A Newsletter Released to Chiropractic Physicians on September 11, 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 originates from the C5 and C6 nerve roots. It 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 temporary but long lasting suprascapular nerve block administered by Dr. Taub serves as a meaningful adjunct for many chiropractic patients.

Clearly, a suprascapular nerve block does not address the original cause of pain. Without restorative treatment such as manipulation and exercise, patients experience a high rate of recurrence.^2,3 However, recent research suggests that the analgesic effects of suprascapular nerve blocks enhances physical therapy programs, and it is likely that chiropractic patients experience similar gains.⁴ 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 physical therapy, reported better sleep patterns due to less pain, and demonstrated increased compliance with the rehabilitation program. It stands to reason that the subset of chiropractic patients who do not experience prompt pain relief from chiropractic treatment, may also, as a group, show greater compliance with treatments, better home exercise patterns, better sleep patterns, and better overall adherence to the chiropractic treatment plan when a safe, simple suprascapular nerve block is used to provide prompt analgesia. Chiropractic patients sometimes seek surgery or other medical options without first consulting the primary chiropractic physician. One way to avoid this sometimes problematic behavior is by advising patients upfront that you will refer the patient for medical analgesia when and if the patient requests such a referral.

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. 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.⁵ This effect suggests that the nerve block breaks the self-perpetuating pain cycle and allows for more rapid and more complete recovery from your restorative treatments. The suprascapular nerve block is considered very safe and may be preferable to repeated consumption of NSAIDs. 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. This treatment can single-handedly delay or eliminate the need for shoulder surgery. In conjunction with effective chiropractic treatment, results can be very good.

Please refer to Neal S. Taub, MD, Physiatrist for
co-management of chiropractic patients.

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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.