A New Approach to Hemiplegic Shoulder Pain; Pericapsular Nerve Group Block

NCT07302711 | Completed

• 1 other identifier: 09.2025.25-0859
• Study Type: observational
• Target: 15
• Locations: 1 country
• Sites: 1

Brief Summary

Hemiplegic shoulder pain (HSP) is a common and clinically significant complication after stroke that negatively affects rehabilitation outcomes. It is associated with shoulder subluxation, capsular contracture, spasticity, and central pain mechanisms, leading to pain, limited range of motion, and reduced quality of life. The suprascapular nerve (SSN) block has been shown to be effective for shoulder pain management; however, the glenohumeral joint (GHJ) receives innervation from multiple nerves including the axillary, subscapular, and lateral pectoral nerves. The recently described pericapsular/periarticular nerve group (PENG) block targets these articular branches and may provide analgesia with minimal motor impairment. This study aims to evaluate the effects of ultrasound-guided PENG block in patients with post-stroke hemiplegic shoulder pain, focusing on pain intensity, range of motion, and quality of life outcomes.

Conditions

Shoulder Pain; Hemiplegia

Keywords

PENG block; shoulder joint pain; Hemiplegic shoulder

Outcome Measures

Primary Outcomes (1)

• Change in Pain Intensity (Numeric Rating Scale, NRS):

  NRS is a scale in which the patient gives points between "0" and "10" for the low back and leg pain felt by the patient, "0" = No pain, "10" = The most severe, unbearable pain

  Baseline, 1 hour, 2 weeks, and 2 months post-intervention. Numeric Rating Scale

Secondary Outcomes (5)

• Fugl-Meyer Assessment for Upper Extremity (FMA-UE)

  Baseline, 2 weeks, and 2 months

• Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) Questionnaire

  Baseline, 2 weeks, and 2 months

• Modified Ashworth Scale (MAS)

  Baseline, 2 weeks, and 2 months

• Stroke-Specific Quality of Life Scale (SS-QOL)

  Baseline, 2 weeks, and 2 months

• Shoulder Range of Motion (ROM)

  Baseline, 2 weeks, and 2 months

Study Arms (1)

1

All participants will receive a single ultrasound-guided Pericapsular/Periarticular Nerve Group (PENG) block

Procedure: Ultrasound-Guided Pericapsular/Periarticular Nerve Group (PENG) Block

Interventions

Ultrasound-Guided Pericapsular/Periarticular Nerve Group (PENG) Block PROCEDURE

Under real-time ultrasound guidance, a 100-mm needle is advanced in-plane between the deltoid muscle and the subscapularis tendon with the patient in the supine position and the affected arm externally rotated and abducted at approximately 45 degrees. A total of 10 mL of 0.25% bupivacaine hydrochloride combined with 4 mg of dexamethasone is injected slowly into the pericapsular space to provide analgesia to the glenohumeral joint.

1

Eligibility Criteria

• Age: 18 Years - 85 Years
• Sex: all
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Patients aged 18 to 85 years with post-stroke hemiplegic shoulder pain and limited shoulder joint range of motion will be recruited from the Pain Medicine and Physical Therapy Departments of Marmara University Pendik Training and Research Hospital. All participants will have experienced a stroke within the past year and will present with a Numeric Rating Scale (NRS) pain score of 4 or higher at baseline.

You may qualify if:

• Age between 18 and 85 years
• Presence of hemiplegic shoulder pain with limited shoulder range of motion confirmed by clinical examination
• Numeric Rating Scale (NRS) pain score ≥ 4

You may not qualify if:

• Severe deformity or pathology of the shoulder region
• Complex regional pain syndrome type I
• Presence of neglect syndrome
• Grade 4 glenohumeral joint degeneration
• Coagulopathy or bleeding disorders
• Fracture on the affected side
• Secondary pathology on MRI (malignancy or infection)
• History of allergic reaction to local anesthetic agents or dexamethasone
• Shoulder intervention or injection within the past 3 months
• Major psychiatric illness
• Refusal to participate in the study

Sponsors & Collaborators

• Marmara University: lead

Study Sites (1)

Marmara University

Istanbul, Turkey, 34722, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Shoulder Pain; Hemiplegia

Interventions

Dental Occlusion

Condition Hierarchy (Ancestors)

Arthralgia; Joint Diseases; Musculoskeletal Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Paralysis; Nervous System Diseases

Intervention Hierarchy (Ancestors)

Dentistry; Dental Physiological Phenomena; Digestive System and Oral Physiological Phenomena

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 11, 2025
• First Posted: December 24, 2025
• Study Start: November 1, 2025
• Primary Completion: June 1, 2026
• Study Completion: June 1, 2026
• Last Updated: July 29, 2026

Record last verified: 2026-07

Locations

TU (1)