Relief of chronic shoulder pain: a comparative study of three approaches

Shoulder pain is one of the most common complaints in pain clinics and rheumatology departments, usually originates from trauma, degeneration, inflammation, vascular disease and also be referred from the hand and neck pain or headache. The aim of this study was to compare the effectiveness of continuous suprascapular nerve block under ultrasound guidance versus intra-articular corticosteroid injection of the shoulder and/or physiotherapy in management of chronic shoulder pain and to assess the effectiveness of these methods for relieving pain, improve range of movement of the shoulder and to demonstrate the most suitable method for treatment of such patients. 50 patients with a total of 63 shoulders were randomly divided into Group 1 [23 shoulders] received continuous suprascapular nerve block under ultrasound guidance in addition to rehabilitation program. Group II [20 shoulders] received intra-articular injection of steroid in addition to rehabilitation program. Group III [20 shoulders] received rehabilitation program only. The patients were followed up for 12 weeks and reviewed for Pain, disability, and range of movement data at weeks 1, 4, and 12 after each treatment. The result of our study demonstrates that, from the first week to 12 weeks, there was marked improvement in pain score in all times of follow up, and the best improvement in group I versus group II or III. The disability score showed improvement of non significant difference over the three time periods. Highly significant mean changes were found in group I versus group II and III [p=0.001] as regard SPADI pain, disability, total SPADI score and active movements. After 12 weeks of follow up, RA patients reported significant differences between 3 approaches of treatment [SSNB was the most effective one] as regard SPADI pain and total SPADI scores but frozen shoulder patients showed significant difference between three groups as regard SPADI pain only. Combination of physical treatment with Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in frozen and arthritis. It improves pain, disability, and range of movement of the shoulders compared with intra-articular corticosteroid injection of the shoulder and/or physiotherapy alone. SSNB is a useful adjunct treatment for management of chronic shoulder pain. Direct ultrasound visualization significantly improve outcome

Comparative study between continuous suprascapular nerve block under ultrasonic guidance, intra-articular corticosteroid injection and / or physiotherapy in relief of chronic shoulder pain

Comparison of continuous suprascapular nerve block under ultrasound guidance, intra-articular corticosteroid injection and/or physiotherapy in relieving pain and improving the range of motion in chronic shoulder pain. Fifty patients with chronic shoulder pain unresponsive to conventional treatment of at least three months duration were included in the study. Their sixty-three shoulders had first and second degrees frozen shoulder or rheumatoid arthritis. Patients who had a known allergy to the injected agents, or had such injections during last 2 months, pervious trauma or surgery to shoulder region or metabolic disorders as diabetes, thyroid disease, severe chronic airways or cardiac disease were excluded. The 63 shoulders were randomly divided into: Group I: 23 shoulders received continuous suprascapular nerve block under ultrasound guidance in addition to rehabilitation program. Group II: 20 shoulders received intra-articular injection of steroid in addition to rehabilitation program. Group III 20 shoulders received rehabilitation program alone. The patients were reviewed for pain, disability and range of movement at weeks I, 4, and 12. From weeks 1 to 12, there was marked improvement in pain score, more so in group I. Disability score showed improvement but with non-significant difference over same occasions. There was a highly significant mean change in group I versus groups II and III [p=0.001] as regard SPADIpain, disability and total SPADI score. The mean change of active movements showed highly significant difference from base line versus week 12 for all movements in group I. After 12 weeks, RA patients reported significant differences between group I as regard SPADI pain and total SPADI scores. Frozen shoulder patients showed significant difference between three groups as regard SPADI pain only. Combination of physical treatment with suprascapular nerve block is a safe and efficacious treatment for shoulder pain and stiffness in frozen and rheumatoid arthritis

Comparing the efficacy of thoracic transforaminal injection of magnesium versus intercostal nerve block with methylprednisolone for chronic post thoracotomy pain syndrome

Pain therapy and quality of life [QOL] are very important in patients with post thoracotomy pain syndrome. I evaluated the pain relieving efficacy, and effects on QOL of thoracic transforaminal [i.e. nerve root approach] injection of magnesium diluted with lidocaine versus intercostal nerve block with methylprednisolone and lidocaine in management of chronic post thoracotomy pain syndrome. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Magnesium group; GM, N=20 were treated with magnesium [transforaminal approach], whereas the patients in steroid group; GS, N=20 were treated with methylprednisolone [intercostal nerve block]. The VAS values, codeine consumption, and quality of life= QOL [assessed by Patient satisfaction scale=PSS, and performance status =PS] were evaluated prior to the procedure and at 2 weeks intervals after the procedure for 14 weeks. The demographic data were found to be similar. The comparisons of difference of VAS values were found to be significantly lower in GM than GS in every control till the 12[th] week. GM patients were found to decrease the codeine consumption significantly more than GS till the 14[th] week. GM patients had significant improvement in QOL values especially after 4 weeks [assessed by Patient satisfaction scale=PSS, and performance status =PS]. Comparing the pain relieving efficacy, QOL - effects of the methods, thoracic transforaminal [i.e. nerve root approach] injection of magnesium may be an alternative to traditional intercostal nerve block with steroids in adult patients with post thoracotomy syndrome