Efficacy of suprascapular nerve blocks for management of hemiplegic shoulder pain: a systematic review and meta-analysis

Abstract

Objective: To compare the efficacy of suprascapular nerve block (SSNB) with other treatment modalities for management of HSP in terms of relieving pain and improving range of motion of shoulder joints.

Materials and methods: An electronic search was carried out in PubMed, CENTRAL, SCOPUS and EMBASE databases using a series of relevant keywords, along with a manual search. Randomized clinical trials comparing the efficacy of SSNB with placebo injections, intra-articular injections (IAI), ultrasound and Pulsed RF were identified. The outcomes assessed were pain relief measured with visual analogue scale and improvement in the range of motion (ROM) at the end of the follow-up period. The meta-analysis was carried out for quantitative analysis of outcome data.

Results: Eight randomized clinical trials were included. The quality of the included trials was low to moderate. SSNB showed improved pain relief at the end of 1 month, compared to placebo (normal saline injections) with mean difference (MD) 1.20 95% CI [0.59,1.80], p<0.0001. When compared to Pulsed radio-frequency (RF), the pain relief at the end of 1 month and 3 months was greater for patients treated with Pulsed RF than SSNB. No significant improvement in the range of motion for flexion, external and internal rotation was observed between SSNB and inter-articular injections.

Conclusions: SSNB is more effective in pain relief than placebo injections and ultrasound, but similar to pulsed RF. Similar effectiveness in ROM improvement was observed with SSNB and intra-articular injections.