conduction changes in hemiplegia. J Brachial Plex Peripher Nerve Inj, 2008, 3: 26.
7. Sanchis MN, Lluch E, Nijs J, et al. The role of central sensitization in shoulder pain: a systematic literature review. Semin Arthritis Rheum, 2015, 44(6): 710-716.
8. 朱明跃, 徐俊峰, 杨丽华. 脑卒中偏瘫后肩痛发病机制分析和治疗进展. 中国疼痛医学杂志, 2014, 20(10): 745-747, 751.
9. Tan B, Jia L. Ultrasound-guided BoNT-A (botulinum toxin A) injection into the subscapularis for hemiplegic shoulder pain: a randomized, double-blind, placebo-controlled trial. Stroke, 2021, 52(12): 3759-3767.
10. 苏建康, 汪杰, 王丛笑, 等. Mulligan 动态关节松动术对脑卒中偏瘫肩痛的疗效观察. 中国康复医学杂志, 2020, 35(11): 1363-1365.
11. 张红霞. 经皮神经电刺激治疗卒中后偏瘫侧肩痛. 中国疼痛医学杂志, 2020, 26(8): 630-631, 634.
12. Zhou M, Li F, Lu W, et al. Efficiency of neuromuscular electrical stimulation and transcutaneous nerve stimulation on hemiplegic shoulder pain: a randomized controlled trial. Arch Phys Med Rehabil, 2018, 99(9): 1730-1739.
13. Deng P, Zhao Z, Zhang S, et al. Effect of kinesio taping on hemiplegic shoulder pain: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2021, 35(3): 317-331.
14. Nadler M, Pauls M. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review. Clin Rehabil, 2017, 31(4): 444-453.
15. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019. 中华神经科杂志, 2019, 52(9) : 710-715.
16. 朱美丽, 胡江飚, 陈海挺, 等. 气弹式体外冲击波治疗偏瘫后肩痛的疗效观察. 心脑血管病防治, 2017, 17(1): 59-60.
17. 张浩冲, 邢更彦. 冲击波在医学中的应用进展. 中国医学前沿杂志(电子版), 2014, 6(1): 29-33.
18. 邢更彦, 张浩冲, 刘水涛, 等. 中国骨肌疾病体外冲击波疗法指南(2019 年版). 中国医学前沿杂志(电子版), 2019, 11(4): 1-10.
19. 王江山, 何明伟, 倪家骧. 体外冲击波疼痛治疗的进展. 中国康复医学杂志, 2011, 26(8): 788-791.
20. 周迪远, 陶惠红, 杨耀琴, 等. 体外冲击波对肌肉骨骼痛症的抗炎镇痛机制. 实用骨科杂志, 2017, 23(7): 618-621, 625.
21. Wess O. Extracorporeal shock waves for pain relief-hypothesis of a neural working mechanism. J Endourol, 2009, 23(A15/A16): 239-241.
22. 赵景春, 咸春静, 于家傲, 等. 体外冲击波疗法对促进创面血管生成及愈合作用的研究进展. 中华损伤与修复杂志(电子版), 2014, 9(1): 71-75.
23. 陈庆梅, 杨卫新. 放散状体外冲击波治疗脑卒中后肩痛 38 例. 交通医学, 2011, 25(3): 266-267.
24. 阚秀丽, 冀磊磊, 周云, 等. 体外冲击波联合肩肱节律训练对卒中后肩痛的疗效观察. 颈腰痛杂志, 2022, 43(3): 358-361.
25. Zhang T, Zhang C. Extracorporeal shock wave therapy for shoulder pain after stroke: a systematic review and meta-analysis. Clin Rehabil, 2023, 37(6): 774-790.

West China Medical Journal

Effect of extracorporeal shock wave therapy on hemiplegic shoulder pain

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