Suprascapular Nerve Block and Proprioception in Hemiplegic Shoulder Pain: A Randomized Controlled Study

The validity and reliability of the laser pointer-assisted joint position sense test in patients with shoulder instability were established by Amir K. Vafadar et al., with inter-observer and intra-observer correlation coefficients of 0.78 and 0.86, respectively. In this test, a laser pointer is secured to the patient's arm using a Velcro strap positioned 5 cm proximal to the elbow. With eyes open, the patient is asked to raise the hemiplegic arm to 90 degrees. The laser point is marked on millimeter paper fixed 1 meter in front of the shoulder joint. The patient is then asked, with eyes open, to relocate the same point to learn the joint position. Subsequently, with eyes closed, the patient is asked to identify the same point again. This second point is marked, and the distance from the initial point is measured along the x- and y-axes. The angular deviation of the shoulder joint position is calculated using the tangent formula.

For the assessment of proprioception, the thumb localization test will be performed. The validity and reliability of this test in patients with hemiplegia were established by Otaka et al., with a weighted kappa value of 0.84 for inter-observer measurements, indicating high agreement. With the patient's eyes closed, the patient is asked to locate and grasp the thumb of the affected hand using the fingers of the unaffected hand

A 0-10 numeric rating scale will be used to assess pain severity.

Shoulder range of motion will be assessed using a standard goniometer, which provides an objective measurement of joint angles in degrees. The goniometer is aligned with anatomical landmarks of the shoulder, and active or passive movements (flexion, abduction, and rotation) are measured according to standardized positioning.

Goal Attainment Scale (GAS) is a goal-oriented functional outcome measure based on the International Classification of Functioning, Disability and Health (ICF) framework and is used to assess the extent to which individuals achieve predefined goals. It quantifies the success or failure of set goals and can be applied in rehabilitation settings. According to this scale, pain during upper extremity dressing was evaluated as follows: -2 = severe pain, -1 = moderate pain, 0 = mild pain, +1 = pain at the end of movement, and +2 = pain-free movement."

Fugl-Meyer Assessment - Upper Extremity: The Fugl-Meyer Upper Extremity Scale is a standardized measure used to evaluate upper extremity motor function after stroke. It is designed to assess movement impairments and loss of muscle control in the upper extremity following stroke. The scale evaluates a range of functions, including shoulder, elbow, wrist, and hand movements, as well as hand use and functional abilities. Each movement is scored on a 0-2 scale, with a maximum total score of 66 points. This scale is widely used in post-stroke rehabilitation programs to assess treatment effectiveness and to monitor motor recovery over time.

Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire: The QuickDASH is a functional assessment tool used to evaluate upper extremity disability. It is designed to measure symptoms such as pain, weakness, and movement limitations related to the arm, shoulder, and hand, as well as the impact of these problems on activities of daily living. The questionnaire consists of 11 items, each related to a specific activity or function, and patients respond based on their condition over the preceding 7 days. Scoring is divided into two sections: the disability/symptom section (11 items scored from 1 to 5) and an optional high-performance work/sport or music module (4 items scored from 1 to 5). Higher scores indicate greater disability.

The Stroke Impact Scale is a measure used to assess quality of life and functional performance in activities of daily living after stroke. It evaluates patients' physical, psychological, and social functioning. The scale consists of eight domains: strength, activities of daily living/self-care, mobility, hand function, emotion, memory and thinking, communication, and social participation. Each domain assesses different aspects of post-stroke functioning. The SIS is widely used to evaluate the effects of post-stroke treatment and to monitor changes during the recovery process in patients undergoing rehabilitation programs.

Modified Ashworth Scale: Shoulder spasticity will be assessed using the Modified Ashworth Scale. Scoring is defined as follows:

0 = No increase in muscle tone;

1 = Slight increase in muscle tone, manifested by a catch and release or minimal resistance at the end of the range of motion;

1+ = Slight increase in muscle tone, manifested by a catch followed by minimal resistance through less than half of the range of motion; 2 = More marked increase in muscle tone through most of the range of motion, but the affected part is easily moved; 3 = Considerable increase in muscle tone, passive movement is difficult; 4 = Affected part rigid in flexion or extension (contracture).