Suprascapular nerve block in chronic shoulder pain: are the radiologists better?
BACKGROUND
Suprascapular nerve block is a safe and effective treatment for chronic shoulder pain in arthritis, which can be performed either by direct imaging (CT guided) or in the clinic using anatomical landmarks to determine needle placement.


OBJECTIVE
To compare a CT guided versus an anatomical landmark approach in a randomised, single blind trial examining the efficacy of suprascapular nerve block for shoulder pain in patients with degenerative joint/rotator cuff disease.


METHODS
67 patients with chronic shoulder pain from degenerative disease participated in the trial. 77 shoulders were randomised. The group randomised to receive the block through the anatomical landmark approach received a single suprascapular nerve block. Those in the CT guided group received an injection of methylprednisolone acetate and a smaller volume of bupivacaine around the suprascapular nerve. The patients were followed up for 12 weeks by a "blinded" observer and reviewed at weeks 1, 4, and 12 after the injection.


RESULTS
Significant improvements were seen in all pain scores and disability in the shoulders receiving both types of nerve block, with no significant differences in the improvement in pain and disability between the two approaches at any time. Improvements in pain and disability scores were clinically and statistically significant. No significant adverse effects occurred in either group. Patient satisfaction scores for pain relief using either approach were high.


CONCLUSIONS
The CT guided control and landmark approaches to performing suprascapular nerve blocks result in similar significant and prolonged pain and disability reductions; both approaches are safe.
Shanahan
E M
EM
Rheumatology Research Unit, Repatriation General Hospital, Daw Park, South Australia, Australia 5041. michael.shanahan@rgh.sa.gov.au
Smith
M D
MD
Wetherall
M
M
Lott
C W
CW
Slavotinek
J
J
FitzGerald
O
O
Ahern
M J
MJ
D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D020069:Shoulder Pain / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone; D002045:Bupivacaine