The use of extracorporeal shock wave therapy in the painful shoulder condition due to subluxation in the stroke patient: case series

Abstract

One of the main causes of the painful shoulder condition after a cerebrovascular accident (CVA), or stroke, seems to be the tractioning of the periarticular structures due to luxation or subluxation, which results in a chronic inflammatory process in these structures. The radial shock wave therapy (RSWT) has shown to be an important resource in the treatment of chronic pains, which were refractory to the conventional therapy. The present study aimed at evaluating the effect of RSWT in the painful shoulder condition due to subluxation after stroke. Nine hemiparetic patients with shoulder pain associated to subluxation that were refractory to the conventional therapy carried out for at least six months, participated in the study. The patients received three radial shock wave applications (2,000 pulses, frequency of 6 Hz), every two weeks. One patient was excluded from the study as he had been submitted to chemical blockage during the treatment. The remaining 8 patients experienced considerable pain relief (between 100% and 34%, according to the visual analogue scale), which persisted up to one month after the end of the treatment. There was an association of pain relief with active mobility improvement, joint range of motion, sleep and decrease in the use of pain medications. No adverse effects were described. The authors conclude that the radial shock waves can be an effective treatment for the control of shoulder pain in hemiplegic patients and provide further evidence for the understanding of the possible inflammatory etiology of shoulder pain in these patients.