Department of Physical and Rehabilitation Medicine, UZ Brussel, Brussels, Belgium -
Department of Physical and Rehabilitation Medicine, Clinique St-Jean, Brussels, Belgium -
Eur J Phys Rehabil Med. 2022 Aug;58(4):630-637. doi: 10.23736/S1973-9087.22.07410-X. Epub 2022 May 16.
Shoulder pain and loss of function remain a therapeutic challenge in adhesive capsulitis. Suprascapular nerve blocks, a common treatment in adhesive capsulitis, are considered a safe and effective method for the resolution of pain and restoration of shoulder range of motion (ROM). To our knowledge, no data are available on the use of suprascapular nerve blocks in adhesive capsulitis in the subacute phase.
The aim of this study was to compare the efficacy of ultrasound-guided suprascapular nerve blocks versus saline injections for treating adhesive capsulitis in the subacute phase.
Randomized double-blinded controlled trial; level of evidence 2.
Out-patient consultation of Physical and Rehabilitation Medicine in a general hospital.
Thirty-five patients with subacute adhesive capsulitis.
Patients were randomly allocated to receive either 3 successive (1-week interval) ultrasound-guided suprascapular nerve blocks with ropivacaine 5 mL 2 mg/mL (intervention group) or ultrasound-guided injections of 5 mL sterile saline solution (NaCl 0.9%) (control group), at the floor of the suprascapular fossa. Primary outcome was shoulder function assessed by the Constant-Murley Score. Secondary outcomes were shoulder ROM and shoulder pain intensity. Assessments were performed before each injection and 4 weeks after the last injection.
A significant increase of Constant-Murley Score (P<0.001), increase of shoulder ROM (all directions: P<0.011) and decrease of pain (P<0.001), were observed over time in both study groups. However, no significant differences were observed between the intervention and the control group.
Three successive suprascapular nerve blocks did not provide a better outcome than saline injections on shoulder function, ROM, and pain in subacute adhesive capsulitis. These negative findings warrant some considerations on the natural history of adhesive capsulitis, as well as timing, type, and placebo effects of injections.
The current place of suprascapular nerve blocks in the treatment strategy of adhesive capsulitis needs to be rediscussed.
肩痛和功能丧失仍然是粘连性肩关节囊炎的治疗难题。肩胛上神经阻滞是粘连性肩关节囊炎的一种常见治疗方法，被认为是缓解疼痛和恢复肩部活动范围（ROM）的安全有效方法。据我们所知，目前尚无亚急性粘连性肩关节囊炎中使用肩胛上神经阻滞的数据。
本研究旨在比较超声引导下肩胛上神经阻滞与生理盐水注射治疗亚急性粘连性肩关节囊炎的疗效。
随机双盲对照试验；证据水平 2。
综合医院物理康复医学门诊。
35 例亚急性粘连性肩关节囊炎患者。
患者随机分为 3 组，每组接受 3 次（间隔 1 周）超声引导下肩胛上神经阻滞，用罗哌卡因 5mL2mg/mL（干预组）或 5mL 无菌生理盐水（NaCl 0.9%）（对照组），在肩胛上窝底部注射。主要结局是用 Constant-Murley 评分评估肩关节功能。次要结局是肩关节活动范围和肩关节疼痛强度。在每次注射前和最后一次注射后 4 周进行评估。
两组患者的 Constant-Murley 评分（P<0.001）、肩关节活动范围（所有方向：P<0.011）和疼痛（P<0.001）均随时间显著增加。然而，干预组与对照组之间无显著差异。
3 次连续肩胛上神经阻滞在亚急性粘连性肩关节囊炎的肩关节功能、ROM 和疼痛方面并未提供优于生理盐水注射的疗效。这些阴性结果需要对粘连性肩关节囊炎的自然史、注射的时机、类型和安慰剂效应进行一些考虑。
肩胛上神经阻滞在粘连性肩关节囊炎治疗策略中的地位需要重新讨论。
