Indian Journal of Physical Medicine and Rehabilitation

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VOLUME 30 , ISSUE 2 ( April-June, 2019 ) > List of Articles

Original Article

Comparison of Ultrasound-guided Suprascapular Nerve Block and Extracorporeal Shock Wave Therapy in Reduction of Pain and Functional Disability in Adhesive Capsulitis of Shoulder: A Randomized Controlled Study

Tripti Swami, Akoijam Joy Singh, L Nilachandra Singh

Keywords : Adhesive capsulitis, Extracorporeal shockwave therapy, Range of motion, Shoulder pain and disability index, Suprascapular nerve block

Citation Information : Swami T, Singh AJ, Singh LN. Comparison of Ultrasound-guided Suprascapular Nerve Block and Extracorporeal Shock Wave Therapy in Reduction of Pain and Functional Disability in Adhesive Capsulitis of Shoulder: A Randomized Controlled Study. Indian J Phy Med Rehab 2019; 30 (2):29-33.

DOI: 10.5005/jp-journals-10066-0045

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Objective: To compare the effectiveness of ultrasound-guided suprascapular nerve block (SSNB) and extracorporeal shockwave therapy (ESWT) in the management of adhesive capsulitis of the shoulder. Study design: Randomized controlled trial. Materials and methods: A total of 88 patients from September 2016 to August 2018 were recruited from outpatient of the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal. While the ESWT group received radial shock waves on average 2,000 impulses once weekly for 4 weeks, the SSNB group got ultrasound-guided single SSNB with 10 mL bupivacaine (0.5%). Range of motion (ROM) and shoulder pain and disability index (SPADI) were measured at week 1, week 4, and week 12. Results: Both groups showed significant improvement in the mean score of ROM and SPADI (p < 0.05). Although SSNB was found to be significantly more effective than ESWT in the reduction of pain and disability in both short term and long term (p < 0.05). Conclusion: The effectiveness of SSNB specifically in short-term pain control and ease of application under ultrasound guidance makes it preferable in the management of adhesive capsulitis of the shoulder. While ESWT also seems to be a promising therapy and a viable alternative to steroids for adhesive capsulitis in case of patients with diabetes.

  1. Calis M, Demir H, Ulker S, et al. Is intraarticular sodium hyaluronate injection an alternative treatment in patients with adhesive capsulitis? Rheumatol Int 2006;26(6):536–540. DOI: 10.1007/s00296-005-0022-2.
  2. Codman EA. Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa Codman EA, The shoulder Boston: Thomas Todd Co; 1934. pp. 216–224.
  3. Dias R, Cutts S, Massoud S. Clinical review: frozen shoulder. BMJ 2005;331(7530):1453–1456. DOI: 10.1136/bmj.331.7530.1453.
  4. Miller III RH, Azar FM, Throckmorton TW. Shoulder and elbow injuries. In: Campbell's operative orthopaedics Terry CS, Beaty JH 12th ed., Missouri: Mosby; 2013. pp. 2235–2236.
  5. Bunker R, Anthony PP. The pathology of frozen shoulder: a dupuytren like disease. J Bone Joint Surg Br 1995;77(5):677–683. DOI: 10.1302/0301-620X.77B5.7559688.
  6. Neviaser RJ, Neviaser TJ. The frozen shoulder. Diagnosis and management. Clin Orthop Relat Res 1987(223):59–64. DOI: 10.1097/00003086-198710000-00008.
  7. Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res 2000;372(1):95–109. DOI: 10.1097/00003086-200003000-00012.
  8. Manske R, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 2008;1(3):180–189. DOI: 10.1007/s12178-008-9031-6.
  9. Anton HA. Frozen shoulder. Can Fam Physician 1993;39(1):1773–1777.
  10. Wertheim HM, Rovenstine EA. Suprascapular nerve block. Anesthesiology 1941;2(5):541–554. DOI: 10.1097/00000542-194109000-00006.
  11. Dangoisse MJ, Wilson DJ, Glynn CJ. MRI and clinical study of an easy and safe technique of suprascapular nerve blockade. Acta Anaesthesiol Belg 1994;45(2):49–54.
  12. Dahan TH, Fortin L, Pelletier M, et al. Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol 2000;27(6):1464–1469.
  13. Loew M, Daecke W, Kusnierczak D, et al. Shock wave therapy is effective for chronic calcifying tendinitis of the shoulder. J Bone Joint Surg Br 1999;81(5):863–867. DOI: 10.1302/0301-620X.81B5.0810863.
  14. Moya D, Ramón S, Schaden W, et al. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Joint Surg Am 2018;100(3):251–263. DOI: 10.2106/JBJS.17.00661.
  15. Wang CJ, Wang FS, Yang KD, et al. Shock wave therapy induced neovascularization at the tendon–bone junction. A study in rabbits. J Orthop Res 2003;21(3):984–989. DOI: 10.1016/S0736-0266(03)00104-9.
  16. Palmer K, Walker-Bone K, Linaker C, et al. The southampton examination schedule for the diagnosis of musculoskeletal disorders of the upper limb. Ann Rheum Dis 2000;59(1):5–11. DOI: 10.1136/ard.59.1.5.
  17. Karataş GK, Meray J. Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques. Arch Phys Med Rehabil 2002;83(5):593–597. DOI: 10.1053/apmr.2002.32472.
  18. Vahdatpour B, Taheri P, Zade A, et al. Efficacy of extracorporeal shock wave therapy in frozen shoulder. Int J Prev Med 2014;5(7):875–881.
  19. Juel NG, Natwig B. Shoulder diagnoses in secondary care, one year cohort. BMC MusculoskeletDisord 2014;15(1):89. DOI: 10.1186/1471-2474-15-89.
  20. De Palma AF. Loss of scapulohumeral motion (frozen shoulder). Ann Surg 1952;135(2):193–204. DOI: 10.1097/00000658-195202000-00005.
  21. Bridgman JF. Periarthritis of the shoulder and diabetes mellitus. Ann Rheum Dis 1972;31(1):69–71. DOI: 10.1136/ard.31.1.69.
  22. Durante C, Corrado B, Galasso O, et al. The frozen shoulder: indications for extracorporeal shockwave therapy. 4th International Congress of the ISMST. Berlin; 2001. pp. 16–17.
  23. Seidl M, Steinbach P, Wörle K. Induction of stress fibres and intercellular gaps in human vascular endothelium by shock-waves. Ultrasonics 1994;32(1):397–400. DOI: 10.1016/0041-624X(94)90111-2.
  24. Jones DS, Chattopadhyay C. Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial. Br J Gen Pract 1999;49(438):39–41.
  25. Ozkan K, Ozcekic AN, Sarar S, et al. Suprascapular nerve block for the treatment of frozen shoulder. Saudi J Anaesth 2012;6(1):52–55. DOI: 10.4103/1658-354X.93061.
  26. Lewis RN. The use of combined suprascapular and circumflex (articular branches) nerve blocks in the management of chronic arthritis of the shoulder joint. Eur Acad Anaesthesiol 1999;16(1):37–41. DOI: 10.1097/00003643-199901000-00008.
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