Subacromial corticosteroid injection for poststroke shoulder pain: a retrospective chart review.
OBJECTIVE
To assess the effectiveness of subacromial corticosteroid injections for the treatment of poststroke shoulder pain.


METHODS
Retrospective chart review.


METHODS
Ambulatory setting, university-affiliated hospital.


METHODS
People (N=60) with stroke-associated hemiparesis and pain in the involved shoulder.


METHODS
Electronic medical records of stroke survivors with shoulder pain in the hemiparetic limb treated with a subacromial corticosteroid injection by a practitioner between January 1, 2005, and June 30, 2007, were reviewed. Patients who had a documented preinjection pain score on the day of injection by using a 0 to 10 numeric rating scale and a postinjection pain score within 16 weeks of injection were included.


METHODS
Pre- and postinjection scores were compared by using the paired t test. Treatment success was defined as a minimum of 2-point absolute or 30% relative pain reduction. Linear and logistic regression analyses were used to identify predictors of pain reduction and treatment success, respectively.


RESULTS
Patients experienced an absolute pain reduction of 2.6+/-3.7 (95% confidence interval, 1.7-3.6; P<.001) and a relative pain reduction of 32.9%+/-53.6%. Fifty-three percent experienced the minimum 2-point absolute pain reduction, whereas 45% experienced the minimum 30% relative pain reduction. Linear regression analyses identified the preinjection pain score as a predictor of absolute pain reduction and concomitant outpatient occupational or physical therapy as a predictor of both absolute and relative pain reduction. No other factors were predictive of pain reduction or treatment success.


CONCLUSIONS
Subacromial corticosteroid injection is associated with a significant reduction in poststroke shoulder pain. However, controlled trials are needed to show a cause-and-effect relationship and rule out spontaneous recovery, placebo effect, and other confounds.
Chae
John
J
Department of Physical Medicine and Rehabilitation, Case Western Reserve University School of Medicine, MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH 44109, USA. jchae@metrohealth.org
Wolf-Johnson
Tova
T
Govil
Harsh
H
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010291:Paresis / Q000209:etiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000145:classification / Q000188:drug therapy* / Q000209:etiology*; D020521:Stroke / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones