Infiltration and Nerve Block in Painful Shoulder: Current Perspectives and Trends

Abstract

Objective To investigate the use of infiltration and nerve block in shoulder pain treatment by shoulder surgery specialists and compared the results with previous research conducted by our group in 2017.

Methods The present study consisted of a cross-sectional analysis of shoulder surgery specialists to investigate the use of infiltration and nerve block in treating shoulder pain. The survey employed a structured questionnaire addressing the clinical practice regarding these procedures. We collected and analyzed the data using descriptive statistics and associated analyses between variables, such as patient age and type of procedure performed.

Results The results revealed a high rate of infiltrations and nerve blocks for shoulder pain treatment, especially in patients over 40. The use of steroids and hyaluronic acid in infiltrations was common, particularly in shoulder osteoarthritis and partial rotator cuff tears. However, ultrasound guidance during the procedures was not frequent. Two thirds of respondents performed nerve blocks, mainly of the suprascapular nerve, with a low complication rate.

Conclusion The present study highlighted the prevalence and trends in clinical practice regarding infiltrations and nerve blocks in shoulder pain treatment. Despite the gaps identified, such as the low use of ultrasound guidance, the results provide valuable insights to improve therapeutic approaches and to consider the adoption of imaging technologies in the field.

Keywords

athrosis - infiltration - nerve block - shoulder - tendinopathy

• Referências

• 1 Diercks R, Bron C, Dorrestijn O. et al. Dutch Orthopaedic Asso- ciation. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Ortho- paedic Association. Acta Orthop 2014; 85 (03) 314-322
• 2 Codsi MJ. The painful shoulder: when to inject and when to refer. Cleve Clin J Med 2007; 74 (07) 473-474 , 477–478, 480–482 passim
• 3 Stevenson K. Evidence-based review of shoulder pain. Musculoskeletal Care 2006; 4 (04) 233-239
• 4 Laslett M, Steele M, Hing W, McNair P, Cadogan A. Shoulder pain patients in primary care–part 1: Clinical outcomes over 12 months following standardized diagnostic workup, corticosteroid injections, and community-based care. J Rehabil Med 2014; 46 (09) 898-907
• 5 Saccomanni B. Inflammation and shoulder pain–a perspective on rotator cuff disease, adhesive capsulitis, and osteoarthritis: conservative treatment. [retracted in: Clin Rheumatol 2012;31(3):583] Clin Rheumatol 2009; 28 (05) 495-500
• 6 Gumucio JP, Korn MA, Saripalli AL. et al. Aging-associated exacerbation in fatty degeneration and infiltration after rotator cuff tear. J Shoulder Elbow Surg 2014; 23 (01) 99-108
• 7 Ahn Y, Moon YS, Park GY. et al. Efficacy of Intra-articular Triamcinolone and Hyaluronic Acid in a Frozen Shoulder Rat Model. Am J Sports Med 2023; 51 (11) 2881-2890
• 8 Sicard J, Klouche S, Conso C. et al. Local infiltration analgesia versus interscalene nerve block for postoperative pain control after shoulder arthroplasty: a prospective, randomized, comparative noninferiority study involving 99 patients. J Shoulder Elbow Surg 2019; 28 (02) 212-219
• 9 Gerber C, Blumenthal S, Curt A, Werner CM. Effect of selective experimental suprascapular nerve block on abduction and external rotation strength of the shoulder. J Shoulder Elbow Surg 2007; 16 (06) 815-820
• 10 Saglam G, Alisar DÇ. A Comparison of the Effectiveness of Ultrasound-Guided Versus Landmark-Guided Suprascapular Nerve Block in Chronic Shoulder Pain: A Prospective Randomized Study. Pain Physician 2020; 23 (06) 581-588
• 11 Sun Y, Chen J, Li H, Jiang J, Chen S. Steroid Injection and Nonsteroidal Anti-inflammatory Agents for Shoulder Pain: A PRISMA Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore) 2015; 94 (50) e2216
• 12 Vieira FA, Olawa PJ, Belangero PS, Arliani GG, Figueiredo EA, Ejnisman B. Rotator cuff injuries: current perspectives and trends for treatment and rehabilitation. Rev Bras Ortop 2015; 50 (06) 647-651
• 13 Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med 2012; 31 (04) 589-604
• 14 Vestermark GL, Van Doren BA, Connor PM, Fleischli JE, Piasecki DP, Hamid N. The prevalence of rotator cuff pathology in the setting of acute proximal biceps tendon rupture. J Shoulder Elbow Surg 2018; 27 (07) 1258-1262
• 15 Bhatia M, Singh B, Nicolaou N, Ravikumar KJ. Correlation between rotator cuff tears and repeated subacromial steroid injections: a case-controlled study. Ann R Coll Surg Engl 2009; 91 (05) 414-416
• 16 Zhang B, Thayaparan A, Horner N, Bedi A, Alolabi B, Khan M. Outcomes of hyaluronic acid injections for glenohumeral osteoarthritis: a systematic review and meta-analysis. J Shoulder Elbow Surg 2019; 28 (03) 596-606
• 17 Nakamura H, Gotoh M, Kanazawa T. et al. Effects of corticosteroids and hyaluronic acid on torn rotator cuff tendons in vitro and in rats. J Orthop Res 2015; 33 (10) 1523-1530
• 18 Henkus HE, Cobben LP, Coerkamp EG, Nelissen RG, van Arkel ER. The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Arthroscopy 2006; 22 (03) 277-282
• 19 Wu T, Song HX, Dong Y, Li JH. Ultrasound-guided versus blind subacromial-subdeltoid bursa injection in adults with shoulder pain: A systematic review and meta-analysis. Semin Arthritis Rheum 2015; 45 (03) 374-378
• 20 Bell AD, Conaway D. Corticosteroid injections for painful shoulders. Int J Clin Pract 2005; 59 (10) 1178-1186
• 21 Marder RA, Kim SH, Labson JD, Hunter JC. Injection of the subacromial bursa in patients with rotator cuff syndrome: a prospective, randomized study comparing the effectiveness of different routes. J Bone Joint Surg Am 2012; 94 (16) 1442-1447
• 22 Tobola A, Cook C, Cassas KJ. et al. Accuracy of glenohumeral joint injections: comparing approach and experience of provider. J Shoulder Elbow Surg 2011; 20 (07) 1147-1154
• 23 Kraeutler MJ, Cohen SB, Ciccotti MG, Dodson CC. Accuracy of intra-articular injections of the glenohumeral joint through an anterior approach: arthroscopic correlation. J Shoulder Elbow Surg 2012; 21 (03) 380-383
• 24 Lara PHS, Pereira VL, Júnior RR, Ribeiro LM, Ejnisman B, Belangero PS. Panorama of Infiltration for Painful Shoulder Among Shoulder Specialists. Rev Bras Ortop 2020; 55 (01) 95-99