Skip to main content
OpenTrials
Not Yet Recruiting

NCT Number: NCT07302711

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

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.

Not Yet Recruiting

Trial opening soon.

Get Notified

Key information

Conditions

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

Age range

18 year–85 year

Sex eligibility

All sexes

Study type

Observational

Primary location

About this study

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.

Who can participate

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

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.

Primary outcomes

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

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

    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

Secondary outcomes

  1. Fugl-Meyer Assessment for Upper Extremity (FMA-UE)

    Time frame: Baseline, 2 weeks, and 2 months

    The Fugl-Meyer Upper Extremity Scale is a validated assessment tool designed to evaluate motor recovery after stroke. It includes motor function of the upper limb, wrist, hand movements, coordination, and reflex activity. Each item is scored from 0 to 2 (0 = cannot perform, 1 = partial performance, 2 = normal performance), with a total possible score of 66 points.

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

    Time frame: Baseline, 2 weeks, and 2 months

    The QuickDASH is an 11-item self-reported questionnaire measuring upper extremity function and symptoms. Scores range from 0 to 100, where higher scores indicate greater disability.

  3. Modified Ashworth Scale (MAS)

    Time frame: Baseline, 2 weeks, and 2 months

    The MAS is a clinical tool used to assess muscle tone and spasticity. Muscle tone is rated from 0 (no increase in tone) to 4 (rigid in flexion or extension). Higher scores indicate more severe spasticity.

  4. Stroke-Specific Quality of Life Scale (SS-QOL)

    Time frame: Baseline, 2 weeks, and 2 months

    The SS-QOL is a 49-item stroke-specific scale assessing 12 domains related to quality of life, including mobility, upper extremity function, mood, energy, social roles, language, and thinking. Each item is rated on a 5-point Likert scale; higher scores represent better quality of life.

  5. Modified Barthel Index (MBI)

    Time frame: Baseline, 2 weeks, and 2 months

    The MBI assesses activities of daily living (ADL) and functional independence. Scores range from 0 to 100, with higher scores indicating greater independence.

  6. Shoulder Range of Motion (ROM)

    Time frame: Baseline, 2 weeks, and 2 months

    Active and passive shoulder joint range of motion (flexion, abduction, internal and external rotation) will be measured using a goniometer. The range will be recorded at the point of pain onset and maximum movement.

Study contacts

Contact information is provided by the study sponsor or research team.

Ozlem M Eksi, MD

CONTACT

[email protected]

05425517553 ext. +90

Savas Sencan, Assoc Prof

CONTACT

[email protected]

05370665713 ext. +90

Sponsors and collaborators

Lead sponsor

Marmara University

Other

Registry information

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Dec 24, 2025
Registry last updated
Dec 24, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.