The Importance of Pectoralis Minor Syndrome in Hemiplegic Shoulder Pain

NCT06613646 | Completed

• 1 other identifier: IstanbulUC-BCetin-01
• Study Type: interventional
• Target: 19
• Locations: 1 country
• Sites: 1

Brief Summary

Hemiplegic shoulder pain, common in stroke patients, often arises from muscle weakness, imbalance, or joint and nerve issues. Previous case reports in literature suggest that pectoralis minor syndrome may play a significant role in this pain. In current study, the investigators aimed to evaluate the role of the pectoralis minor muscle in patients with hemiplegic shoulder pain and to reveal the contribution of pectoralis minor syndrome to hemiplegic shoulder pain. Additionally, this study may provide fundamental information to improve clinical practice in determining rehabilitation and treatment strategies, contribute to the development of new approaches in managing hemiplegic shoulder pain, and assist in optimizing rehabilitation programs.

Conditions

Hemiplegic Shoulder Pain; Pectoralis Minor Syndrome

Keywords

Pectoralis Minor Syndrome; Ultrasound Guided Injections; Hemiplegia; Hemiplegic Shoulder Pain

Outcome Measures

Primary Outcomes (2)

• Pain Relief

  Pain will be assessed using the Numerical Rating Scale (NRS), which ranges from 0 (no pain) to 10 (worst pain imaginable), at rest, during movement, at night, and overall, both before and after injections into the subacromial bursa and the pectoralis minor muscle. Higher scores indicate worse pain outcomes.

  Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month

• Passive Range of Motion of Shoulder

  Passive shoulder flexion, abduction, and external rotation will be measured with a goniometer. Flexion and abduction will be measured from 0° (no range of motion) to 180° (full range of motion), while external rotation will be measured from 0° to 90°. Higher scores indicate better outcomes in terms of range of motion.

  Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month

Secondary Outcomes (5)

• Modified Ashworth Scale

  Baseline

• Brunnstrom Stages of Recovery for Upper Extremity Motor Function and Hand Function

  Baseline

• Functional Ambulation Scale

  Baseline

• Subluxation in the glenohumeral joint

  Baseline

• Overall Improvement

  One hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, one month

Study Arms (1)

Intervention Arm

EXPERIMENTAL

Patients presenting to the outpatient clinic with shoulder pain on the hemiplegic side will first undergo a diagnostic subacromial bursa injection, followed by a pectoralis minor muscle block.

Procedure: Ultrasound-guided injection of the subacromial bursa and pectoralis minor; Drug: Lidocaine (drug)

Interventions

Ultrasound-guided injection of the subacromial bursa and pectoralis minor PROCEDURE

Patients will first receive an ultrasound-guided injection of the subacromial bursa. After the subacromial bursa injection, patients will be monitored for 1 hour, after which the level of relief in their complaints will be assessed using the Numeric Rating Scale (NRS), and passive range of motion will be measured. Following the subacromial bursa injection, patients will receive an ultrasound-guided injection of the pectoralis minor muscle. After the pectoralis minor muscle injection, patients will again be monitored for 1 hour, after which the level of relief in their complaints will be assessed using the NRS, and passive range of motion will be measured.

Intervention Arm

Lidocaine (drug) DRUG

5 mL of 2% lidocaine will be used as a local anesthetic for the subacromial bursa injection, and 4 mL of 2% lidocaine will be used for the pectoralis minor muscle injection.

Intervention Arm

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Development of spastic hemiplegia due to stroke
• Presence of shoulder pain on the hemiplegic side

You may not qualify if:

• Lack of medical stability
• Inability to communicate verbally
• History of severe sensitivity to lidocaine injections
• Surgical history related to the hemiplegic shoulder
• Presence of a prosthesis in the hemiplegic shoulder
• Malignancy in the hemiplegic shoulder
• Severe psychiatric illness
• History of injections to the hemiplegic shoulder within the last 6 months
• Pregnancy
• History of inflammatory rheumatic disease

Sponsors & Collaborators

• Istanbul University - Cerrahpasa: lead

Study Sites (1)

Istanbul University - Cerrahpasa (IUC)

Istanbul, 34098, Turkey (Türkiye)

Location

Related Publications (10)

• Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983 Mar;(173):70-7. No abstract available.

  PMID: 6825348 RESULT

• Aktas I, Kaya E, Akpinar P, Atici A, Unlu Ozkan F, Palamar D, Akgun K. Spasticity-induced Pectoralis minor syndrome: a case-report. Top Stroke Rehabil. 2020 May;27(4):316-319. doi: 10.1080/10749357.2019.1691807. Epub 2019 Nov 27.

  PMID: 31774031 RESULT

• Lin PH. Sonographic findings of painful hemiplegic shoulder after stroke. J Chin Med Assoc. 2018 Jul;81(7):657-661. doi: 10.1016/j.jcma.2017.07.018. Epub 2017 Dec 6.

  PMID: 29217360 RESULT

• Sanders RJ, Annest SJ. Thoracic outlet and pectoralis minor syndromes. Semin Vasc Surg. 2014 Jun;27(2):86-117. doi: 10.1053/j.semvascsurg.2015.02.001. Epub 2015 Feb 18.

  PMID: 25868762 RESULT

• Lee KW, Choi YJ, Lee HJ, Gil YC, Kim HJ, Tansatit T, Hu KS. Classification of unusual insertion of the pectoralis minor muscle. Surg Radiol Anat. 2018 Dec;40(12):1357-1361. doi: 10.1007/s00276-018-2107-0. Epub 2018 Oct 10.

  PMID: 30306210 RESULT

• Murie-Fernandez M, Carmona Iragui M, Gnanakumar V, Meyer M, Foley N, Teasell R. [Painful hemiplegic shoulder in stroke patients: causes and management]. Neurologia. 2012 May;27(4):234-44. doi: 10.1016/j.nrl.2011.02.010. Epub 2011 Apr 22. Spanish.

  PMID: 21514698 RESULT

• Adey-Wakeling Z, Arima H, Crotty M, Leyden J, Kleinig T, Anderson CS, Newbury J; SEARCH Study Collaborative. Incidence and associations of hemiplegic shoulder pain poststroke: prospective population-based study. Arch Phys Med Rehabil. 2015 Feb;96(2):241-247.e1. doi: 10.1016/j.apmr.2014.09.007. Epub 2014 Sep 28.

  PMID: 25264111 RESULT

• Lindgren I, Jonsson AC, Norrving B, Lindgren A. Shoulder pain after stroke: a prospective population-based study. Stroke. 2007 Feb;38(2):343-8. doi: 10.1161/01.STR.0000254598.16739.4e. Epub 2006 Dec 21.

  PMID: 17185637 RESULT

• Griffin JW. Hemiplegic shoulder pain. Phys Ther. 1986 Dec;66(12):1884-93. doi: 10.1093/ptj/66.12.1884.

  PMID: 2431421 RESULT

• Bender L, McKenna K. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil. 2001 Nov 10;23(16):698-705. doi: 10.1080/09638280110062149.

  PMID: 11732559 RESULT

MeSH Terms

Conditions

Hemiplegia

Interventions

Lidocaine; Pharmaceutical Preparations

Condition Hierarchy (Ancestors)

Paralysis; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Acetanilides; Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Medical Doctor

Study Record Dates

• First Submitted: September 12, 2024
• First Posted: September 26, 2024
• Study Start: May 1, 2025
• Primary Completion: October 1, 2025
• Study Completion: October 1, 2025
• Last Updated: November 19, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)