Development of a painful shoulder and limitation of ranges of motion in the hemiplegic patient is a significant and serious problem. The subscapularis muscle is the prime internal rotator of the shoulder and plays a critical role commonly seen in spastic hemiplegia. The subacromial area of the shoulder is a location of pain-producing structure in hemiplegic patient.

Twenty-five patients with chronic spastic hemiplegia, limited range of motion especially in external rotation, and painful shoulders underwent subscapular nerve block by needle insertion of the subscapularis muscle and iontophoresis at subacromial bursa. Three to six ml of 5% phenol was injected. Patients' age ranges from 42 to 71 (mean: 58.7) and the durations of hemiplegia from 13 to 81 weeks (mean: 33.5).

Statistically, significant improvements of range of motion of hemiplegic shoulder were observed in flexion (19.3^o), abduction (18.1^o), and external rotation (19.4^o). Subjective reduction of shoulder pain following phenol blocks to the nerves to the subscapularis muscle and iontophoresis at subacromial bursa was also noted. Subscapularis nerve block and iontophoresis at subacromial bursa is a new and potentially useful technique in the management of the painful hemiplegic shoulder.

Keywords :Hemiplegia, Nerve block, Pain, Shoulder