The role of suprascapular nerve block in hydrodilatation for frozen shoulder

Abstract

Introduction: Frozen shoulder is a debilitating problem that requires comprehensive diagnosis and management. Patients usually recover, but the possibility of not reobtaining a full range of motion exists. Thus, early shoulder exercises are necessary to achieve their full range of motion. This study aims to understand the effects of suprascapular nerve block (SSNB) augmentation at the spinoglenoid notch in hydrodilatation to treat frozen shoulder to facilitate early shoulder exercises.

Methods: The current study retrospectively observed 31 patients, including 40-60-year-old patients diagnosed and treated with primary frozen shoulder. The participants were divided into groups A (hydrodilatation) and B (hydrodilatation and the augmentation of an SSNB). Shoulder function and pain scores were assessed before, during, and after the intervention (at months 1 and 6).

Results: The result of this study shows that suprascapular nerve block plays a role in decreasing pain in intraintervention (0.69 vs. 5.73; p < 0.05), month 1 of follow-up (3.44 vs. 6.40; p < 0.05), but not significant on month 6 of group A and B after intervention (5.88 vs. 7.20; p > 0.05). Better delta functional scores were noted in the therapy group during month 1 of the follow-up (delta American shoulder and elbow surgeons [ASES]: 19.29 vs. 34.40, p < 0.05; delta disabilities of the arm, shoulder, and hand [DASH]: 17.88 vs. 38.15, p < 0.05). The difference in functional score on month 6 between both groups was not significantly different (delta ASES: 31.97 vs. 30.31, p > 0.05; delta DASH: 36.63 vs. 38.92, p > 0.05).

Discussion: One rationale for using an SSNB augmentation at spinoglenoid notch in hydrodilatation for treating frozen shoulder was to obtain pain relief immediately to facilitate early manual exercise. SSNB has positive effects on short-term evaluation of shoulder pain and function after glenohumeral hydrodilatation, but not in the long term.

Keywords: Corticosteroid; Frozen shoulder; Hydrodilatation; Spinoglenoid notch; Suprascapular nerve block.

Figure 1

The suprascapular nerve at the supraglenoid notch using USG. The operator stands behind the patient, parallel to the ultrasound monitor, to achieve an ergonomic position. The ultrasound monitor is placed in front of the patient. The patient is in a lateral decubitus position, with the affected palm against the nonaffected shoulder and padding to protect the prominent area of the body. A sterile technique was used to prepare and clean the affected shoulder. The injection site for the suprascapular nerve block at the spinoglenoid notch is 2 cm below the spine scapula (A). An echogenic 23-G (3.5 in) spinal needle is inserted from medial to lateral (B). Injection (20 mg triamcinolone acetonide, 4 mL 2% lidocaine, and 4 mL 0.5% bupivacaine as a cocktail) was given and waited for 1–2 min.

Figure 2

Identification and glenohumeral hydrodilatation on frozen shoulder. A posterior approach for glenohumeral joint injection created an anatomical landmark approximately 1–2 cm below the posterolateral acromion and shifted to the medial, short-axis probe position (A). Echogenic needle insertion in-plane position from the lateral to the medial, penetrating the infraspinatus muscle and posterior capsule, injecting the steroid (40 mg triamcinolone acetonide) as 15–20 mL aquabidest (B).

Figure 3

Research sampling flow. This study retrospectively observed and followed 31 patients. The samples were divided into two groups in the study. Group A received hydrodilatation with saline and corticosteroid injection without suprascapular nerve block augmentation at the spinoglenoid notch. Group B received hydrodilatation with saline, corticosteroid injection, and suprascapular nerve block augmentation at the spinoglenoid aperture. Groups A and B consisted of 16 and 15 patients, respectively.