Ultrasound-Guided Corticosteroid Block Versus Alcohol Neurolysis of the Suprascapular Nerve for Chronic Hemiplegic Shoulder Pain

OBJECTIVE: To compare the clinical effectiveness of corticosteroid block versus alcohol neurolysis of the suprascapular nerve (SSN) in patients with chronic post-stroke hemiplegic shoulder pain (HSP). DESIGN: This prospective service evaluation, reported per STROBE guidelines, enrolled 26 consecutive patients with chronic post-stroke HSP (>3 mo) receiving ultrasound-guided SSNB with triamcinolone acetonide 40 mg/lidocaine (corticosteroid, n=13) or 70% ethanol/lidocaine (alcohol neurolysis, n=13) as part of routine clinical care. Pain (Numeric Rating Scale, 0-10) and shoulder range of motion (Constant-Murley ROM) were assessed at baseline, weekly for six weeks, and six months. RESULTS: Both groups showed significant within-group improvements in all pain domains and ROM at one and six weeks. At six months, resting and movement pain remained improved in both groups. Nocturnal pain and ROM improvements persisted in the alcohol neurolysis group (P=0.005; P=0.004) but not the corticosteroid group (P=0.162; P=0.058). No between-group differences were observed (all P>0.05; effect sizes r=0.03-0.31). Both interventions were well tolerated, with transient post-procedural pain exacerbation reported in two alcohol-treated patients. CONCLUSIONS: Both interventions produced significant improvements in pain and ROM with no between-group differences. The six-month pattern suggests more durable benefit following alcohol neurolysis; however, dequately powered randomized controlled trials are required.