Suprascapular Nerve Block and Pulsed Radiofrequency
The anatomy of suprascapular nerve
The suprascapular nerve arises from the brachial plexus (a network of nerve fibres) and runs from the neck to the upper end of the scapula and into the shoulder. The suprascapular nerve is responsible for innervating 60 – 80% of the shoulder joint and several of the muscles which are attached to the scapula (also known as the shoulder bone); in particular, the infraspinatus and supraspinatus muscles.
Two recognised treatments for shoulder pain are suprascapular nerve block and pulsed radiofrequency. Local anaesthetic and steroid nerve blocks can break the vicious cycle of pain and spasms. The improved ranges of movement and pain relief enabling rehabilitation and physiotherapy.
Suprascapular nerve block and pulsed radiofrequency procedure
A suprascapular nerve block can provide relief to individuals suffering from acute or chronic shoulder pain.
Suprascapular nerve block or Pulsed radiofrequency are day case procedures which can be performed with an anatomical landmark technique or ultrasound guidance. This will take place in theatre under full aseptic conditions with the patient sitting or in a semi-reclined position. A small needle in the back of your hand can be used to administer sedation or in case of an emergency. The skin is well cleaned before a small amount of local anaesthetic is applied in order to numb the injection area. The physician then directs a small needle to the nerve. A small mixture of steroid (anti-inflammatory medication) and anaesthetic is then injected into the nerve.
Pulsed radiofrequency is a relatively new treatment for shoulder pain which uses neurostimulation therapy in order to modulate the function of the nerve. Pain signals to the brain are interrupted by an electrical pulse, meaning the patient does not feel the same pain as he or she did previously. This may be indicated if there is a significant reduction in the pain levels after the suprascapular nerve block to prolong the benefit. This procedure can be described as a ‘retuning’ of the nerves so that they modulate pain transmission.
Patients are then monitored in a recovery area before transfer to the ward and discharge home. Patients may experience a numb feeling for a few hours. Pain at the injection site may increase for four or more days. It is advisable to rest for 24 hours and resume stretches and exercises when the pain eases. This window of pain relief should be utilised for performance of strengthening exercises and rehabilitation physiotherapy.
There is a variable response to injection treatment. It is important to discuss both the benefits and risks of the procedure with your doctor before any agreement to undergo the procedure is reached. Although the chance of any complications is generally low, as with all surgical procedures, there is an element of risk involved including failure to get benefit or pain aggravation. There may be an allergic reaction to the steroid or any of the medications, or that the injection causes an infection or bleeding. Pneumothorax (from lung puncture) or nerve damage is extremely rare.