A Newsletter Released to Physicians on October 9, 2007

The Suprascapular Nerve &
Shoulder Pain

Lack of bony stability and superlative capacity for motion make the shoulder one of the body’s most vulnerable regions for pain, injury, and dysfunction. Everyday, an estimated 15-30% of adults experience shoulder pain.¹ The suprascapular nerve conducts those pain signals in most cases. The suprascapular nerve provides sensation for about 70% of the shoulder joint including the superior and posterior regions of the shoulder joint and capsule and the acromioclavicular joint. A fast-acting, long-lasting suprascapular nerve block administered by Dr. Taub serves as an easy medical solution for shoulder pain.

The treatment does not permanently damage the nerve, and the nerve returns to normal function in time. The pain relief from the block outlasts the pharmocological effect of the drug.² This effect suggests that the nerve block breaks the self-perpetuating pain cycle. The suprascapular nerve block is considered very safe and may be preferable to repeated consumption of NSAIDs. When there are reasons to delay or avoid surgery, the suprascapular nerve block can delay surgery indefinitely or eliminate the need for surgery.

Some cases of shoulder pain require restorative treatment such as targeted exercises and/or manipulation to achieve optimal function and pain-free living long-term.^3,4 Even in these cases, recent research suggests that suprascapular nerve blocks enhance physical therapy programs. Di Lorenzo et al treated one group of shoulder pain patients with standard physical therapy, and they treated another group with physical therapy plus a suprascapular nerve block. Compared to patients receiving only physical therapy, the patients also receiving a suprascapular nerve block reported less pain during therapy, showed higher compliance with the rehabilitation program, and reported better sleep patterns due to less pain.⁵ Physiatrists have extensive training in working closely with physical and occupational therapists. At your discretion, Dr. Taub can evaluate the need for therapy, prescribe and supervise therapy, and ensure that you receive succinct, quality updates for your patient’s file. This arrangement spares practitioners the inconvenience of signing orders for outpatient therapy. However, Dr. Taub will avoid prescribing physical therapy without first consulting with you, the referring practitioner, in case you prefer to order and supervise therapy yourself.

Dr. Taub performs the suprascapular nerve block by injecting steroids or a dilute phenol solution into the nerve. Dr. Taub sometimes performs a circumflex nerve block in conjunction with the suprascapular nerve block to improve results. Analgesia lasts two to three months. Dr. Taub uses ultrasound imaging to guide the injections. Using imaging during shoulder injections has been shown to improve accuracy and efficacy.^6,7 Ultrasound imaging during this process also allows for possible diagnosis of tears and other problems in the shoulder. Patients can receive suprascapular nerve blocks periodically.

Please refer to Neal S. Taub, MD, Physiatrist for
pain management & rehabilitation.

References:

1. Pope D, Croft P, Pritchard C, et al. “Prevalence of shoulder pain in the community: the influence of case definition.” Ann Rheum Dis 1997; 56: 308-12.
2. Winters JC, et al. Treatment of shoulder complaints in general practice: long-term results of a randomized, single blind study comparing physiotherapy, manipulation, and corticosteroid injection. BMJ May 22, 1999;318:1395-6.
   
3. Woodward TW, Best TM. The Painful Shoulder: Part II. Acute and Chronic Disorders. Am Fam Phys, June 1, 2000; 61 (11): 3291-3302.
   
4. Di Lorenzo, Pappagallo M, Gimigliano R, et al. “Pain relief in early rehabilitation of rotator cuff tendinitis: any role for indirect suprascapular nerve block?” Eura Medicophys. 2006; 42 (3): 195-204.
   
5. Shanahan E, Ahern M, Smith M. “Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain.” Ann Rheum Dis 2003; 62: 400-406.
   
6. Karata G, Meray J. “Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques.” Arch Phys Med Rehabil. 2002; 83(5): 593-7.
   
7. Naredo E, Cabero F, Beneyto P, et al. “A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder.” J Rheumatol. 2004 Feb; 31(2): 308-14.