Ultrasound-Guided Block of the Suprascapular Nerve in Breast Cancer Survivors with Limited Shoulder Motion – Case Series

Abstract

Background: Suprascapular nerve block is performed in the management of chronic shoulder pain and frozen shoulder. Objective: To investigate the effects of ultrasound-guided suprascapular nerve block in restoration of shoulder motion in breast cancer survivors. Study Design: A cohort study. Setting: A training and research hospital, outpatient setting. Methods: A total of 18 breast cancer survivors with limited shoulder motion, pain, and difficulty in positioning the upper extremity for radiation treatment following surgery were enrolled in this study. Ultrasound-guided suprascapular nerve blocks were performed while the patients were seated in a chair without a backrest. After visualization of the suprascapular nerve under the transverse suprascapular ligament, 20 mg of triamcinolone and 4 mL of 0.5% bupivacaine were injected. Shoulder range of motion, pain, disability, and upper extremity circumference measurements were assessed in all participants before and 10 days after the block. Results: A significant decrease was observed in severity of pain and disability 10 days after the block. The ranges of shoulder abduction, flexion, and external rotation were improved significantly. All patients were able to receive radiation therapy without delay. Limitations: Absence of a control group and absence of randomization reduces the strength of our findings. Small sample size and absence of long-term follow-up are other limitations of this study. Conclusions: This is the first study investigating the effect of ultrasound-guided suprascapular block on shoulder limitation in breast cancer survivors. The results demonstrate that it may be a promising treatment approach for rapid recovery of shoulder motion in women with breast cancer before radiation treatment. Key words: Breast cancer, upper extremity, shoulder pain, range of motion, disability, ultrasound, injection, triamcinolone, local anesthetics

Intercostobrachial neuralgia—a case of bizzare diagnosis?

“…The physical exam showed some signs of axillary cording with physical palpation of the axilla. The neural tissue was adhered to the subcutaneous tissue of the axilla and presented with mild symptoms of active shoulder flexion and abduction [16]. The cervical segmental testing showed extension, left side bending restriction in C0-C1, and open dysfunction of C1-C2.…”

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain

“…We included 53 studies from 14 different countries in this review (Table 1). Of which, 13 studies came from Turkey, [26][27][28][29][30][31][32][33][34][35][36][37][38] 7 each from Australia 20,23,39,38,39,[40][41][42][43] and India, [44][45][46][47][48][49][50] 6 from the United Kingdom, [51][52][53][54][55][56] 4 each from the United States [57][58][59][60] and South Korea, [61][62][63][64] 2 each from Brazil, 65,66 Canada, 67,68 Egypt 69,70 and Italy, 7...…”

“…Local anaesthetic was used in all 53 studies. Local anaesthetics were used alone in 20 studies, 27,29,[58][59][60]62,63,67,68,70,74,76,30,33,37,38,46,49,54,57 used with steroid in 29 studies 20,23,26,28,32,[34][35][36][39][40][41][42][43][44][45]47,48,[50][51][52][53]55,56,64,66,69,71,73,75 and used with a combination of steroid and…”

“…Bupivacaine was the most common local anaesthetic used at various concentrations and volumes in 30 studies. 20,31,46,47,[49][50][51][52][53]55,58,59,33,60,[64][65][66][68][69][70][71]73,75,34,[39][40][41][42][43][44] Of which, 24 studies reported using 0.5% bupivaca ine 20,31,46,49,[51][52][53]55,64,65,68,69,33,70,71,73,75,34,[39][40][41][42]…”

“…53 Triamcinolone was used in seven studies. 26,34,36,48,55,64,66 Of which, 40 mg was used in four studies 26,36,48,66 and 20 mg in three studies. 34,55,64 Betamethasone at a volume of 1 mL was used in four studies.…”