Bennett Jonathan, Patel Neal, Nantha-Kumar Nakulan, Phillips Veronica, Nayar Sandeep K, Kang Niel
University of Cambridge, Cambridge, UK.
University College London, London, UK.
Bone Joint J. 2025 Jan 1;107-B(1):19-26. doi: 10.1302/0301-620X.107B1.BJJ-2024-0644.R1.
Frozen shoulder is a common and debilitating condition characterized by pain and restricted movement at the glenohumeral joint. Various treatment methods have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder.
The study protocol was registered with PROSPERO (CRD42023475851). We searched the MEDLINE, Embase, and Cochrane Library databases in November 2023. Randomized controlled trials (RCTs) comparing SSNB against other interventions were included. The primary outcome was any functional patient-reported outcome measure. Secondary outcomes were the visual analogue scale (VAS) for pain, range of motion (ROM), and complications. Risk of bias was assessed using the Cochrane risk of bias v. 2.0 tool.
A total of 12 RCTs were identified (702 patients; mean age 55 years (30 to 72)). Eight RCTs were deemed "low" risk-of-bias and four raised "some concerns". Comparator interventions included intra-articular steroid injection (IAI), hydrodistension, physiotherapy, and placebo injection with 0.9% saline. Seven studies compared SSNB to IAI, with SSNB resulting in greater improvement in the Shoulder and Pain Disability Index (mean difference -4.75 (95% CI -8.11 to -1.39); p = 0.006) and external rotation (mean difference 11.64 (95% CI -0.05 to 23.33); p = 0.050). In three studies, SSNB demonstrated better VAS (mean difference -0.31 (95% CI -0.53 to 1.79); p = 0.004) compared to physiotherapy (with or without placebo injection). One study favoured hydrodistension over SSNB in improving ROM and VAS. There was no significant difference in outcomes between SSNB administered under ultrasound guidance or using a landmark technique.
SSNB can be administered in the outpatient clinic with promising outcomes compared to IAI or physiotherapy based on level I evidence. It can therefore be considered as a first-line treatment option.
肩周炎是一种常见且使人衰弱的病症，其特征为盂肱关节疼痛和活动受限。人们探索了各种治疗方法来缓解症状，肩胛上神经阻滞（SSNB）成为一种有前景的干预措施。本荟萃分析旨在评估SSNB治疗肩周炎的有效性。
该研究方案已在国际前瞻性注册系统（PROSPERO，注册号CRD42023475851）登记。我们于2023年11月检索了MEDLINE、Embase和Cochrane图书馆数据库。纳入比较SSNB与其他干预措施的随机对照试验（RCT）。主要结局是患者报告的任何功能结局指标。次要结局包括疼痛视觉模拟量表（VAS）、活动范围（ROM）和并发症。使用Cochrane偏倚风险v.2.0工具评估偏倚风险。
共识别出12项RCT（702例患者；平均年龄55岁（30至72岁））。8项RCT被判定为“低”偏倚风险，4项存在“一些担忧”。对照干预措施包括关节内注射类固醇（IAI）、液压扩张、物理治疗以及0.9%盐水安慰剂注射。7项研究将SSNB与IAI进行比较，SSNB在肩部和疼痛残疾指数方面改善更大（平均差值 -4.75（95%CI -8.11至 -1.39）；p = 0.006），在外旋方面也有改善（平均差值11.64（95%CI -0.05至23.33）；p = 0.050）。在3项研究中，与物理治疗（无论是否联合安慰剂注射）相比，SSNB的VAS表现更好（平均差值 -0.31（95%CI -0.53至 -1.79）；p = 0.004）。一项研究表明在改善ROM和VAS方面液压扩张优于SSNB。超声引导下进行SSNB与采用体表标志技术进行SSNB的结局无显著差异。
基于I级证据，与IAI或物理治疗相比，SSNB可在门诊进行且疗效良好。因此可将其视为一线治疗选择。
