Randomized controlled trial of suprascapular nerve blocks for subacute adhesive capsulitis

BACKGROUND: 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.

AIM: To compare the efficacy of ultrasound-guided suprascapular nerve blocks versus saline injections for treating adhesive capsulitis in the subacute phase.

DESIGN: Randomized double-blinded controlled trial; Level of evidence, 2.

SETTING: Out-patient consultation of Physical and Rehabilitation Medicine in a general hospital.

POPULATION: Thirty-five patients with subacute adhesive capsulitis.

METHODS: Patients were randomly allocated to receive either 3 successive (1-week interval) ultrasound-guided suprascapular nerve blocks with ropivacaine 5ml 2mg/ml (intervention group) or ultrasound-guided injections of 5ml 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.

RESULTS: 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.

CONCLUSIONS: 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.

CLINICAL REHABILITATION IMPACT: The current place of suprascapular nerve blocks in the treatment strategy of adhesive capsulitis needs to be rediscussed.