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Proximal vs Distal Approach of Ultrasound-guided Suprascapular Nerve Block for Patients With Adhesive Capsulitis of the Shoulder: Prospective Randomized Controlled Trial

Published:December 01, 2020DOI:https://doi.org/10.1016/j.apmr.2020.11.003

      Abstract

      Objectives

      To evaluate the early clinical outcomes of ultrasound (US)-guided suprascapular nerve block (SSNB) using a proximal approach compared with a distal approach for outpatient treatment of adhesive capsulitis.

      Design

      Randomized controlled trial.

      Setting

      Outpatient clinic

      Participants

      Participants (N=47) with symptomatic adhesive capsulitis.

      Interventions

      Participants were randomly assigned to either US-guided SSNB using a proximal approach (n=23, proximal group) or a distal approach (n=24, distal group).

      Main Outcome Measures

      The primary outcome measure was the visual analog scale (VAS) for pain at week 12. Secondary outcomes included the American Shoulder Elbow Surgeon’s (ASES) score, University California Los Angeles score, Short Form-36 mental and physical component summaries, and range of motion. All patients completed clinical follow-up at 2, 6, and 12 weeks after treatment. On US images, depth and insertion angle of needle during injection were measured.

      Results

      The VAS significantly improved in both groups at week 12. After treatment, no significant differences were found in early clinical outcomes (weeks 2, 6, and 12) between groups (all P>.05), except that ASES at 2 weeks showed a significantly higher score in the distal group than in the proximal group (87.1±4.8 and 83.0±6.3, respectively; P=.014). The mean depth and insertion angle of needle was significantly lower (depth: 13.4±3.9 and 30.6±4.3 mm, respectively; P<.001; insertion angle: 19.6°±6.4° and 38.7°±5.8°; P<.001) in the proximal group than in the distal group.

      Conclusions

      This study demonstrated that proximal approach of US-guided SSNB provided favorable short-term outcomes of pain and functional improvement and that outcomes were comparable to those of the distal approach in adhesive capsulitis. The suprascapular nerve was located more superficially and easily identified in the proximal approach, suggesting that this method might improve the accuracy of injection.

      Keywords

      List of abbreviations:

      ASES (American Shoulder Elbow Surgeon’s score), MCID (minimal clinically important difference), SF36-MCS (Short Form-36 mental component summary), SF36- PCS (Short Form-36 physical component summary), SSN (suprascapular nerve), SSNB (suprascapular nerve block), UCLA (University of California Los Angeles score), US (ultrasound), VAS (visual analog scale)
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