Suprascapular nerve block for improving pain and function in patients with musculoskeletal shoulder pain – a critically appraised topic

Abstract

Relevance: This report highlights the key themes of evidence based practice and service change. Injection therapy has been a modality within the scope of UK Physical Therapy practice for the past 20 years and its prevalence may be set to expand with the introduction of prescribing rights for UK Physical Therapists. Suprascapular Nerve Blocks (SSNB) have been used for many years to treat refractory shoulder pain. The evidence outlined below would suggest that there is value in adopting this technique into routine physiotherapy practice.Purpose: Shoulder pathologies such as arthritis, or capsulitis can be difficult to treat, with some patients having high pain and disability scores. The effectiveness of SSNB's for patients with common musculoskeletal causes of shoulder pain has been poorly understood in the published literature, and uncertainty regarding the effectiveness of this intervention has led to this technique being rarely used in Orthopaedic or Musculoskeletal settings.Methods/analysis: A critically appraised topic was used to find and appraise the most relevant and rigorous literature within a time scale appropriate to clinical practice.53 studies initially reviewed. 11 studies potentially relevant. Two studies answered the PICO topic and included in the final analysis.Results: One large multicentre RCT (n = 108) found significant decreases in pain with SSNB in patients with shoulder pain >3 months. Mean VAS improvements between 13 and 22 on a 100 point VAS scale and consistently better than placebo (P < 0.05). The benefits were still noticeable at 12 weeks. A modest but significant improvement in disability was also noted with SSNB compared to placebo injection (P < 0.01).A systematic review into interventions for adhesive capsulitis also identified three studies of relevance. One trial compared Bupivacaine SSNB with placebo SSNB (n = 34). They observed a 62% overall reduction in pain with SSNB compared to 13% in the placebo group (P = 0.03). Another high quality RCT compared a single SSNB with a series of intra-articular corticosteroid injections (n = 30) and demonstrated significantly better pain relief (P = 0.001) and ROM (P = <0.05) at 12 weeks. A low quality study also favoured SSNB for pain relief and ROM 30 minutes post treatment when compared to acupuncture (n = 100).