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

ABSTRACT

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