Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain

• Published in: Annals of the rheumatic diseases Vol. 62; no. 5; pp. 400 - 406
• Main Authors: Shanahan, E M, Ahern, M, Smith, M, Wetherall, M, Bresnihan, B, FitzGerald, O
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.05.2003; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Anesthetics, Local - administration & dosage; Anti-Inflammatory Agents - administration & dosage; Arthritis, Rheumatoid - drug therapy; Biological and medical sciences; Bupivacaine - administration & dosage; Chronic Disease; Diseases of the osteoarticular system. Orthopedic treatment; Double-Blind Method; Drug Administration Routes; Drug Therapy, Combination; Extended Report; Female; Humans; Male; Medical sciences; Methylprednisolone - administration & dosage; Methylprednisolone - analogs & derivatives; Methylprednisolone Acetate; Middle Aged; Nerve Block - methods; non-steroidal anti-inflammatory drugs; NSAIDs; Pain management; Pain Measurement - methods; Patients; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Range of Motion, Articular - physiology; rheumatoid arthritis; SF-36; Short Form-36; Shoulder; shoulder pain; Shoulder Pain - drug therapy; shoulder pain and disability index; SPADI; Studies; suprascapular nerve block; Treatment Outcome; Diseases of the osteoarticular system; Inflammatory joint disease; Arthritis; Methylprednisolone; Route of administration; Suprascapular nerve; Bupivacaine; Shoulder; Clinical trial; Degenerative disease; Upper limb; Anilide; Human; Corticosteroid; Range of motion; Treatment efficiency; Instrumentation therapy; Inflammation; Injection; Analgesia; Chemotherapy; Treatment; Placebo; Arthropathy; Organic amide; Technique; Comparative study
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.62.5.400

Background: Shoulder pain from inflammatory arthritis and/or degenerative disease is a common cause of morbidity in the community. It is difficult to treat and there are limited data on the efficacy of most interventions. Suprascapular nerve block has shown promise in limited trials in reducing shoulder pain. There have been no large randomised placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain in arthritis and/or degenerative disease using pain and disability end points. Objective: To perform a randomised, double blind, placebo controlled trial of the efficacy of suprascapular nerve block for shoulder pain in rheumatoid arthritis (RA) and/or degenerative disease of the shoulder. Methods: 83 people with chronic shoulder pain from degenerative disease or RA took part in the trial. If a person had two painful shoulders, these were randomised separately. A total of 108 shoulders were randomised. Patients in the group receiving active treatment had a single suprascapular nerve block following the protocol described by Dangoisse et al, while those in the other group received a placebo injection of normal saline administered subcutaneously. The patients were followed up for 12 weeks by an observer who was unaware of the randomisation and reviewed at weeks 1, 4, and 12 after the injection. Pain, disability, and range of movement data were gathered. Results: Clinically and statistically significant improvements in all pain scores, all disability scores, and some range of movement scores in the shoulders receiving suprascapular nerve block compared with those receiving placebo were seen at weeks 1, 4, and 12. There were no significant adverse effects in either group. Conclusion: Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in degenerative disease and/or arthritis. It improves pain, disability, and range of movement at the shoulder compared with placebo. It is a useful adjunct treatment for the practising clinician to assist in the management of a difficult and common clinical problem.