Restricted accessResearch articleFirst published online 2021-11
A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain
Suprascapular nerve block (SSNB) injections are growing in popularity as a treatment option for people with chronic shoulder pain. The optimal method of injection and aftercare is unknown. This review describes the current methods and drugs used for performing SSNB injections in the non-surgical management of adults with chronic shoulder pain in order to inform future research in this area. Systematic searches of CINAHL, MEDLINE (OVID), AMED, Embase databases and the Cochrane Library were undertaken from inception to June 2020. Data on the method and drugs used for injection and aftercare were extracted and summarised for areas of commonality and discrepancy. We included 53 studies in this review. In total, eight different injection methods were reported within the included studies. Indirect surface land-marked methods were the most common method reported in 21 studies. Direct surface land-marked methods were reported in 12 studies. Ultrasound-guided methods used alone were reported in 16 studies. Both fluoroscopy and computed tomography methods used alone were reported in one study each. Electromyography was used in combination with other injection methods in nine studies. Wide variation in the composition of the injectate was observed between studies. Local anaesthetic was used within injectate preparations in all studies. Local anaesthetic used alone was reported in 20 studies, combined with steroid in 29 studies and combined with various other components in 5 studies. Physiotherapy following injection was reported in 26 studies. Reported details of physiotherapy varied considerably. This review identified substantial variation in the methods and drugs used to perform SSNB injection in clinical trials. Current literature demonstrates a wide range of methods used for SSNB injection administration. Consensus research defining standardised practice for SSNB injection is now needed to guide future clinical practice and research.
LinsellLDawsonJZondervanK, et al. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology (Oxford)2006; 45(2): 215–221.
3.
UrwinMSymmonsDAllisonT, et al. Estimating the burden of musculoskeletal disorders in the community : the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis1998; 57(11): 649–655.
4.
van der WindtDABurkeDLBabatundeO, et al. Predictors of the effects of treatment for shoulder pain: protocol of an individual participant data meta-analysis. Diagn Progn Res2019; 3: 15.
5.
LewisJ.Rotator cuff related shoulder pain: assessment, management and uncertainties. Man Ther2016; 23: 57–68.
BuryJLC. Rotator cuff disorders: a survey of current (2016) UK physiotherapy practice. Shoulder Elbow2016; 10: 52–61.
8.
RoddyEZwierskaIJordanKP, et al. Musculoskeletal clinical assessment and treatment services at the primary-secondary care interface: an observational study. Br J Gen Pract2013; 63(607): e141–148.
9.
JowettSCrawshawDPHelliwellPS, et al. Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis. Rheumatology (Oxford)2013; 52(8): 1485–1491.
10.
CrawshawDPHelliwellPSHensorEMA, et al. Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial. BMJ2010; 340: c3037.
11.
DeanBJFLostisEMorreyME, et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum2013; 43: 570–576.
12.
DesaiVSCampCLBoddapatiV, et al. Injections within a year preoperatively may be associated with a higher rate of subsequent revision rotator cuff surgery. Arthroscopy2019; 35(1): 45–50.
13.
WoolfSK.Editorial commentary: steroid injections prior to arthroscopic rotator cuff repair – is it time to rethink a conservative treatment paradigm. Arthroscopy2019; 35(3): 714–716.
14.
WeberAETrasoliniNAMayerEN, et al. Injections prior to rotator cuff repair are associated. Arthroscopy2019; 35(3): 717–724.
15.
SaltEVan Der WindtDChestertonL, et al. Physiotherapists’ use of suprascapular nerve blocks: an online survey. Physiotherapy2019; 105(4): 461–468.
16.
HackneyRCowlingPIsmailM, et al. The management of large and massive rotator cuff tears – Current trends amongst UK shoulder surgeons. Peertechz J Orthop Rheumatol2018; 3: 005–0011.
17.
BlumALecocqSLouisM, et al. The nerves around the shoulder. Eur J Radiol2013; 82: 2–16.
18.
VorsterWLangeCPEBrietRJP, et al. The sensory branch distribution of the suprascapular nerve: an anatomic study. J Shoulder Elbow Surg2008; 17(3): 500–502.
BradnamLShanahanEMHendyK, et al. Afferent inhibition and cortical silent periods in shoulder primary motor cortex and effect of a suprascapular nerve block in people experiencing chronic shoulder pain. Clin Neurophysiol2016; 127(1): 769–778.
21.
KulkarniRGibsonJBrownsonP, et al. Subacromial shoulder pain. Shoulder Elbow2015; 7: 135–143.
22.
ThomasMBidwaiARanganA, et al. BESS/BOA patient care pathways glenohumeral osteoarthritis. Shoulder Elbow2016; 8: 203–214.
23.
CooryJAParrAFWilkinsonMP, et al. Efficacy of suprascapular nerve block compared with subacromial injection : a randomized controlled trial in patients with rotator cuff tears. J Shoulder Elbow Surg2019; 28(3): 430–436.
24.
ChangKVHungCYWuWT, et al. Comparison of the effectiveness of suprascapular nerve block with physical therapy, placebo, and intra-articular injection in management of chronic shoulder pain: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil2016; 97: 1366–1380.
25.
FernandesMRBarbosaMASousaALL, et al. Suprascapular nerve block: important procedure in clinical practice. Part II. Rev Bras Reumatol2012; 52: 612–622.
26.
Kasapoğlu-AksoyMAykurt-KarlibelIAltanL.Comparison of the efficacy of intramuscular botulinum toxin type-A injection into the pectoralis major and the teres major muscles and suprascapular nerve block for hemiplegic shoulder pain: a prospective, double-blind, randomized, controlled trial. Neurol Sci2020; 41(8): 2225–2230.
27.
TerlemezRÇiftçiSTopalogluM, et al. Suprascapular nerve block in hemiplegic shoulder pain: comparison of the effectiveness of placebo, local anesthetic, and corticosteroid injections – a randomized controlled study. Neurol Sci2020; 41: 3243–3247.
28.
OzkanKOzcekicANSararS, et al. Suprascapular nerve block for the treatment of frozen shoulder. Saudi J Anaesth2012; 6: 52–55.
29.
YasarEVuralDSafazI, et al. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehabil2011; 25: 60–68.
30.
KaratasGKMerayJ.Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques. Arch Phys Med Rehabil2002; 83(5): 593–597.
31.
YilmazE.A prospective, comparative study of subacromial corticosteroid injection and subacromial corticosteroid injection plus suprascapular nerve block in patients with shoulder impingement syndrome. Arch Orthop Trauma Surg. Epub ahead of print 30 April 2020. DOI: 10.1007/s00402-020-03455-x.
32.
AydinTSenEIYardimciMY, et al. Efficacy of ultrasound-guided suprascapular nerve block treatment in patients with painful hemiplegic shoulder. Neurol Sci2019; 40(5): 985–991.
33.
SencanSCelenliogluAEKaradag-SaygiE, et al. Effects of fluoroscopy-guided intraarticular injection, suprascapular nerve block, and combination therapy in hemiplegic shoulder pain: a prospective double-blind, randomized clinical study. Neurol Sci2019; 40(5): 939–946.
34.
OkurSCOzyemisci-TaskiranOPekindoganY, et al. Ultrasound–guided block of the suprascapular nerve in breast cancer survivors with limited shoulder motion – case series. Pain Physician2017; 20(2): E233–E239.
35.
KülcüDTaraktaşABadurN, et al. Blinded and stimulator guided comparison of suprascapular nerve block in hemiplegic shoulder pain: a pilot study. Turkish J Phys Med Rehabil2017; 63: 42–49.
36.
Bariş BayramKBalSSafa SatogluI, et al. Does suprascapular nerve block improve shoulder disability in impingement syndrome? A randomized placebo-controlled study. J Musculoskelet Pain2014; 22: 170–174.
37.
TaskaynatanMAOzgulAAydemirK, et al. Accuracy of ultrasound-guided suprascapular nerve block measured with neurostimulation. Rheumatol Int2012; 32(7): 2125–2128.
38.
TaskaynatanMAYilmazBOzgulA, et al. Suprascapular nerve block versus steroid injection for non-specific shoulder pain. Tohoku J Exp Med2005; 205(1): 19–25.
39.
ShanahanEMGlaezterKGillT, et al. A case series of suprascapular nerve block (with an historical comparator) for shoulder pain in motor neurone disease. Palliat Med2020; 34(8): 1127–1133.
40.
ShanahanEMShanahanKRHillCL, et al. Safety and acceptability of suprascapular nerve block in rheumatology patients. Clin Rheumatol2012; 31(1): 145–149.
41.
ShanahanEMSmithMDWetherallM, et al. Suprascapular nerve block in chronic shoulder pain: are the radiologists better. Ann Rheum Dis2004; 63(9): 1035–1040.
42.
ShanahanEMAhernMSmithM, et al. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis2003; 62(5): 400–406.
43.
Adey-WakelingZCrottyMShanahanEM.Suprascapular nerve block for shoulder pain in the first year after stroke. Stroke2013; 44(11): 3136–3141.
44.
SalgiaAAgarwalTPuriSR, et al. Role of suprascapular nerve block in chronic shoulder pain: a comparative study of 60 cases. Med J Drdy Patil Univ2014; 7: 44.
45.
ChansoriaMDasGMathankarN, et al. A preliminary study of a novel technique of suprascapular nerve block in treating chronic shoulder pain. Indian J Pain2015; 29: 91.
46.
SonuneSPGaurAKGuptaS.Comparative study of ultrasound guided supra-scapular nerve block versus intra-articular steroid injection in frozen shoulder. Int J Res Orthop2016; 2: 387.
47.
MitraPKBhattacharyaD.Comparison of clinical effects of ultrasound guided suprascapular nerve block and oral pregabalin versus suprascapular nerve block alone for pain relief in frozen shoulder. Indian J Pain2016; 30: 49–54.
48.
KammiliS.Suprascapular nerve block as an adjunct to exercise therapy in periarthritis of shoulder. J Med Sci Clin Res2017; 5: 18591–18598.
49.
VermaDKNeyazONandaS, et al. 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 Rheumatol2019; 14: 113.
50.
KamalKDahiyaNSinghR, et al. Comparative study of anatomical landmark-guided versus ultrasound-guided suprascapular nerve block in chronic shoulder pain. Saudi J Anaesth2018; 12(1): 22–27.
GadoKEmeryP.Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. Ann Rheum Dis1993; 52(3): 215–218.
53.
DangoisseMJWilsonDJGlynnCJ.MRI and clinical study of an easy and safe technique of suprascapular nerve blockade. Acta Anaesthesiol Belg1994; 45(2): 49–54.
54.
LewisRN.The use of combined suprascapular and circumflex (articular branches) nerve blocks in the management of chronic arthritis of the shoulder joint. Eur J Anaesthesiol1999; 16(1): 37–41.
55.
JonesDSChattopadhyayC.Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial. Br J Gen Pract1999; 49(438): 39–41.
56.
SaltEvan der WindtDAChestertonL, et al. Physiotherapist-led suprascapular nerve blocks for persistent shoulder pain: evaluation of a new service in the UK. Musculoskeletal Care2018; 16(1): 214–221.
57.
MitraRHarrisAUmphreyC, et al. Adhesive capsulitis: a new management protocol to improve passive range of motion. PMR2009; 1(12): 1064–1068.
58.
WassefMR.Suprascapular nerve block. A new approach for the management of frozen shoulder. Anaesthesia1992; 47: 120–124.
59.
LongJPeerGCwikJ.The triscapular block: a new application of therapy of periscapular pain and glenohumeral restriction. Reg Anesth1987; 12: 70–75.
60.
RowlingsonJArasiR.The use of suprascapular nerve blocks in the management of shoulder pain. Reg Anesth1986; 11: 156–159.
61.
GorthiVMoonYLKangJ.The effectiveness of ultrasonography-guided suprascapular nerve block for perishoulder pain. Orthopedics2010; 33(4): 20100225-11.
62.
KangSSJungJWSongCK, et al. A new anterior approach for fluoroscopy-guided suprascapular nerve block: a preliminary report. Korean J Pain2012; 25(3): 168–172.
63.
JeonWHParkGWJeongHJ, et al. The comparison of effects of suprascapular nerve block, intra-articular steroid injection, and a combination therapy on hemiplegic shoulder pain: pilot study. Ann Rehabil Med2014; 38(2): 167–173.
64.
JungTWLeeSYMinSK, et al. Does combining a suprascapular nerve block with an intra-articular corticosteroid injection have an additive effect in the treatment of adhesive capsulitis? A comparison of functional outcomes after short-term and minimum 1-year follow-up. Orthop J Sports Med2019; 7(7): 2325967119859277.
65.
FernandesMR.Patient-reported measures of quality of life and functional capacity in adhesive capsulitis. Rev Assoc Med Bras (1992)2017; 63(4): 347–354.
66.
MalheiroNSAfonsoNRPereiraD, et al. Efficacy of ultrasound guided suprascapular block in patients with chronic shoulder pain: observational, retrospective study. Brazilian J Anesthesiol (English Ed)2020; 70: 15–21.
67.
GofeldMRestrepo-GarcesCETheodoreBR, et al. Pulsed radiofrequency of suprascapular nerve for chronic shoulder pain: a randomized double-blind active placebo-controlled study. Pain Pract2013; 13(2): 96–103.
68.
DahanTFontinLPelletierM, et al. Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve block in frozen shoulder. J Rheumatol2000; 27: 1464–1469.
69.
El-BadawyMFathallaM.Suprascapular nerve block followed by Codman′s manipulation and exercise in the rehabilitation of idiopathic frozen shoulder. Egypt Rheumatol Rehabil2014; 41: 172.
70.
MortadaMAEzzeldinNAbbasSF, et al. Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients. J Back Musculoskelet Rehabil2017; 30(3): 537–542.
71.
PicelliABonazzaSLobbaD, et al. Suprascapular nerve block for the treatment of hemiplegic shoulder pain in patients with long-term chronic stroke: a pilot study. Neurol Sci2017; 38(9): 1697–1701.
72.
Di LorenzoIPappagalloMGimiglianoR. Pain relief in early rehabilitation of rotator cuff tendonitis: any role for indirect suprascapular nerve block?Eura Medicophys2006; 42: 195–204.
73.
Arcila LoteroMARivera DíazRCCampuzano EscobarD, et al. Efficacy and safety of ultrasound-guided suprascapular nerve block in patients with chronic shoulder pain. Colomb J Anesthesiol2013; 41: 104–108.
74.
DornCRumpold-SeitlingerGFarziS, et al. The effect of the modified lateral suprascapular block on shoulder function in patients with chronic shoulder pain. Anesth Pain Med2015; 5: 5–8.
75.
KhanJADevkotaPAcharyaBM, et al. Manipulation under local anesthesia in idiopathic frozen shoulder–a new effective and simple technique. Nepal Med Coll J2009; 11: 247–253.
76.
BoonsongPJaroenarpornwatanaABoonhongJ.Preliminary study of suprascapular nerve block (SSNB) in hemiplegic shoulder pain. J Med Assoc Thai2009; 92(12): 1669–1674.
77.
WertheimHMRovenstineEA.Suprascapular nerve block. Anesthesiology. J Am Soc Anesthesiol1941; 2: 541–545.
78.
ShanthannaHBusseJWThabaneL, et al. Local anesthetic injections with or without steroid for chronic non-cancer pain: a protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev2016; 5: 1–14.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
