Pulsed Radiofrequency On Suprascapular Nerve And Axillary Nerve For The Patient With Hemiplegic Shoulder Pain

Objective: Hemiplegic shoulder pain(HSP)is one of the most common complications after stroke patients,which results in pain and limited activities because of pain when passive or active activity of shoulder joint,with or without swelling in the hands and wrists.HSP usually occurred in about 2 weeks after the stroke.Hemiplegic shoulder pain will hinder the recovery of upper limb function and influence daily life activities ability.Patients with serious pain could suffer from mood disorders and psychological barriers.Pathogenesis of hemiplegic shoulder pain has not been completely clear,it may caused by many factors such as adhesive capsulitis joint,subluxation of shoulder joint,the increased sympathetic nerve excitability and vascular spasm and abnormal muscle spasm and so on,so the treatment methods varied as well.Currently,there are many treatment methods of hemiplegic shoulder pain,such as early prevention,loose technique,acupuncture,physical therapy combines modern rehabilitation techniques for comprehensive treatment.Besides,there are a few reports on the suprascapular nerve block combines comprehensive therapy,but the long-term curative effect has not been undefined yet.The shoulder pain of majority of patients after regular treatment can alleviate,but the effect is usually limited and recovery process is relatively slow.pulsed radiofrequency treatment technology is a kind of emerging technology for pain treatment in recent years.Compared with the traditional radiofrequency thermo coagulation,pulsed radiofrequency is produced by the discontinuous radiofrequency current,and temperature produced by it is less than 42 ?,which selectively results in activity lost of pain conduction fiber,and will not cause the destruction of the anatomical structure of nerve fibers,so that it will not cause complications such as decreased muscle movement and skin feels obstacle,and avoids the discomfort of patients [2].Pulsed radiofrequency treatment is widely used in clinical treatment and became one of the important methods for the treatment of pain because of its many advantages such as accurate positioning,significant effect,low recurrence rate,less complications and adverse reactions [3].Currently,pulsed radiofrequency technique is mainly used for the treatment of trigeminal neuralgia,neck and shoulder injury Yaotui of pain,and the treatment of patients with neuralgia after herpes zoster.However,it has not been reported in the treatment of hemiplegic shoulder pain,yet.Suprascapular nerve and axillary nerve play vital roles in skin feel and muscle movement of the shoulder,so in this study,we choose these two nerves for pulsed radiofrequency treatment.This paper observed clinical effectiveness of pulsed radiofrequency treatment of suprascapular nerve and axillary nerve on the degree of pain,upper limb movement function and the ability of daily life in hemiplegic shoulder pain patients on the basis of routine rehabilitation training,and to explore a new effective therapy.Methods: 60 patients with moderately to severe hemiplegic shoulder pain were randomly divided into 2 groups,and there are 30 cases in each group.Routine rehabilitation training were given to control group,mainly includes: keeping the patients in proper posture,exercise therapy,alternating hot and cold water immersion method,physical agents therapy and traditional Chinese medicine treatment,Treatment group were given pulsed radiofrequency treatment of suprascapular nerve and axillary nerve,besides the conventional rehabilitation training.Visual analogue scale(VAS)was used for assessing the degree of pain before and after the treatment of patients.VAS less than 3 points is regarded into cured,the cure rate is the ratio of numbers of patients with a VAS less than 3 points.The ipsilateral upper limb motor function was assessed by the Fugl-Meyer upper limb movement rating scale(FMA),and the daily life activities ability of the patients was assessed by the Barthel index(BI).And let the patients and their families score for their overall satisfaction rate from the treatment methods,treatment effect and the attitude of the therapist.All scale assessments were conducted by a specially trained therapist.Results: VAS score in both two groups were decreased after treatment(P < 0.05),which means the degree of shoulder pain was alleviated.Meanwhile,FMA and BI score were higher(P <0.05),that is,not only the ipsilateral upper limb motor function,but also the daily life ability were improved significantly after treatment.In addition,compared to the control group,the degree of shoulder pain,the ipsilateral upper limb motor function and daily life ability of the treatment group were improved more significantly,and patients and their families have higher satisfaction with treatment(P <0.05).Conclusion:1.Pulsed radiofrequency treatment of suprascapular nerve and axillary nerve can significantly relieve shoulder pain.2.Pulsed radiofrequency treatment of suprascapular nerve and axillary nerve can significantly improve motor function of the ipsilateral upper limb and daily life ability in the hemiplegic shoulder pain patients.3.Compared to the conventional rehabilitation therapy,the patient satisfaction is higher.