Abstract
Objective
To explore the effectiveness of suprascapular nerve block (SSNB) at different timing
after administration compared with physical therapy, placebo, and intra-articular
injections in patients with chronic shoulder pain.
Data Source
Two electronic data sources, PubMed and Scopus, were mainly searched from the earliest
record to September 2015.
Study Selection
Eleven randomized controlled trials that compared SSNB with physical therapy, placebo,
and intra-articular injections were included, comprising 591 patients.
Data Extraction
Patient demographics, regimens for SSNB and intra-articular injections, use of fluoroscopy
or ultrasound guidance, conjunction with physical therapy, methods of randomization,
and measurements of functional change and pain improvement were retrieved. The standardized
mean differences (SMDs) of pain relief and functional improvement were calculated
1, 4, and 12 weeks after intervention.
Data Synthesis
Regarding pain relief, SSNB provided better pain relief for 12 weeks compared with
physical therapy (SMD=.75; 95% confidence interval [CI], .35–1.14) and placebo injections
(SMD=.70; 95% CI, .40–1.00), but was not superior to intra-articular injections. Differences
in patient populations and use of pulsed radiofrequency did not cause a significant
variation in therapeutic efficacy, but guidance using ultrasound showed consistently
better effectiveness than guidance using surface landmarks and fluoroscopy.
Conclusions
This meta-analysis demonstrated the superiority of SSNB to placebo and physical therapy
and a similar efficacy of SSNB compared with intra-articular injection for treatment
of chronic shoulder pain. Ultrasound was the most preferable guidance tool, and future
studies are advised to integrate physical therapy in order to improve the long-term
effectiveness of SSNB.
Keywords
List of abbreviations:
CI (confidence interval), RCT (randomized controlled trial), SMD (standardized mean difference), SSNB (suprascapular nerve block)To read this article in full you will need to make a payment
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References
- Prevalence and comparative troublesomeness by age of musculoskeletal pain in different body locations.Fam Pract. 2007; 24: 308-316
- Intra-articular infiltration therapy for patients with glenohumeral osteoarthritis: a systematic review of the literature.Int J Shoulder Surg. 2014; 8: 114-121
- Corticosteroid injections for painful shoulder: a meta-analysis.Br J Gen Pract. 2005; 55: 224-228
- Manual therapy and exercise for adhesive capsulitis (frozen shoulder).Cochrane Database Syst Rev. 2014; 8: CD011275
- Nonsteroidal anti-inflammatory drugs versus corticosteroid for treatment of shoulder pain: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2014; 95: 1824-1831
- The sensory branch distribution of the suprascapular nerve: an anatomic study.J Shoulder Elbow Surg. 2008; 17: 500-502
- The role of sensitization in musculoskeletal shoulder pain.Braz J Phys Ther. 2015; 19: 251-257
- Suprascapular nerve block: important procedure in clinical practice.Rev Bras Anestesiol. 2012; 62: 96-104
- Comparative effectiveness of autologous blood-derived products, shock-wave therapy and corticosteroids for treatment of plantar fasciitis: a network meta-analysis.Rheumatology. 2015; 54: 1735-1743
- Early versus delayed passive range of motion exercise for arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials.Am J Sports Med. 2015; 43: 1265-1273
- Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis.Arch Phys Med Rehabil. 2014; 95: 562-575
- Effectiveness of bisphosphonate analogues and functional electrical stimulation on attenuating post-injury osteoporosis in spinal cord injury patients—a systematic review and meta-analysis.PLoS One. 2013; 8: e81124
- Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial.Clin Rehabil. 2011; 25: 60-68
- Suprascapular nerve block for shoulder pain in the first year after stroke: a randomized controlled trial.Stroke. 2013; 44: 3136-3141
- Preliminary study of suprascapular nerve block (SSNB) in hemiplegic shoulder pain.J Med Assoc Thai. 2009; 92: 1669-1674
- Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?.Anesth Analg. 1997; 84: 1306-1312
- Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block.Anesth Analg. 2004; 99 (table of contents): 589-592
- A randomized study of the effectiveness of suprascapular nerve block in patient satisfaction and outcome after arthroscopic subacromial decompression.Arthroscopy. 2011; 27: 1323-1328
- Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair.Open Access J Sports Med. 2014; 5: 129-136
- Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine and 0.9% saline.Anesth Analg. 2002; 94 (table of contents): 199-202
- Suprascapular nerve block or a piroxicam patch for shoulder tip pain after day case laparoscopic surgery.Eur J Anaesthesiol. 2003; 20: 234-238
- Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery.Eur J Cardiothorac Surg. 2011; 40: 106-112
- A comparison of suprascapular nerve block and procedural sedation analgesia in shoulder dislocation reduction.Am J Emerg Med. 2014; 32: 549-552
- Pulsed radiofrequency of suprascapular nerve for chronic shoulder pain: a randomized double-blind active placebo-controlled study.Pain Pract. 2013; 13: 96-103
- The effectiveness of ultrasonography-guided suprascapular nerve block for perishoulder pain.Orthopedics. 2010; 33: 238-241
- Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial.Br J Gen Pract. 1999; 49: 39-41
- Suprascapular nerve block versus steroid injection for non-specific shoulder pain.Tohoku J Exp Med. 2005; 205: 19-25
- Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder: a prospective, randomized, single-blinded study.Clin J Pain. 2010; 26: 386-392
- Relief of chronic shoulder pain: a comparative study of three approaches.Middle East J Anaesthesiol. 2011; 21: 83-92
- Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder.J Rheumatol. 2000; 27: 1464-1469
- Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain.Ann Rheum Dis. 2003; 62: 400-406
- Does suprascapular nerve block improve shoulder disability in impingement syndrome? A randomized placebo-controlled study.J Musculoskelet Pain. 2014; 22: 5
- Pain relief in early rehabilitation of rotator cuff tendinitis: any role for indirect suprascapular nerve block?.Eura Medicophys. 2006; 42: 195-204
- Pulsed radiofrequency versus conventional transcutaneous electrical nerve stimulation in painful shoulder: a prospective, randomized study.Clin Rehabil. 2010; 24: 1000-1008
- Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis: a prospective, randomized, controlled trial.Anesth Analg. 2014; 119: 686-692
- Addition of suprascapular nerve block to a physical therapy program produces an extra benefit to adhesive capsulitis: a randomized controlled trial.Am J Phys Med Rehabil. 2015; 94: 912-920
- Suprascapular nerve block: a narrative review.Reg Anesth Pain Med. 2011; 36: 358-373
Article info
Publication history
Published online: December 14, 2015
Footnotes
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
