Role of suprascapular nerve block in idiopathic frozen shoulder treatment: a clinical trial survey

Abstract

Background: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy.

Methods: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention.

Results: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001).

Conclusions: Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

Keywords: Frozen shoulder; Nerve block; Should; Surgery; Shoulder adhesive capsulitis.

Fig. 1.

Intra-articular corticosteroid injection.

Fig. 2.

Suprascapular nerve block method. (A) Injection site. (B) Identify the suprascapular nerve with an ultrasound probe. (C) Perform the injection under an ultrasound guide. SpsM: supraspinatus muscle, SpsA: suprascapular artery, SpsN: suprascapular nerve.

Fig. 3.

Flowchart. PT: physiotherapy, IACI: intra-articular corticosteroid injections, SSNB: suprascapular nerve block.

Fig. 4.

Distribution of different degrees of range of motion (ROM) in patients in the three study groups divided by measurement times. (A) External rotation. (B) Internal rotation. (C) Flexion. (D) Abduction. PT: physiotherapy, IACI: intra-articular corticosteroid injections, SSNB: suprascapular nerve block.

Fig. 5.

Distribution of different degrees of shoulder pain and disability index (SPADI) in patients of the three groups divided by the time measurement. PT: physiotherapy, IACI: intra-articular corticosteroid injections, SSNB: suprascapular nerve block.

Fig. 6.

Distribution of different degrees of visual analog scale (VAS) score in patients of the three groups divided by measurement times. PT: physiotherapy, IACI: intra-articular corticosteroid injections, SSNB: suprascapular nerve block.