Role of ultrasound guided suprascapular nerve block aided mobilization physiotherapy in frozen shoulder recovery: a prospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20240422Keywords:
Frozen shoulder, Adhesive capsulitis, Suprascapular nerve block, Physiotherapy, Shoulder pain and disability indexAbstract
Background: Frozen shoulder is debilitating condition marked by progressive shoulder pain and restricted mobility, affecting sleep and activities of daily living of a person. The objective of this study was to evaluate the efficacy of USG guided suprascapular nerve block aided mobilization physiotherapy for management of frozen shoulder so as to improve the quality of living of patients.
Methods: This prospective interventional study was conducted at the Department of Orthopaedics of a teaching institute of Central India from January 2021 to April 2023 after obtaining ethical clearance. Patients diagnosed with frozen shoulder and giving written consent were included in this study after considering the inclusion and exclusion criteria. Baseline demographics, symptom duration, degree of active and passive shoulder range of movement, Shoulder pain and disability index (SPADI) score were documented on day of presentation (preintervention) after which USG guided suprascapular nerve block was given. Post SSNB, 10 sessions of supervised mobilization physiotherapy was given. SPADI scores and degree of active and passive range of movement were noted at 3rd, 6th and 12th week and compared using statistical tests namely repeated measure ANOVA and chi square test of independence.
Results: A total of 54 patients enrolled in the study after meeting inclusion criteria, only 46 completed the follow up and their mean SPADI pain score and mean SPADI disability score at presentation significantly reduced at 12 weeks post intervention. Range of flexion, abduction and external rotation of shoulder also showed significant increase (p value<0.05). Number of participants with severe restriction of shoulder internal rotation also decreased after SSNB aided physiotherapy.
Conclusions: USG guided suprascapular nerve block aided physiotherapy exercise schedule is a safe and effective outpatient treatment for frozen shoulder providing early pain relief and improving shoulder mobility.
References
Georgiannos D, Markopoulos G, Devetzi E, Bisbinas I. Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review. Open Orthop J. 2017;11:65-76.
Kılıç Z, Filiz MB, Çakır T, Toraman NF. AB0879 Effects of Suprascapular Nerve Blockage on Pain and Functional Status in Adhesive Capsulitis: A Prospective Controlled Trial. Ann Rheum Dis. 2014;73(2):1092.
Pandey V, Madi S. Clinical Guidelines in the Management of Frozen Shoulder: An Update! Indian J Orthop. 2021;55(2):299-309.
Fields BKK, Skalski MR, Patel DB, White EA, Tomasian A, Gross JS, et al. Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol. 2019;48(8):1171-84.
Ozkan K, Ozcekic AN, Sarar S, Cift H, Ozkan FU, Unay K. Suprascapular nerve block for the treatment of frozen shoulder. Saudi J Anaesth. 2012;6(1):52-5.
Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20(3):502-14.
Abodonya AM, Alrawaili SM, Abdelbasset WK. Evaluation of shoulder pain, disability, mobility, and quality of life in patients with adhesive capsulitis following suprascapular nerve block combined with low-intensity laser therapy. Eur Rev Med Pharmacol Sci. 2023;27(3):845-51.
Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231-6.
Cho CH, Bae KC, Kim DH. Treatment Strategy for Frozen Shoulder. Clin Orthop Surg. 2019;11(3):249-57.
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.
Dahan TH, Fortin L, Pelletier M, Petit M, Vadeboncoeur R, Suissa S. Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol. 2000;27(6):1464-9.
Shanahan EM, 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.
Fernandes MR. Patient-reported measures of quality of life and functional capacity in adhesive capsulitis. Rev Assoc Med Bras (1992). 2017;63(4):347-54.
Verma DK, Neyaz O, Nanda S, Handa G. Comparison of outcome of ultrasound-guided suprascapular nerve block versus intra-articular steroid injection in adhesive capsulitis of shoulder: A randomized control trial. Indian J Rheumatol. 2019;14(2):113-8.
Mardani-Kivi M, Nabi BN, Mousavi MH, Shirangi A, Leili EK, Ghadim-Limudahi ZH. Role of suprascapular nerve block in idiopathic frozen shoulder treatment: a clinical trial survey. Clin Shoulder Elb. 2022;25(2):129-39.
Jadon A, Sanyal S, Pavan S, Bakshi A, Bharadwaj A, Singh AP. Suprascapular Nerve Block (SSNB) improves the outcome in exercise based management of Primary Adhesive Capsulitis (PAC): A prospective randomized comparative study. J Anaesthesiol Clin Pharmacol. 2023;39(2):195-200.
Robinson PM, Norris J, Roberts CP. Randomized controlled trial of supervised physiotherapy versus a home exercise program after hydrodilatation for the management of primary frozen shoulder. J Shoulder Elbow Surg. 2017;26(5):757-65.
Swami T, Singh AJ, Singh LN. Comparison of Ultrasound-guided Suprascapular Nerve Block and Extracorporeal Shock Wave Therapy in Reduction of Pain and Functional Disability in Adhesive Capsulitis of Shoulder: A Randomized Controlled Study. Indian J Phys Med Rehabil. 2019;30(2):29-33.
Gencer Atalay K, Kurt S, Kaplan E, Yağcı İ. Clinical effects of suprascapular nerve block in addition to intra-articular corticosteroid injection in the early stages of adhesive capsulitis: A singleblind, randomized controlled trial. Acta Orthop Traumatol Turc. 2021;55(6):459-65.
Agrawal A, Nayak B, Kumar M, Kowshik S. Management of periarthritis of shoulder joint by suprascapular nerve block. J Orthop Traumatol Rehabil. 2019;11(2):109.
Mortada MA, Ezzeldin N, Abbas SF, Ammar HA, Salama NA. Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients. J Back Musculoskelet Rehabil. 2017;30(3):537-42.
Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017;9(2):75-84.
Jain A, Nagar M, Jain S, Barasker SK. Suprascapular nerve block is faster and as effective as hydrodistension in relieving frozen shoulder-associated pain and disability: A prospective, single-blind observational study with a follow-up of 24 weeks. J Anaesthesiol Clin Pharmacol. 2023;39(1):45-50.