Skip to main content

Advertisement

Log in

A prospective, comparative study of subacromial corticosteroid injection and subacromial corticosteroid injection plus suprascapular nerve block in patients with shoulder impingement syndrome

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Efforts are recently focused on the management of shoulder impingement syndrome (SIS) with a conservative and targeted approach because of its psychosocial impact, reduction in the quality of life, the cost to the economy and its negative effect on daily activities. Therefore, many studies have been designed to evaluate and compare the effectiveness of different treatments. The main purpose of this study was to identify the effect of combination of subacromial corticosteroid injection (SCI) and suprascapular nerve block (SSNB) on shoulder impingement syndrome (SIS).

Materials and methods

66 patients with SIS were randomly divided into two groups (33 patients per group): Group 1: SCI; Group 2: SCI plus SSNB. The estimation of the severity of pain by the visual analogue scale (VAS) and shoulder disability using quick DASH (Disabilities of the Arm, Shoulder and Hand) were assessed at baseline and 1, 3 months post-injection.

Results

The mean age of patients was 55.55 ± 10.42 years in Group 1 and 57.24 ± 12.75 years in Group 2. In steroid group, pre- and post-treatment (at 1 and 3 months) VAS/quickDASH scores were 8.64 ± 0.99/78.03 ± 9.24, 2.09 ± 0.84/15.58 ± 7.23 and 3.06 ± 1.12/25.06 ± 8.74, respectively. In steroid plus SSNB group, pre- and post-treatment (at 1 and 3 months) VAS/quickDASH scores were 8.45 ± 0.90/75.15 ± 9.86, 1.24 ± 0.43/10.88 ± 2.14 and 1.51 ± 0.56/15.51 ± 5.04, respectively. Both treatment groups showed a significant relief of pain at 1 and 3 months post-injection (p < 0.05). However, the VAS and quickDASH scores at 1 and 3 months were significantly lower in Group 2 versus Group 1 (p < 0.05).

Conclusion

The combination of SCI and SSNB seems to produce the long-term effect in pain relief and functional improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Meislin RJ, Sperling JW, Stitik TP (2005) Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop (Belle Mead, NJ) 34(12 Suppl):5–9

    Google Scholar 

  2. Green S, Buchbinder R, Hetrick S (2003) Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004258

    Article  PubMed  PubMed Central  Google Scholar 

  3. van der Windt DA, Koes BW, de Jong BA, Bouter LM (1995) Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 54(12):959–964. https://doi.org/10.1136/ard.54.12.959

    Article  PubMed  PubMed Central  Google Scholar 

  4. Braman JP, Zhao KD, Lawrence RL, Harrison AK, Ludewig PM (2014) Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy. Med Biol Eng Comput 52(3):211–219. https://doi.org/10.1007/s11517-013-1074-1

    Article  PubMed  Google Scholar 

  5. Seitz AL, McClure PW, Finucane S, Boardman ND 3rd, Michener LA (2011) Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech (Bristol, Avon) 26(1):1–12. https://doi.org/10.1016/j.clinbiomech.2010.08.001

    Article  Google Scholar 

  6. Neer CS 2nd (1983) Impingement lesions. Clin Orthop Relat Res 173:70–77

    Google Scholar 

  7. Karduna AR, Kerner PJ, Lazarus MD (2005) Contact forces in the subacromial space: effects of scapular orientation. J Shoulder Elbow Surg 14(4):393–399. https://doi.org/10.1016/jse.2004.09.001

    Article  PubMed  Google Scholar 

  8. Bey MJ, Brock SK, Beierwaltes WN, Zauel R, Kolowich PA, Lock TR (2007) In vivo measurement of subacromial space width during shoulder elevation: technique and preliminary results in patients following unilateral rotator cuff repair. Clin Biomech (Bristol, Avon) 22(7):767–773. https://doi.org/10.1016/j.clinbiomech.2007.04.006

    Article  Google Scholar 

  9. Koester MC, George MS, Kuhn JE (2005) Shoulder impingement syndrome. Am J Med. 118(5):452–455. https://doi.org/10.1016/j.amjmed.2005.01.040

    Article  PubMed  Google Scholar 

  10. Longo UG, Franceschi F, Berton A, Maffulli N, Droena V (2012) Conservative treatment and rotator cuff tear progression. Med Sport Sci 57:90–99. https://doi.org/10.1159/000328910

    Article  PubMed  Google Scholar 

  11. Cole BF, Peters KS, Hackett L, Murrell GA (2016) Ultrasound-guided versus blind subacromial corticosteroid injections for subacromial impingement syndrome: a randomized, double-blind clinical trial. Am J Sport Med 44(3):702–707. https://doi.org/10.1177/0363546515618653

    Article  Google Scholar 

  12. Roddy E, Zwierska I, Hay EM, Jowett S, Lewis M, Stevenson K, van der Windt D, Foster NE, SUPPORT trial team (2014) Subacromial impingement syndrome and pain: protocol for a randomised controlled trial of exercise and corticosteroid injection (the SUPPORT trial). BMC Musculoskelet Disord 15:81. https://doi.org/10.1186/1471-2474-15-81

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Karatas GK, Meray J (2002) Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques. Arch Phys Med Rehab 83:593–597. https://doi.org/10.1053/aprm.2002.32472

    Article  Google Scholar 

  14. Shanahan EM, Ahern M, Smith M, Wetherall M, Bresnihan B, FitzGerald O (2003) Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis 62(5):400–406. https://doi.org/10.1136/ard.62.5.400

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Buchbinder R, Green S, Youd JM (2003) Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004016

    Article  PubMed  PubMed Central  Google Scholar 

  16. Meier G, Bauereis C, Maurer H (2002) The modified technique of continuous suprascapular nerve block. A safe technique in the treatment of shoulder pain. Anaesthesist 51:747–753. https://doi.org/10.1007/s00101-002-0380-z

    Article  CAS  PubMed  Google Scholar 

  17. Feigl GC, Anderhuber F, Dorn C, Pipam W, Rosmarin W, Likar R (2007) Modified lateral block of the suprascapular nerve: a safe approach and how much to inject? A morphological study. Reg Anesth Pain Med 32:488–494. https://doi.org/10.1016/j.rapm.2007.06.394

    Article  PubMed  Google Scholar 

  18. Jerosch J, Saad M, Greig M, Filler T (2008) Suprascapular nerve block as a method of preemptive pain control in shoulder surgery. Knee Surg Sports Traumatol Arthrosc 16:602–607. https://doi.org/10.1007/s00167-008-0520-3

    Article  CAS  PubMed  Google Scholar 

  19. Khan K, Cook J, Maffulli N, Kannus P (2000) Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 34(2):81–83. https://doi.org/10.1136/bjsm.34.2.81

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Voloshin I, Gelinas J, Maloney MD, O’Keefe RJ, Bigliani LU, Blaine TA (2005) Proinflammatory cytokines and metalloproteases are expressed in the subacromial bursa in patients with rotator cuff disease. Arthroscopy 21(9):1076. https://doi.org/10.1016/j.arthro.2005.05.017

    Article  PubMed  Google Scholar 

  21. Blaine TA, Kim YS, Voloshin I, Chen D, Murakami K, Chang SS, Winchester R, Lee FY, O’keefe RJ, Bigliani LU (2005) The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Shoulder Elbow Surg 14(1 Suppl S):84–89. https://doi.org/10.1016/j.jse.2004.09.022

    Article  Google Scholar 

  22. Edelstein L, Thomas SJ, Soslowsky LJ (2011) Rotator cuff tears: what have we learned from animal models? J Musculoskelet Neuronal Interact 11(12):150–162

    CAS  PubMed  Google Scholar 

  23. Hollmann MW, Durieux ME (2000) Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 93(3):858–875. https://doi.org/10.1097/00000542-200009000-00038

    Article  CAS  PubMed  Google Scholar 

  24. Bradnam L, Shanahan EM, Hendy K, Reed A, Skipworth T, Visser A, Lennon S (2016) Afferent inhibition and cortical silent periods in shoulder primary motor cortex and effect of a suprascapular nerve block in people experiencing chronic shoulder pain. Clin Neurophysiol 127(1):769–778. https://doi.org/10.1016/j.clinph.2015.03.012

    Article  PubMed  Google Scholar 

  25. Cook T, Minns Lowe C, Maybury M, Lewis JS (2018) Are corticosteroid injections more beneficial than anaesthetic injections alone in the management of rotator cuff-related shoulder pain? A systematic review. Br J Sports Med 52(8):497–504. https://doi.org/10.1136/bjsports-2016-097444

    Article  PubMed  Google Scholar 

  26. Min KS, St Pierre P, Ryan PM, Marchant BG, Wilson CJ, Arrington ED (2013) A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg 22(5):595–601. https://doi.org/10.1016/j.jse.2012.08.026

    Article  PubMed  Google Scholar 

  27. Bowens C Jr, Sripada R (2012) Regional blockade of the shoulder: approaches and outcomes. Anesthesiol Res Pract. https://doi.org/10.1155/2012/971963

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chang KV, Hung CY, Wu WT, Han DS, Yang RS, Lin CP (2016) Comparison of the effectiveness of suprascapular nerve block with physical therapy, placebo, and intra-articular injection in management of chronic shoulder pain: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 97(8):1366–1380. https://doi.org/10.1016/j.apmr.2015.11.009

    Article  PubMed  Google Scholar 

  29. Rutten MJ, Maresch BJ, Jager GJ, de Waal Malefijt MC (2007) Injection of the subacromial-subdeltoid bursa: blind or ultrasound-guided? Acta Orthop 78(2):254–257. https://doi.org/10.1080/17453670710013762

    Article  PubMed  Google Scholar 

  30. Bloom JE, Rischin A, Johnston RV, Buchbinder R (2012) Image-guided versus blind glucocorticoid injection for shoulder pain. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009147.pub2

    Article  PubMed  Google Scholar 

  31. Shanahan EM, Smith MD, Wetherall M, Lott CW, Slavonitek J, FitzGerald O, Ahern MJ (2004) Suprascapular nerve block in chronic shoulder pain: are the radiologists better? Ann Rheum Dis 63(9):1035–1040. https://doi.org/10.1136/ard.2003.015909

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kamal K, Dahiya N, Singh R, Saini S, Taxak S, Kapoor S (2018) Comparative study of anatomical landmark-guided versus ultrasound-guided suprascapular nerve block in chronic shoulder pain. Saudi J Anaesth 12(1):22–27. https://doi.org/10.4103/sja.SJA_123_17

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, Zhang TY, Jiang ZC, Welle K, Kabir K (2015) Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis. Medicine (Baltimore) 94(10):e510. https://doi.org/10.1097/MD.0000000000000510

    Article  CAS  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ebru Yilmaz.

Ethics declarations

Conflict of interest

The author declares no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yilmaz, E. A prospective, comparative study of subacromial corticosteroid injection and subacromial corticosteroid injection plus suprascapular nerve block in patients with shoulder impingement syndrome. Arch Orthop Trauma Surg 141, 733–741 (2021). https://doi.org/10.1007/s00402-020-03455-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03455-x

Keywords

Navigation