Evaluation of suprascapular nerve block and intra-articular steroid injection as a treatment modality in patients with periarthritis shoulder

Abstract

Periarthritis shoulder (PA) characterized by gradual onset of pain with restriction of active and passive shoulder range of motion is one of the commonest musculoskeletal conditions of upper limb. Treatment options include rest, NSAID, active and passive mobilization, physical modalities, hydro-dilatation, manipulation under anaesthesia, arthroscopic capsular release, intra-articular injections and regional nerve blocks. Ninety patients of periarthrits shoulder were enrolled in the study and randomly allocated into two groups. Group A received methyl prednisolone 80 mg intra-articular injection and group B received suprascapular nerve block of 0.5% bupivacaine and methyl prednisolone. Each patient was assessed before intervention, at 1, 4 and 12 weeks after intervention. 0–10 Numeric Pain Intensity Scale, Active and passive range of motion, Quick Disability of Arm, Shoulder and Hand (DASH) score and Shoulder Pain and Disability Index (SPADI) were used for assessment. Group A showed statistically significant improvement ( P < 0.05) in pain, ROM and functional index on follow-up at 1, 4 and 12 weeks whereas, group B showed improvement ( P < 0.05) in all parameters except passive flexion and external rotation on first follow-up. However, this difference disappeared at subsequent follow-ups. Comparison between the groups revealed a better outcome in group A, in terms of Numerical Pain Intensity Scale Scores, SPADI Score, passive extension, active and passive internal and external rotations at 1, 4 and 12 weeks. Both the groups were comparable in terms of qDASH, active and passive abduction, flexion and active extension at first week with group A showing subsequent improvement. Both intrarticular steroid injection and suprascapular nerve block showed improvement in patients with periarthritis shoulder, but intrarticular steroid injection was found to be more efficacious as compared to suprascapular nerve block.