Post Stroke Hemiplegic Shoulder Pain – Plain Local Suprascapular Block as Good as Steroid Injection in Shoulder

Beefing up my contention that suprascapular nerve blocks have therapeutic shoulder effects, is a new article finding it works as well as steroid injections into shoulder – without having to use steroids.

Clin Rehabil. 2010 Oct 13. [Epub ahead of print]
Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial.
Yasar E, Vural D, Safaz I, Balaban B, Yilmaz B, Goktepe AS, Alaca R.     abstract here

  • 11 cases intra-articular steroid versus 15 cases of suprascapular block
  • Most early 60’s
  • even split from left to right sides
  • Pain VAS level 8/10(that’s bad)

Intra-articular steroid injections:

  • posterior approach: “the needle advanced to the anteromedial region of the shoulder [from] below the posteroinferior border of the posterolateral trigon of acromion. “
  • Triamcinolone acetonide 40 mg (1mL Kenacort A) and 6mL of prilocaine (Citanest 2%)

Suprscapular nerve block (older style technique)

  • seated
  • “spine of scapula was identified as the horizontal line and a perpendicular line was drawn from the angle of the scapula upward to bisect the spine of the scapula. The needle was inserted at the suprascapular notch point about 2 cm lateral and ~1.5 cm superior to the intersecting point of the horizontal and perpendicular lines”.
  • 10mL of prilocaine (Citanest 2%) by self into suprascapular notch.
  • Both helped with pain and range of motion.

Their conclusion – “Suprascapular nerve block is a simple, safe and inexpensive technique to relieve pain originating from the hemiplegic shoulder”

Comment – It looks like suprascapular blocks could be useful without steroid in a variety of shoulder issues. Being steroid sparing would be a big benefit.

This entry was posted in Injection, shoulder. Bookmark the permalink.

Leave a Reply

Your email address will not be published.