Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain

Abstract

Background: Shoulder pain from inflammatory arthritis and/or degenerative disease is a common cause of morbidity in the community. It is difficult to treat and there are limited data on the efficacy of most interventions. Suprascapular nerve block has shown promise in limited trials in reducing shoulder pain. There have been no large randomised placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain in arthritis and/or degenerative disease using pain and disability end points. Objective: To perform a randomised, double blind, placebo controlled trial of the efficacy of suprascapular nerve block for shoulder pain in rheumatoid arthritis (RA) and/or degenerative disease of the shoulder. Methods: 83 people with chronic shoulder pain from degenerative disease or RA took part in the trial. If a person had two painful shoulders, these were randomised separately. A total of 108 shoulders were randomised. Patients in the group receiving active treatment had a single suprascapular nerve block following the protocol described by Dangoisse et al, while those in the other group received a placebo injection of normal saline administered subcutaneously. The patients were followed up for 12 weeks by an observer who was unaware of the randomisation and reviewed at weeks 1, 4, and 12 after the injection. Pain, disability, and range of movement data were gathered. Results: Clinically and statistically significant improvements in all pain scores, all disability scores, and some range of movement scores in the shoulders receiving suprascapular nerve block compared with those receiving placebo were seen at weeks 1, 4, and 12. There were no significant adverse effects in either group. Conclusion: Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in degenerative disease and/or arthritis. It improves pain, disability, and range of movement at the shoulder compared with placebo. It is a useful adjunct treatment for the practising clinician to assist in the management of a difficult and common clinical problem.

Comparative study of ultrasound guided supra-scapular nerve block versus intra-articular steroid injection in frozen shoulder

“…8,9 Carette et al and Siraj, et al had similar results for intra-articular steroid. 10,11 In our study it was clearly seen that there is definite efficacy of both, supra-scapular nerve block and intraarticular shoulder steroid injection, in treatment of frozen shoulder.…”

Suprascapular Nerve Block versus Steroid Injection for Non-Specific Shoulder Pain

“…There are comparatively fewer studies of SSNB than SI. It has been studied in glenohumeral arthritis (Brown et al 1988), frozen shoulder (Karatas and Meray 2002), rheumatoid arthritis and osteoarthritis (Gado and Emery 1993;Shanahan et al 2003), hemiplegic shoulder (Lee and Khunadorn 1986), rotator cuff lesions (Vecchio et al 1993) and found to be effective in these clinical pictures. Up to our knowledge, we are the first comparing the effects of these two interventions in non-specific shoulder pain.…”

Bloqueio do nervo supraescapular: procedimento importante na prática clínica. Parte II

“…4 It is also an effi cient alternative for patients who cannot undergo surgery. 8 A relative indication would be for patients with advancedstage shoulder tumors, with a level of pain diffi cult to treat and who would benefi t from interventional techniques, among which are SSNB, as it seems very effective and with low rates of adverse effects. In this case, the method works as palliative care, as it treats the symptoms without necessarily having an effect on the cause.…”

“…[2][3][4] The procedure has been increasingly used in severe pain control and postoperative analgesia after shoulder surgery, [4][5][6][7] as other therapeutic options such as anti-infl ammatory drugs and intra-articular steroid injections have their limitations, mainly in the elderly population, which has many comorbidities. 4,8 The SSNB is a safe, simple, inexpensive procedure, applicable to the majority of physicians working with pain management, 9 in addition to being well tolerated even by patients with several pathologies that affect the shoulder region. 4 It is also an effi cient alternative for patients who cannot undergo surgery.…”