The Importance of Pectoralis Minor Syndrome in Hemiplegic Shoulder Pain
NCT ID: NCT06613646
Last Updated: 2025-11-19
Study Results
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Basic Information
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COMPLETED
NA
19 participants
INTERVENTIONAL
2025-05-01
2025-10-01
Brief Summary
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Detailed Description
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Treatment goals for hemiplegic shoulder pain include pain reduction, restoring shoulder mobility, improving functional activities, and preventing degenerative changes. Treatment options range from conservative methods like shoulder slings, range-of-motion exercises, pain relievers, physical therapy, and various injection therapies, to surgical interventions for cases unresponsive to conservative measures.
Pectoralis minor syndrome, associated with hemiplegic shoulder pain, can occur in stroke patients. The pectoralis minor muscle plays a crucial role in shoulder stability and movement. Compression or irritation of neurovascular structures in the retropectoral space by this muscle leads to pectoralis minor syndrome, often diagnosed through clinical evaluation rather than specific radiological or electrophysiological tests. Ultrasound-guided pectoralis minor muscle blocks have become significant in both diagnosis and treatment, demonstrating marked pain reduction in affected patients. Research on pectoralis minor syndrome aims to enhance understanding of its causes, effects, and treatment strategies, contributing to the development of more effective and specific approaches for managing hemiplegic shoulder pain.
Conditions
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Study Design
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NA
SINGLE_GROUP
TREATMENT
NONE
Study Groups
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Intervention Arm
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.
Ultrasound-guided injection of the subacromial bursa and pectoralis minor
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.
Lidocaine (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.
Interventions
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Ultrasound-guided injection of the subacromial bursa and pectoralis minor
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.
Lidocaine (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.
Eligibility Criteria
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Inclusion Criteria
* Presence of shoulder pain on the hemiplegic side
Exclusion Criteria
* 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
18 Years
ALL
No
Sponsors
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Istanbul University - Cerrahpasa
OTHER
Responsible Party
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Burak Ugur Cetin
Medical Doctor
Locations
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Istanbul University - Cerrahpasa (IUC)
Istanbul, , Turkey (Türkiye)
Countries
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References
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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.
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.
Griffin JW. Hemiplegic shoulder pain. Phys Ther. 1986 Dec;66(12):1884-93. doi: 10.1093/ptj/66.12.1884.
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.
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.
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.
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.
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.
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.
Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983 Mar;(173):70-7. No abstract available.
Other Identifiers
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IstanbulUC-BCetin-01
Identifier Type: -
Identifier Source: org_study_id
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