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

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.

Inclusion Criteria: * 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 Exclusion Criteria: * 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