The Importance of Pectoralis Minor Syndrome in Hemiplegic Shoulder Pain

November 18, 2025 updated by: Burak Ugur Cetin, Istanbul University - Cerrahpasa

The Importance of Pectoralis Minor Syndrome in Hemiplegic Shoulder Pain: A Prospective, Interventional Study

Hemiplegic shoulder pain, common in stroke patients, often arises from muscle weakness, imbalance, or joint and nerve issues. Previous case reports in literature suggest that pectoralis minor syndrome may play a significant role in this pain. In current study, the investigators aimed to evaluate the role of the pectoralis minor muscle in patients with hemiplegic shoulder pain and to reveal the contribution of pectoralis minor syndrome to hemiplegic shoulder pain. Additionally, this study may provide fundamental information to improve clinical practice in determining rehabilitation and treatment strategies, contribute to the development of new approaches in managing hemiplegic shoulder pain, and assist in optimizing rehabilitation programs.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Hemiplegic shoulder pain is a common complication following a stroke, with a prevalence ranging from 22% to 47%, typically occurring two to three months post-stroke. This pain can lead to withdrawal from rehabilitation programs, longer hospital stays, reduced joint mobility, and impaired quality of life. Various factors contribute to its development, including decreased muscle tone, shoulder subluxation, increased muscle tone, impingement syndrome, frozen shoulder, brachial plexus injury, and thalamic syndrome. Among these, subacromial/subdeltoid bursitis is the most frequently reported cause of pain, and significant pain relief following local anesthetic injections into the subacromial/subdeltoid bursa is diagnostic of subacromial impingement syndrome.

Treatment goals for hemiplegic shoulder pain include pain reduction, restoring shoulder mobility, improving functional activities, and preventing degenerative changes. Treatment options range from conservative methods like shoulder slings, range-of-motion exercises, pain relievers, physical therapy, and various injection therapies, to surgical interventions for cases unresponsive to conservative measures.

Pectoralis minor syndrome, associated with hemiplegic shoulder pain, can occur in stroke patients. The pectoralis minor muscle plays a crucial role in shoulder stability and movement. Compression or irritation of neurovascular structures in the retropectoral space by this muscle leads to pectoralis minor syndrome, often diagnosed through clinical evaluation rather than specific radiological or electrophysiological tests. Ultrasound-guided pectoralis minor muscle blocks have become significant in both diagnosis and treatment, demonstrating marked pain reduction in affected patients. Research on pectoralis minor syndrome aims to enhance understanding of its causes, effects, and treatment strategies, contributing to the development of more effective and specific approaches for managing hemiplegic shoulder pain.

Study Type

Interventional

Enrollment (Actual)

19

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
      • Istanbul, Turkey (Türkiye), 34098
        • Istanbul University - Cerrahpasa (IUC)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Development of spastic hemiplegia due to stroke
  • Presence of shoulder pain on the hemiplegic side

Exclusion Criteria:

  • Lack of medical stability
  • Inability to communicate verbally
  • History of severe sensitivity to lidocaine injections
  • Surgical history related to the hemiplegic shoulder
  • Presence of a prosthesis in the hemiplegic shoulder
  • Malignancy in the hemiplegic shoulder
  • Severe psychiatric illness
  • History of injections to the hemiplegic shoulder within the last 6 months
  • Pregnancy
  • History of inflammatory rheumatic disease

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Arm
Patients presenting to the outpatient clinic with shoulder pain on the hemiplegic side will first undergo a diagnostic subacromial bursa injection, followed by a pectoralis minor muscle block.
Procedure: Ultrasound-guided injection of the subacromial bursa and pectoralis minor

Patients will first receive an ultrasound-guided injection of the subacromial bursa. After the subacromial bursa injection, patients will be monitored for 1 hour, after which the level of relief in their complaints will be assessed using the Numeric Rating Scale (NRS), and passive range of motion will be measured.

Following the subacromial bursa injection, patients will receive an ultrasound-guided injection of the pectoralis minor muscle. After the pectoralis minor muscle injection, patients will again be monitored for 1 hour, after which the level of relief in their complaints will be assessed using the NRS, and passive range of motion will be measured.

Drug: Lidocaine (drug)
5 mL of 2% lidocaine will be used as a local anesthetic for the subacromial bursa injection, and 4 mL of 2% lidocaine will be used for the pectoralis minor muscle injection.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Pain Relief
Time Frame: Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month
Pain will be assessed using the Numerical Rating Scale (NRS), which ranges from 0 (no pain) to 10 (worst pain imaginable), at rest, during movement, at night, and overall, both before and after injections into the subacromial bursa and the pectoralis minor muscle. Higher scores indicate worse pain outcomes.
Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month
Passive Range of Motion of Shoulder
Time Frame: Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month
Passive shoulder flexion, abduction, and external rotation will be measured with a goniometer. Flexion and abduction will be measured from 0° (no range of motion) to 180° (full range of motion), while external rotation will be measured from 0° to 90°. Higher scores indicate better outcomes in terms of range of motion.
Baseline, one hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, and one month

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Modified Ashworth Scale
Time Frame: Baseline
Spasticity in upper extremity muscles will be assessed using the Modified Ashworth Scale (MAS), which ranges from 0 to 4. A score of 0 indicates no increase in muscle tone, while a score of 4 indicates the affected part is rigid in flexion or extension. Higher scores on the MAS indicate worse spasticity outcomes.
Baseline
Brunnstrom Stages of Recovery for Upper Extremity Motor Function and Hand Function
Time Frame: Baseline
Upper extremity motor function and hand function will be assessed using the Brunnstrom Stages of Recovery. This scale ranges from Stage 1 (flaccidity, no voluntary movement) to Stage 6 (normal motor function). For both upper extremity motor function and hand function, higher scores indicate better recovery and motor outcomes.
Baseline
Functional Ambulation Scale
Time Frame: Baseline
Ambulation will be assessed using the Functional Ambulation Scale, which ranges from 0 to 5. A score of 0 indicates the inability to walk or requiring maximal assistance, while a score of 5 indicates independent ambulation on all surfaces without assistance. Higher scores indicate better ambulation outcomes.
Baseline
Subluxation in the glenohumeral joint
Time Frame: Baseline
It will be assessed by placing the ultrasound probe along the long axis of the humerus over the lateral edge of the acromion. The distance is defined as the relative lateral distance between the lateral edge of the acromion and the nearest edge of the superior part of the greater tuberosity of the humerus. A difference greater than 0.4 cm indicates the presence of subluxation.
Baseline
Overall Improvement
Time Frame: One hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, one month
Overall improvement will be assessed as a self-reported percentage, ranging from 0% (no improvement) to 100% (complete improvement). Higher percentages indicate better outcomes, with 100% representing full recovery as perceived by the patient.
One hour after subacromial bursa injection, one hour after pectoralis minor injection, one week, one month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Istanbul University - Cerrahpasa

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 1, 2025

Primary Completion (Actual)

October 1, 2025

Study Completion (Actual)

October 1, 2025

Study Registration Dates

First Submitted

September 12, 2024

First Submitted That Met QC Criteria

September 25, 2024

First Posted (Actual)

September 26, 2024

Study Record Updates

Last Update Posted (Actual)

November 19, 2025

Last Update Submitted That Met QC Criteria

November 18, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IstanbulUC-BCetin-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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