A suprascapular nerve block is one of several injections used to treat chronic shoulder pain, and ultrasound makes it accurate and straightforward. So how do we perform a suprascapular nerve block under 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 and supplies the shoulder joint, tendons, and bursa.
When is a suprascapular nerve block used?
Several types of shoulder problems improve with a suprascapular nerve block, including:
- Shoulder arthritis
- Rotator cuff tears
- Frozen shoulder
- Suprascapular nerve entrapment
Recent evidence suggests these injections effectively relieve shoulder arthritis pain compared with other injections. They’re ideal for people who aren’t good candidates for surgery, or don’t want it, such as those with severe shoulder arthritis or large rotator cuff tears in older patients.
The evidence base is growing:
- One study found that nerve blocks are superior to cortisone injections for rotator cuff tears.
- Another found a nerve block combined with a shoulder joint injection was superior to placebo in frozen shoulder.
- More recently, for rotator cuff tendonitis, a combined suprascapular nerve block and subacromial cortisone injection was superior to either injection alone.
The suprascapular nerve block reduces pain by blocking the pain fibres that carry pain messages to the brain. It’s usually performed with a local anaesthetic (lidocaine) and cortisone. We believe the block anaesthetises the suprascapular nerve for a period, reducing shoulder pain — and this local effect also changes the pain networks in the brain, reducing pain over time.
Suprascapular nerve block technique
Traditionally, practitioners performed suprascapular nerve injections using scapular landmarks alone. They direct the needle from the inside to the outside, targeting the nerve within the hollow at the back of the scapula.
Imaging now allows a far more accurate injection. We use ultrasound or X-ray to guide the needle into the correct position. The advantages of ultrasound for a suprascapular nerve block include no ionising radiation and lower cost.
We typically use 6–10 mL of local anaesthetic and 20–40 mg of cortisone, though the most effective dose for this block is still unknown. We often perform the block alongside other shoulder injections, and consider it when other injections have been ineffective, or when surgery isn’t indicated.
How much does a suprascapular nerve block cost?
Dr Masci performs the suprascapular nerve block as a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided injection is £400. Other clinic locations cost more. See the full one-stop injection fees here and our clinic locations.
Frequently asked questions about a suprascapular nerve block
What conditions is a suprascapular nerve block used for?
It’s used for chronic shoulder pain from shoulder arthritis, rotator cuff tears, frozen shoulder, and suprascapular nerve entrapment — particularly in people who want to avoid surgery. It’s often combined with a shoulder joint or subacromial injection.
Is a suprascapular nerve block better than a cortisone injection?
For some conditions, the evidence suggests it is. One randomised trial found a nerve block superior to a subacromial cortisone injection for rotator cuff tears. Because it targets the nerve, the effect tends to last longer than a standard cortisone injection into a joint or tendon.
How long does a suprascapular nerve block last?
It’s hard to predict precisely, but because the injection targets the nerve, the effect usually lasts longer than a cortisone injection around a tendon or into a joint.
Can a suprascapular nerve block be repeated?
Yes. If you have an excellent response, the block can be repeated — though we recommend waiting at least three months between injections.
Can you use a suprascapular nerve block for frozen shoulder?
Yes. We usually perform a shoulder joint injection or hydrodistension for frozen shoulder, and recent evidence suggests a nerve block is equally effective. Combining the two may work better than either alone — one study found a nerve block plus a joint injection more effective than a joint injection with a placebo block. Another found a nerve block more effective than a joint injection at three months.
Is the injection painful?
Most people tolerate it well. We use local anaesthetic, and because ultrasound places the needle accurately, the injection tends to be quick and comfortable.
What are the side effects of a suprascapular nerve block?
Patients generally tolerate the block well, and side effects are rare. They can include temporary shoulder weakness (days to weeks) from needle contact with the nerve; symptoms such as a racing heart, dizziness, or slurred speech if anaesthetic is accidentally injected into a blood vessel; and, rarely, lung puncture (pneumothorax) if the needle is directed into the wrong space. We use ultrasound throughout to avoid blood vessels and place the needle safely.
Final word from Sport Doctor London about the suprascapular nerve block
A suprascapular nerve block is a valuable option for chronic shoulder pain — including rotator cuff tendonitis and frozen shoulder — where other injections and treatments haven’t worked. Ultrasound guidance improves the accuracy and safety of the injection.
Dr Masci teaches this advanced procedure on his advanced ultrasound-guided injection courses, based in Amsterdam through SonoSkills.
To discuss a suprascapular nerve block with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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