Abstract
An effective technique for managing shoulder discomfort and providing regional anaesthesia has emerged in recent years: ultrasound-guided interfascial blocks of the anterior and posterior thoracic walls. Their role in treating poststroke shoulder spasticity (SPS) remains underexplored. In order to assess whether or not ultrasound-guided phenol (PN) interfascial nerve blocks are beneficial in the treatment of pain and spasticity in stroke patients who have been diagnosed with SPS, the goal of this research is to investigate the effectiveness of these blocks. 110 stroke patients participated in a prospective research that was carried out with clinically significant SPS. Patients received interfascial phenol blocks (IPB) targeting both the anterior and posterior thoracic wall, specifically the pectoral nerves (PNB) and subscapular nerves (SNB). Clinical outcomes were assessed using the Modified Ashworth Scale (MAS) for spasticity, the Visual Analogue Scale (VAS) was used to assess the level of discomfort, and a goniometer was used to quantify the active range of motion (AROM) of the shoulder joint that was impacted. In the two, eight, and twelve weeks that followed the intervention, follow-up assessments were carried out. Phenol-based IPB was well tolerated and produced significant clinical improvements. At all follow-up points, patients demonstrated reduced shoulder spasticity (MAS), decreased pain scores (VAS), and increased AROM compared to baseline. Improvements were sustained up to 12 weeks, with notable functional gains in upper limb mobility. Ultrasound-guided interfascial phenol blocks provide an effective, longacting option for managing shoulder spasticity in post-stroke patients. This approach may be particularly useful when oral antispastic medications or high-dose botulinum toxin (BoNT) are ineffective, contraindicated, or financially limiting, and can be integrated with BoNT therapy to enhance cost-effectiveness and outcomes.
Keywords: Spastic Painful Shoulder, Phenol, Interfascial Phenol Blocks, Ultrasound-Guided