Comparative study of ultrasound guided supra-scapular nerve block versus intra-articular steroid injection in frozen shoulder


  • Swapnil P. Sonune Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, Maharashtra, India
  • Anil K. Gaur Department of Physical Medicine and Rehabilitation, All India Institute of Physical Medicine and Rehabilitation, Mumbai, Maharashtra, India
  • Shefali Gupta Department of Radiodiagnosis, All India Institute of Physical Medicine and Rehabilitation, Mumbai, Maharashtra, India



Supra-scapular nerve block, Adhesive capsulitis, Periarthritis shoulder, Shoulder pain


Background: Frozen shoulder is one of the most common musculoskeletal problems seen in orthopaedics. Many treatment modes are available however, it is difficult to treat and data on the comparative efficacy of various interventions are limited. Intra-articular corticosteroid injection (IASI) is a commonly used to treat frozen shoulder pain. Supra-scapular nerve block (SSNB) is also effective method to treat pain in chronic diseases that affect the shoulder. The present study was done to compare efficacy of ultrasound guided SSNB and IASI in management of painful frozen shoulder.

Methods: 60 patients with painful frozen shoulder were divided in two groups, Group A received ultra-sound guided SSNB with 6 ml 0.5% Bupivacaine; Group B received IASI using 40 mg Triamcinolone. Outcome measures were shoulder ranges mainly lateral rotation and abduction, shoulder pain and disability index and visual analogue scale (VAS). Patients were followed-up on 2nd day, at 1st, 3rd and 6th week.

Results: All baseline parameters improved significantly in both groups; however, on comparison Group A showed significant improvement in passive lateral rotation on 2nd day and 1st week follow up (P =0.038 and 0.040 respectively). VAS score showed significance at all follow-up in Group A, whereas, in Group B significance was seen after 1 week. On inter group comparison Group A shows significance on 2nd day (P =0.050), 1st week (P =0.042) and 3rd week (P =0.036).

Conclusions:Both SSNB and IASI have efficacy in management of frozen shoulder. But supra-scapular nerve block is better than intra-articular injection and should be considered prior to steroid as it has early onset pain relief, early improvement in ranges, potentially lesser contraindications and side effects.



Hsu JE, Anakwenze OA, Warrenderb WJ, Abboud J. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20:502-14.

Mao CY, Jaw WC, Cheng HC. Frozen shoulder: Correlation between the response to Physical therapy and follow up shoulder arthrography. Arch Phys Med Rehabil. 1997;78:857-9.

Robert CM. Clinical commentary and literature review: diagnosis, conservative and surgical management of adhesive capsulitis. Shoulder and Elbow. 2010;2:238–54.

Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res. 2000;(372):95-109.

Milgrom C, Novack V, Weil Y, Jaber S, Radeva-Petrova DR, Finestone A. Risk factors for idiopathic frozen shoulder. Isr Med Assoc J. 2008;10(5):361-4.

Jones DS, Chattopadhyay C. Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial. Br J Gen Pract. 1999;49(438):39-41.

Taskaynatan MA, Yilmaz B, Ozgul A, Yazicioglu K, Kalyon TA. Suprascapular nerve block versus steroid injection for non-specific shoulder pain. Tohoku J Exp Med. 2005;205(1):19-25.

Iqbal MJ, Anwar W, Rahman N, Kashif S, Khan A. Suprascapular Nerve Block in the Treatment of Frozen Shoulder. J Surg Pakistan (In). 2012;17:1.

Shanahan E, Ahern M, Smith M, Wetherall M, Bresnihan B, FitzGerald O. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis. 2003;62(5):400–6.

Carette S, Moffet H, Tardif J, Bessette L, Morin F, Frémont P, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: A placebo‐controlled trial. Arthritis Rheum. 2003;48(3):829-38.

Siraj Md, Anwar W, Iqbal MJ, Rahman N, Kashif S, Khan A, et al. Effectiveness of Intra-articular Corticosteroid Injection in the Treatment of Idiopathic Frozen Shoulder. J Surg Pakistan (In). 2012;17:2.

Chin-wern C, Peng PWH. Suprascapular nerve block: a narrative review. Reg Anesth Pain Med. 2011;36(4):358-73.

Blanchard V, Barr S, Cerisola FL. The effectiveness of corticosteroid injections compared with physiotherapeutic interventions for adhesive capsulitis: a systematic review. Physiotherapy. 2010;96:95-107.

Song A, Higgins LD, Newman J, Jain NB. Glenohumeral Corticosteroid Injections in Adhesive Capsulitis: A Systematic Search and Review. PM R. 2014;6(12):1143-56.






Original Research Articles