Evaluation of the Effectiveness of Pericapsular Nerve Group Block in Hemiplegic Shoulder Pain

NCT ID: NCT07302711

Last Updated: 2025-12-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

15 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-12-20

Study Completion Date

2026-03-20

Brief Summary

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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 adding an ultrasound-guided PENG block to conventional physical therapy in patients with post-stroke hemiplegic shoulder pain, focusing on pain intensity, range of motion, and quality of life outcomes.

Detailed Description

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Pericapsular/Periarticular Nerve Group (PENG) Block Procedure:

The procedure is performed with the patient in the supine position, the affected arm externally rotated and abducted approximately 45 degrees. A high-frequency linear ultrasound probe is placed longitudinally between the coracoid process and the humeral head. After identifying the humeral head, the subscapularis muscle tendon, and the overlying deltoid muscle, an in-plane approach is used to advance a 100-mm needle between the deltoid muscle and the subscapularis tendon under real-time ultrasound guidance.

After confirming the needle tip position, a total of 10 mL of 0.25% bupivacaine hydrochloride combined with 4 mg of dexamethasone is injected slowly, ensuring appropriate spread within the targeted pericapsular space. The goal of the block is to provide analgesia for the glenohumeral joint by targeting the articular branches of the axillary, subscapular, and lateral pectoral nerves with minimal motor impairment.

No major complications have been reported for this technique in the literature. However, minor complications such as local bleeding, infection, or transient vasovagal reactions may occur.

Conditions

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Shoulder Pain Hemiplegia

Keywords

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PENG block shoulder joint pain Hemiplegic shoulder

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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1

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

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

Intervention Type 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.

Interventions

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

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.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age between 18 and 85 years

Stroke onset less than 1 year

Presence of hemiplegic shoulder pain with limited shoulder range of motion confirmed by clinical examination

Numeric Rating Scale (NRS) pain score ≥ 4

Exclusion Criteria

* Severe deformity or pathology of the shoulder region

Complex regional pain syndrome type I

Modified Ashworth Scale score ≥ 3

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)

Presence of pacemaker

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
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Marmara University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Marmara University

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Central Contacts

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Savas Sencan, Assoc Prof

Role: CONTACT

Phone: 05370665713

Email: [email protected]

Ozlem M Eksi, MD

Role: CONTACT

Phone: 05425517553

Email: [email protected]

Facility Contacts

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Ozlem M Eksi, MD

Role: primary

Other Identifiers

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09.2025.25-0859

Identifier Type: -

Identifier Source: org_study_id