Is Landmark-guided Suprascapular Nerve Block for Hemiplegic Shoulder Pain an Effective Intervention?

Background Hemiplegic shoulder pain (HSP) is a common complication following stroke, with an incidence of up to 84%. It negatively affects participation in rehabilitation, functional recovery, and quality of life. Suprascapular nerve block (SSNB) is an established intervention for other shoulder pathologies, but evidence for effectiveness in HSP remains limited. Objective To evaluate the effectiveness of landmark-guided SSNB in patients with HSP on a stroke rehabilitation unit. Methods A retrospective service evaluation was conducted in patients receiving landmark-guided SSNB for HSP on a stroke rehabilitation unit between March 2022 and November 2023. All injections used 10 mL of 0.5% bupivacaine without a steroid. Pain was assessed using the Numerical Rating Scale (NRS) across four domains (rest, night pain, personal care, and therapy). Secondary outcomes included passive range of movement (PROM) and spasticity assessed using the Modified Ashworth Scale. Outcomes were recorded preintervention and at 1 h, 24-48 h, and 7 days postintervention. Results Fourteen patients were included. Statistically significant improvements in NRS pain scores were observed across all domains at 7 days postintervention compared with baseline, with the greatest reduction seen at 24-48 h. PROM improved in all planes, most notably in forward flexion. Spasticity improved in 50% of patients with preexisting spasticity. No complications were recorded. Conclusion Landmark-guided SSNB using local anesthetic appears to be a safe and effective short-term intervention for reducing pain and improving PROM in HSP. Further controlled studies are required to assess long-term outcomes and functional impact.