Relief of chronic shoulder pain: a comparative study of three approaches

Abstract

Background: Shoulder pain is one of the most common complaints in pain clinics and rheumatology departments, usually originates from trauma, degeneration, inflammation, vascular disease and also be referred from the hand and neck pain or headache.

Objectives: The aim of this study was to compare the effectiveness of continuous suprascapular nerve block under ultrasound guidance versus intra-articular corticosteroid injection of the shoulder and/or physiotherapy in management of chronic shoulder pain and to assess the effectiveness of these methods for relieving pain, improve range of movement of the shoulder and to demonstrate the most suitable method for treatment of such patients.

Subjects & methods: 50 patients with a total of 63 shoulders were randomly divided into Group 1 (23 shoulders) received continuous suprascapular nerve block under ultrasound guidance in addition to rehabilitation program. Group II (20 shoulders) received intra-articular injection of steroid in addition to rehabilitation program. Group III (20 shoulders) received rehabilitation program only. The patients were followed up for 12 weeks and reviewed for Pain, disability, and range of movement data at weeks 1, 4, and 12 after each treatment.

Results: The result of our study demonstrates that, from the first week to 12 weeks, there was marked improvement in pain score in all times of follow up, and the best improvement in group I versus group II or III. The disability score showed improvement of non significant difference over the three time periods. Highly significant mean changes were found in group I versus group II & III (p = 0.001) as regard SPADI pain, disability, total SPADI score and active movements. After 12 weeks of follow up, RA patients reported significant differences between 3 approaches of treatment (SSNB was the most effective one) as regard SPADI pain and total SPADI scores but frozen shoulder patients showed significant difference between three groups as regard SPADI pain only.

Conclusion: Combination of physical treatment with Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in frozen and arthritis. It improves pain, disability, and range of movement of the shoulders compared with intra-articular corticosteroid injection of the shoulder and/or physiotherapy alone. SSNB is a useful adjunct treatment for management of chronic shoulder pain. Direct ultrasound visualization significantly improve outcome.