Continuous Interscalene Nerve Block Following Adhesive Capsulitis Manipulation

Abstract

To the Editor: We report on a prospective series of patients who were treated with a 3-day ambulatory perineural local anesthetic infusion in addition to the customary single-injection brachial plexus block for shoulder manipulation, using specific prospectively-defined endpoints. Shoulder adhesive capsulitis may be treated with manipulation under anesthesia to physically break up scar tissue associated with the joint capsule. After manipulation, frequent intensive range-of-motion exercises are critical to prevent recurrence of pathology.1,2 Unfortunately, shoulder motion following manipulation is often painful, greatly limiting adherence to the exercise regimen and resulting in a return of capsular adhesions.3 While treating shoulder pain with continuous interscalene nerve blocks has been studied previously following invasive surgical procedures in the immediate postoperative period,4 their application in non-surgical patients—and any longer-term, post-infusion effects on range-of-motion—remain uninvestigated.