Jadon Ashok, Sanyal Subhojit, Pavan Sudarshan, Bakshi Apoorva, Bharadwaj Arvind, Singh Abhay Pratap
Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Telco Colony, Jamshedpur, Jharkhand, India.
Department of Orthopaedics, IPGMER, Kolkata, West Bengal, India.
J Anaesthesiol Clin Pharmacol. 2023 Apr-Jun;39(2):195-200. doi: 10.4103/joacp.joacp_263_21. Epub 2022 Jan 11.
Increased pain and associated stiffness hinders the advantages of exercise and process of recovery in primary adhesive capsulitis. We hypothesized that suprascapular nerve block may positively affect the outcome due to its role in pain relief of acute or chronic shoulder pain. We compared the effect of suprascapular nerve block and exercise with only exercise on the recovery of primary adhesive capsulitis.
A total of 96 patients of both sexes presenting with primary adhesive capsulitis were divided by computer randomization in two equal groups ( = 48). Group A received exercise only and Group B received suprascapular nerve block followed by exercise. Oral paracetamol was given for analgesia as desired. Patients were followed up at 4, 8, 16, and 24 weeks. Pain was assessed by visual analog scale; functional outcome by Shoulder Pain and Disability Index and range of movement by goniometer.
The pain scores and Shoulder Pain and Disability Index scores were significantly lower at all observation points of 4, 8,16, and 24 weeks in Group B than Group A ( < 0.05). The range of movement in all the ranges of forward flexion, extension, internal and external rotation, and abduction at all observation points was significantly higher in Group-B ( < 0.05) compared to Group A. The consumption of analgesics was significantly more in Group A than Group B at 4 and 8 weeks ( = 0.020 and = 0.044) but comparable at 12 and 24 weeks ( = 0.145 and = 0.237 respectively).
Combining SSNB with exercise is more effective in treatment of primary adhesive capsulitis than exercise alone and reduces the use of analgesics. SSNB it is effective and safe to use in primary adhesive capsulitis.
疼痛加剧及相关的僵硬会妨碍原发性粘连性肩周炎患者运动带来的益处及恢复进程。我们推测，肩胛上神经阻滞因其在缓解急慢性肩部疼痛中的作用，可能对治疗结果产生积极影响。我们比较了肩胛上神经阻滞联合运动与单纯运动对原发性粘连性肩周炎恢复的效果。
共有96例原发性粘连性肩周炎患者通过计算机随机分为两组（每组n = 48）。A组仅接受运动治疗，B组接受肩胛上神经阻滞，随后进行运动治疗。根据需要给予口服对乙酰氨基酚用于镇痛。在4、8、16和24周对患者进行随访。通过视觉模拟量表评估疼痛；通过肩痛和功能障碍指数评估功能结果，通过量角器评估活动范围。
在4、8、16和24周的所有观察点，B组的疼痛评分以及肩痛和功能障碍指数评分均显著低于A组（P < 0.05）。与A组相比，B组在所有观察点的前屈、后伸、内旋、外旋和外展活动范围均显著更大（P < 0.05）。在4周和8周时，A组的镇痛药消耗量显著高于B组（P = 0.020和P = 0.044），但在12周和24周时相当（分别为P = 0.145和P = 0.237）。
肩胛上神经阻滞联合运动治疗原发性粘连性肩周炎比单纯运动更有效，且减少了镇痛药的使用。肩胛上神经阻滞用于原发性粘连性肩周炎有效且安全。
