Pain relief in early rehabilitation of rotator cuff tendinitis: any role for indirect suprascapular nerve block?
OBJECTIVE
The purpose of the trial was to evaluate the efficacy of suprascapular nerve block (SSNB) to relieve the shoulder pain, ameliorate recovery after physiotherapy and reduce disability due to a rotator cuff tendinitis (RCT). A prospective, randomized, comparison cross over investigation was performed in the setting of a large inpatient rehabilitation unit with more than 200 admissions annually.


METHODS
A total of 40 potential study subjects, who complained of shoulder pain from a RCT, were enrolled and randomly assigned to standard rehabilitation treatment plus SSNB (Group A) or to standard rehabilitation treatment alone (Group B). The UCLA shoulder rating scale was used to assess the shoulder mobility on admission and discharge, and to calculate the percentage of potential improvement achieved during rehabilitation (effectiveness). A pain visual analogic scale was used to serially assess pain. At the end of the trial, a self-report questionnaire evaluated whether patients could sleep and achieve activity of day life carry out everyday activities better than they could before treatment.


RESULTS
Forty patients suffering from RCT entered the study. Those receiving nerve block from the beginning of the treatment in addition to standard rehabilitation therapy reported significantly less pain during physiotherapy and better final outcomes. During treatment with SSNBs, patients reported a more significant reduction in the intensity of pain and a better reduction of pain during sleep and rehabilitation exercises in comparison to with the standard therapy alone. A statistically significant inverse correlation was found between shoulder pain and mobility.


CONCLUSIONS
The results indicate that combining nerve block with standard rehabilitative therapy may improve the final outcome of painful RCT. It decreased the severity and frequency of the perceived pain, improved the compliance with physiotherapy, restored more normal sleep patterns, and increased compliance with the rehabilitation program. This result proves to be an effective, safe and inexpensive therapeutic option for patients suffering from painful disabling shoulder tendinitis.
Di Lorenzo
L
L
Rehabilitation Unit, G. Rummo Hospital, Level II DEA, Via Dell'Angeli 1, Benevento, Italy. luigidelorenzo2005@libero.it
Pappagallo
M
M
Gimigliano
R
R
Palmieri
E
E
Saviano
E
E
Bello
A
A
Forte
A
A
DeBlasio
E
E
Trombetti
C
C
D016009:Chi-Square Distribution; D018592:Cross-Over Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020069:Shoulder Pain / Q000534:rehabilitation*; D052256:Tendinopathy / Q000503:physiopathology / Q000534:rehabilitation*; D016896:Treatment Outcome