Patient tolerability of suprascapular and median nerve blocks for the management of pain in post-stroke shoulder-hand syndrome.

BACKGROUND: Current management options for pain in stroke patients with the shoulder-hand syndrome (SHS) are limited and often ineffective. The use of peripheral nerve blocking in SHS has been limited due to concerns of hyperalgesia and allodynia in these patients. This study assessed the tolerability of suprascapular nerve (SSN) and median nerve blocks for acute control of pain in patients with post-stroke SHS. METHODS: All SHS patients fulfilled diagnosis using the Budapest criteria. Patient tolerability was defined by a composite score that included a change on the visual analog scale (VAS) from baseline for shoulder and hand pain, presence of adverse events, and a self-reported patient satisfaction score. Pain assessment was performed 1 h before (baseline), and 1 h and 2 weeks after the procedure. RESULTS: Five patients (68.5 ± 9.5 years) with post-stroke SHS underwent SSN and median nerve blocks. Participant assessment 1 h after the procedure indicated that the 2 blocking procedures were well tolerated and that VAS scores for shoulder and hand pain decreased by 79% (- 62.6 mm ± 25.6; p = 0.043) and 48% (- 33 mm ± 40.2; p = 0.080), respectively from baseline. After 2 weeks, average VAS scores remained 56% and 37% below baseline, respectively. There were no adverse events and all patients were satisfied after the procedure. CONCLUSIONS: Suprascapular and median nerve blocks are safe and well-tolerated procedures for acute pain control in post-stroke SHS. Further studies should address the benefit of these procedures on overall pain reduction, functional recovery, and quality of life in SHS patients.

Fibularis Intersection Syndrome: A Rare Cause of Lateral Foot Pain in Runners.

ABSTRACT: Running is a common cause of foot and ankle injuries. Accurate diagnosis is important for appropriate management to resolve the issue. For clarity of diagnoses, the physician should be able to perform a thorough physical examination in conjunction with point-of-care ultrasound. The authors report a case study of a young male runner with lateral ankle pain. Based on clinical assessment and point-of-care ultrasound, a diagnosis of fibularis intersection syndrome was proposed. This type of injury can be treated with graded eccentric loading of fibularis tendons and proprioceptive exercises. This case report highlights the importance of point-of-care ultrasound to determine the appropriate diagnosis and management.

Influence of vestibular afferent input on common modulation of human soleus motor units during standing.

The purpose of this study was to investigate whether application of bipolar galvanic vestibular stimulation (GVS) would influence the common modulation of motor unit discharge rate in bilateral soleus muscles during quiet standing. Soleus motor unit activity was recorded with fine wire electrodes in each leg. Subjects stood, with eyes closed, on two adjacent force platforms to record postural sway with the head facing straight ahead, turned to right, or turned left. Subjects also swayed voluntarily without GVS to the same position as evoked during the GVS. There was no difference in the common drive to bilateral soleus motoneurons during quiet standing and voluntary sway tasks. Common drive was significantly lower during right cathode GVS with the head straight or turned to the right. These results demonstrate that manipulation of vestibular afferent input influences the common modulation of bilateral soleus motor unit pairs during quiet standing.