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.
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
John
J
Chae
Tova
T
Wolf-Johnson
Harsh
H
Govil
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