Management of periarthritis of shoulder joint by suprascapular nerve block by Dr Bipul Borthakur

2.  Periarthritis of the shoulder joint is characterized by:
Painful and global restriction
of active and passive
glenohumeral range of motion
in atleast two directions, most
commonly shoulder abduction
and external rotation.

3.  Incidence:
 3-5% in general population
 20% in diabetics
 More commonly seen in females
 Peaks in 40-60 years age group
 10 times more common in diabetics

4.  Shoulder joint
 Structurally synovial ball and socket joint
 Functionally diarthrosis and multiaxial joint
 Formed by articulation between
glenoid cavity of scapula and head
of the humerus
 Most mobile joint of human body
because of the limited interface of
the humerus and scapula due to the
very loose joint capsule

5.  Capsule of glenohumeral joint
 It completely surrounds the joint
 Attachments:
Above: Circumference of the
glenoid cavity
Below: Anatomical neck of
humerus

6.  Suprascapular nerve
 It is a mixed nerve
 Originates in upper trunk of
brachial plexus (C5 and C6 roots)

8. Just proximal to suprascapular notch,
suprascapular nerve gives off sensory branches
Travels through notch
Proceeds laterally
Innervates - Acromioclavicular joint
- Associated bursa
- Coracoclavicular and
coracohumeral ligaments

9.  Sensory fibres of suprascapular nerve supplies:
 Superior and posterolateral regions of shoulder joint
 Capsule
 Acromioclavicular joint

10. Inflammation of the joint capsule
Release of inflammatory cytokines
in glenohumeral and subacromial bursa
Myofibroblasts along with type-3 collagen
deposition on coracohumeral ligament
and rotator interval capsule
Stiffness
Pain
Capsular fibrosis

11.  Therapeutic options for management of periarthrirtis shoulder
include:
 NSAIDs
 Intra-articular steroid injections
 Suprascapular nerve block (SSNB)
 Platelet-rich plasma injections
 Manipulation under general anaesthesia
 Arthroscopic capsular release

12.  Nerve blockage in patients with periarthritis shoulder provided
better pain tolerability
 Implementation of imaging guidance with ultrasound has improved
the accuracy of blocking the suprascapular nerve
 Ultrasound guided nerve block had more significant and longer pain
relief than traditional blind technique

13.  Patient is made to sit upright
 An ultrasound probe is placed over the suprascapular region
 The suprascapular nerve is identified in the scapular notch
 2% lignocaine is injected for local anaesthesia
 A short bevel needle is advanced in-plane under ultrasound
guidance towards the scapular notch
 A mixture of lignocaine and depot methylprednisolone is injected
near the nerve.
 Improvement is evaluated using Constant and Murley shoulder
assessment score.

15.  A significant decrease in pain and increase in activity of the
shoulder joint is seen after ultrasound-guided SSNB without major
adverse effects

16. THANK YOU