Suprascapular Nerve Block: Evaluation in the Therapy of Shoulder Pain

Milowsky, Jack; Rovenstine, E. A.

doi:10.1097/00000542-194901000-00009

Cited by 10 publications

(5 citation statements)

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“…Ultrasound-guided suprascapular nerve block was originally described by Milowsky and Rovenstine [12]. Harmon et al (2007) used the nerve block method on a 44-year old man suffering from severe painful osteoarthritis with a frozen right shoulder.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Procedural Sedation and Analgesia (Psa) and Ultrasound-Guided Suprascapular Nerve Block Techniques in Shoulder Reduction

2020

jcr

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Background: Shoulder dislocation is one of the commonest joint dislocation and choosing the proper and best method for sedation and analgesia when reduction is performed is important. The routine methods used for treating the shoulder are procedural sedation and analgesia (PSA) and the nerve block. In this study, we aimed to compare the effectiveness of these two above methods, length of emergency department stay, the rate of success, the satisfaction of the physician and the patient, and the complications caused by each of them. Material and Methods: In this clinical trial, 200 patients who were admitted to the emergency department of Hafte Tir and Rasoul-e-Akram Hospitals during 2018 to 2019, were randomly assigned to receive PSA or ultrasound guided suprascapular nerve blocking. Data was collected, recorded and analyzed by SPSS v.22 software. Results: The average of age was 46.55 years and 63% of patients were male. In the nerve block group, 66% of the cases were failed and need to be placed in the PSA method. The duration of reduction was less in PSA method (p<0.05). Also in the PSA group, the length of ED stay was significantly shorter than the nerve block group (p<0.05). The report of patients about pain severity in the time of reduction was markedly lower than the nerve block method (p<0.05). The complications of PSA method such as apnea and hypotension were seen in 35% of patients, whereas, only 6% in nerve block group were suffered from local hematoma and other minor complications. Conclusion: Based on our results, the suprascapular nerve blocking is not a suitable method for shoulder reduction in ED but it can be considered as an alternative and auxiliary method. This method can be considered for high-risk patients, such as a patient with advanced age and cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

A Comparison of the Procedural Sedation and Analgesia (Psa) and Ultrasound-Guided Suprascapular Nerve Block Techniques in Shoulder Reduction

2020

jcr

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“…Blind suprascapular nerve blockade is one of the possible treatment options for both the acute and chronic pain management of suprascapular neuropathy, but the limitations of the procedure include some possible complications such as pneumothorax or injury to the neighboring vascular structures [22,23]. Ultrasound (US) visualisation of the related anatomic part and the needle itself may improve the success of the procedure and lower the complication rates [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Developments in high-frequency ultrasound transducer technology have enabled the precise investigation of several anatomical structures on small areas (nerves, vessels small band-shape fascicular structures) [15,26,27]. Ultrasonographic visualisation of the suprascapular nerve may also increase the success rate of blockage [23,24]. The use of ultrasound (US) to perform peripheral nerve blocks is a relatively new technique that is rapidly gaining popularity over the more traditional techniques.…”

Section: Discussionmentioning

confidence: 99%

Morphological Aspects in Ultrasound Visualisation of the Suprascapular Notch Region: A Study Based on a New Four-Step Protocol

Jezierski¹,

Podgórski

Wysiadecki

et al. 2018

JCM

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Background: Sonographic evaluation of the suprascapular notch (SSN) region is clinically important, because it is the most common location for performing suprascapular nerve block. The aim of the study was to describe the morphology of the SSN region based on ultrasound examination and in accordance with the patients’ body mass index (BMI). Material and Methods: The SSN region was sonographically examined in 120 healthy volunteers according to our new four-step protocol. The morphometry of the SSN and the neurovascular bundle was assessed, and patients’ BMI were calculated. The shape of the suprascapular notch was classified based on its superior transverse diameter (STD) and maximal depth (MD). Result: The type III scapular notch was the most prevalent (64%). The BMI was higher in type IV/V (27.38 ± 3.76) than in type I (24.77 ± 3.49). However, no significant differences were observed in the distribution of SSN notch types with regard to BMI (p = 0.0536). The suprascapular artery was visualised in all of the recognised SSNs, while the suprascapular vein and nerve were visualised only in 74.9% and 48.1% of the SSNs, respectively. The suprascapular nerve was significantly thicker on the right side (3.5 ± 1.1 mm) than on the left (1.3 ± 0.4 mm) (p = 0.001). In contrast, the suprascapular vein (1.5 ± 0.9 mm) was found to be a significantly wider on the left side than the right (1.2 ± 0.7 mm) (p = 0.001). Conclusion: Our original four-step sonographic protocol enabled characterising the morphology of the SSN region, despite the SSN notch types. The suprascapular artery is the best sonographic landmark for the suprascapular notch region. No significant differences were found between sides regarding the thickness of the soft tissue above the suprascapular nerve and vessels. Recognition of the SSN morphology is not affected by the BMI.

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“…Appropriate ultrasonographic visualization of the suprascapular notch and the suprascapular neurovascular bundle is necessary during suprascapular nerve block (SsNB). The first reports of SsNB were made by Wertheim and Rovenstine [ 20 ] in 1941 and by Milowsky and Rovenstine [ 21 ] in 1949. This procedure has since been widely used by anaesthetists in situations ranging from adhesive capsulitis to pain after shoulder arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Suprascapular Notch Shape on the Visualization of Structures in the Suprascapular Notch Region: Studies Based on a New Four-Stage Ultrasonographic Protocol

Jezierski¹,

Podgórski

Stefańczyk

et al. 2017

BioMed Research International

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Evaluation of the morphology of the suprascapular notch region is important from a clinical point of view because it is the most common site of suprascapular nerve compression and injury. A group of 120 patients underwent ultrasound examination of the suprascapular notch region according to our original four-stage “step-by-step” protocol. The notches were classified based on their morphology and measurements like maximal depth (MD) and superior transverse diameter (STD) as follows: type I-MD is longer than STD, type II-MD and STD are equal, type III-STD is longer than MD, and in type IV/V-notches only the bony margin was visualized without depression. Both suprascapular notches were fully visualized in 115 of 120 patients. The type III suprascapular notch was the most prevalent (64.2%), followed by type IV/V (18.7%), type I (11.1%), and type II (6.0%). Color Doppler analysis allowed the suprascapular artery to be recognized in all visualized notches. The suprascapular vein was visible in 176 notches and the suprascapular nerve in 150. Notches containing both suprascapular nerve and vein were significantly wider and shallower than average. As the suprascapular artery is the most easily recognised structure in the area, it may serve as a useful landmark of the suprascapular notch.

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Suprascapular Nerve Block: Evaluation in the Therapy of Shoulder Pain

Cited by 10 publications

References 0 publications

A Comparison of the Procedural Sedation and Analgesia (Psa) and Ultrasound-Guided Suprascapular Nerve Block Techniques in Shoulder Reduction

A Comparison of the Procedural Sedation and Analgesia (Psa) and Ultrasound-Guided Suprascapular Nerve Block Techniques in Shoulder Reduction

Morphological Aspects in Ultrasound Visualisation of the Suprascapular Notch Region: A Study Based on a New Four-Step Protocol

The Influence of Suprascapular Notch Shape on the Visualization of Structures in the Suprascapular Notch Region: Studies Based on a New Four-Stage Ultrasonographic Protocol

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