Effectiveness of suprascapular nerve block associated with physiotherapy compared with physiotherapy isolated for treatment of adhesive capsulitis: a randomized controlled trial

Abstract

Background: Adhesive capsulitis (AC) is one of the primary causes of shoulder girdle dysfunction, characterized by pain and restricted mobility in the glenohumeral joint. There is no consensus concerning treatment, with various clinical and surgical approaches proposed. The purpose of this paper is to compare the results of AC treatment in patients who underwent suprascapular nerve block (SSNB) associated with physiotherapy (PT) and those who only underwent physiotherapy.

Methods: Patients diagnosed with AC, presenting with spontaneous shoulder pain and progressively restricted glenohumeral movement in all directions, including a loss of at least 50% of external rotation, were included. Eligibility criteria required no prior treatment and magnetic resonance imaging findings showing a T2 hypersignal in the inferior joint capsule, thickening >4 mm, reduced axillary recess filling, and edema in the rotator interval. Exclusion criteria included secondary frozen shoulder, type I diabetes mellitus, rotator cuff tear, calcific tendonitis, symptomatic cervical radiculopathy, previous shoulder fracture or surgery, acute or chronic shoulder infection, pregnancy, recent shoulder injection (within the last 6 weeks), or other secondary conditions potentially affecting shoulder function (eg, rheumatologic disease or hemiplegia). Patients were randomized into 2 groups: the Block group (SSNB + PT) and the Control group (PT). The Block group received 4 serial blocks of 6 ml of 0.25% bupivacaine at 15-day intervals. Both groups were assessed for range motion using digital goniometry, the University of California, Los Angeles score, and the visual analog scale before treatment and at 2, 4, and 6 months. Statistical analyses were conducted with a 95% confidence interval, and a P < .05 was considered significant.

Results: A total of 290 patients were randomized, with 182 of them being followed up. Sixty-nine patients received nerve block and physiotherapy (SSNB + PT), and 113 were controls (only PT). The t-test showed no statistical difference between the 2 groups at baseline, and at 2, 4, and 6 months (P > .05) for all evaluated scores. After 6 months, 15 patients underwent surgery, with no difference between groups.

Conclusion: Serial suprascapular nerve block was not statistically superior in improving the parameters measured compared to the control group for AC treatment.

Keywords: Frozen shoulder; UCLA scale; adhesive capsulitis; nerve block; physiotherapy; visual analog scale (VAS).