A suprascapular nerve block is one of several injections to treat chronic shoulder pain. Doing this injeciton with ultrasound makes it easy. So how do we do a suprascapular nerve block ultrasound, and how useful is it in shoulder pain?
What is the suprascapular nerve?
The suprascapular nerve is one of the primary nerves that supply the shoulder. It arises from a cluster of nerves in front of the shoulder called the brachial plexus. It supplies the joint, tendons, and bursa of the shoulder.
Indications
Different types of shoulder pathology improve with a suprascapular nerve block. Examples include:
- Rotator cuff tears
Recent evidence suggests that these injections effectively relieve shoulder arthritis pain compared to other injections. These injections are perfect for people who are not good candidates or don’t want surgery, such as severe shoulder arthritis or large rotator cuff tendon tears in the elderly.
One study found that nerve blocks are superior to cortisone injection for rotator cuff tears. Another study found that a nerve block combined with a glenohumeral joint injection was superior to a placebo in patients with frozen shoulder.
More recently, for rotator cuff tendonitis, the combined suprascapular nerve block and subacromial cortisone injeciton was superior to either injection alone.
The suprascapular nerve block reduces pain by blocking the pain fibres that transmit pain messages to the brain. Usually, this injection is performed using the local numbing drug (also called lidocaine) and cortisone. We hypothesise that these blocks anaesthetise the suprascapular nerve for a period, reducing shoulder pain. This local effect also changes nerve networks in the brain, reducing pain over time.
Suprascapular Nerve Block Technique
Traditionally, practitioners performed suprascapular nerve injections using simple scapular landmarks. We direct the needle from medial to lateral, targeting the nerve within the hollow at the posterior aspect of the scapula.
Recently, imaging has enabled more accurate injection. We use ultrasound or X-ray to guide the needle to the correct position. However, the advantages of ultrasound for suprascapular nerve block include the absence of ionising radiation and lower cost.
Generally, we use 6-10 mL of local anaesthetic and 20-40 mg of cortisone. However, the most effective dose for this block is still unknown.
We often administer this injection in combination with other shoulder injections. Also, we consider a nerve block when other injections are ineffective or when surgery is not indicated.
Commonly Asked Questions about Suprascapular Nerve Block Ultrasound
How long does a suprascapular nerve block last?
It is difficult to know precisely how long the effect of this injection will last. However, because the injection targets the nerve, the effect lasts longer than that of a cortisone injection administered around a tendon or into a joint.
Can you perform repeated suprascapular nerve blocks? be performed
Yes. If you have an excellent response to a block, you can always have the block repeated. Nonetheless, we recommend waiting at least 3 months before repeating the injection.
Can you use an ultrasound suprascapular nerve block for frozen shoulder?
Yes. Generally, we perform a shoulder joint injection or hydrodistension. Recent evidence suggests that a nerve block is equally effective as a hydrodistension. Combining the two injections may yield a more effective result than using either one alone. One study found that a nerve block combined with a joint injection was more effective than a joint injection with a placebo nerve block. Another study found that a nerve block was more effective than a joint injection after 3 months.
What are the side effects of a suprascapular nerve block ultrasound?
In general, patients tolerate this nerve block well. Side effects are rare but may include nerve damage from the needle, resulting in shoulder weakness that lasts for days to weeks. Additionally, accidentally injecting numbing agents into the blood vessels can cause symptoms such as a racing heart, dizziness, slurred speech, and shortness of breath. We use an ultrasound scan to avoid injecting into blood vessels. Finally, directing the needle into the wrong space can lead to lung puncture, also called pneumothorax.
Final word from Sportdoctorlondon about suprascapular nerve block ultrasound
A suprascapular nerve block can be used in chronic shoulder pain, including rotator cuff tendonitis and frozen shoulder, where other injections and treatments have been ineffective. Ultrasound-guided injection improves accuracy.
Dr Masci teaches this advanced procedure in his advanced ultrasound-guided injection courses based in Amsterdam through Sonoskills.
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