Publication:

Comparative study of ultrasound guided supra-scapular nerve block versus intra-articular steroid injection in frozen shoulder

Background Frozen shoulder is one of the most common musculoskeletal problems seen in orthopaedics. Many treatment modes are available however, it is difficult to treat and data on the comparative efficacy of various interventions are limited. Intra-articular corticosteroid injection (IASI) is a commonly used to treat frozen shoulder pain. Supra-scapular nerve block (SSNB) is also effective method to treat pain in chronic diseases that affect the shoulder. The present study was done to compare efficacy of ultrasound guided SSNB and IASI in management of painful frozen shoulder.

Methods 60 patients with painful frozen shoulder were divided in two groups, Group A received ultra-sound guided SSNB with 6 ml 0.5% Bupivacaine; Group B received IASI using 40 mg Triamcinolone. Outcome measures were shoulder ranges mainly lateral rotation and abduction, shoulder pain and disability index and visual analogue scale (VAS). Patients were followed-up on 2nd day, at 1st, 3rd and 6th week.

Results All baseline parameters improved significantly in both groups; however, on comparison Group A showed significant improvement in passive lateral rotation on 2nd day and 1st week follow up (P =0.038 and 0.040 respectively). VAS score showed significance at all follow-up in Group A, whereas, in Group B significance was seen after 1 week. On inter group comparison Group A shows significance on 2nd day (P =0.050), 1st week (P =0.042) and 3rd week (P =0.036).

Conclusions Both SSNB and IASI have efficacy in management of frozen shoulder. But supra-scapular nerve block is better than intra-articular injection and should be considered prior to steroid as it has early onset pain relief, early improvement in ranges, potentially lesser contraindications and side effects.