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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 257-258

Ultrasound-guided suprascapular nerve block versus intra-articular steroid injection in adhesive capsulitis of shoulder: Comments on treatment options


1 Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
2 Department of Pharmacy, Singapore General Hospital, Singapore

Date of Web Publication30-Aug-2019

Correspondence Address:
Dr. Yeow Leng Tan
Department of Rehabilitation Medicine, Singapore General Hospital, Outram Road
Singapore
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injr.injr_116_19

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How to cite this article:
Tan YL, Lee JY. Ultrasound-guided suprascapular nerve block versus intra-articular steroid injection in adhesive capsulitis of shoulder: Comments on treatment options. Indian J Rheumatol 2019;14:257-8

How to cite this URL:
Tan YL, Lee JY. Ultrasound-guided suprascapular nerve block versus intra-articular steroid injection in adhesive capsulitis of shoulder: Comments on treatment options. Indian J Rheumatol [serial online] 2019 [cited 2019 Nov 13];14:257-8. Available from: http://www.indianjrheumatol.com/text.asp?2019/14/3/257/265828

Dear Editor,

We read with great interest the publication by Verma et al. titled “Comparison of outcome of ultrasound-guided suprascapular nerve block (USNB) versus intra-articular steroid injection (IASI) in adhesive capsulitis of shoulder: A randomized control trial.”[1]

The authors commented on the use of posterior arthroscopic portal landmarks for the IASI group. The location is classically described as 2 cm inferior and 1 cm medial to the posterior lateral corner of acromion. We inquire if authors have instead considered the ultrasound-guided injection for the IASI group. As the posterior glenohumeral joint is a deeper structure, comparative studies have suggested a higher success rate of sonographic guidance of 95% when performing injection into this joint versus anatomical landmark approach (79%).[2] Future studies could consider both ultrasound-guided approaches for both the IASI group and the suprascapular nerve block group. We advocate the use of sonographic guidance due to improved accuracy of injections.

We agree with the study outcome indicating that IASI is similar in efficacy to USNB up to a period of 6 weeks. For pain relief in adhesive capsulitis, Wang et al. conducted a systematic review of IASI versus control groups. They conducted that pain relief for IASI did not last beyond 8 weeks and there was no difference in pain relief between the IASI and control groups from 9 to 24 weeks.[3] In the study by Verma et al., the study follow-ups were up to 6 weeks postintervention. Therefore, it will be interesting to evaluate if the efficacy of IASI in adhesive capsulitis is similar to the USNB group beyond 8 weeks after intervention.

The combination of USNB and IASI has also been described in adhesive capsulitis. Jung et al. retrospectively reviewed patients with adhesive capsulitis at 2 months.[4] Those with the combined method of ultrasonic guidance of USNB and IASI revealed improved pain and function. As no single therapeutic intervention is currently accepted as the most effective treatment for adhesive capsulitis, we could potentially anticipate more publications on the combined methods of intervention and their efficacy.

In summary, various therapeutic interventions are currently available to treat adhesive capsulitis. While in search of the best treatment modality, we support the use of USNB in improving pain and function in patients with adhesive capsulitis. A comparison of therapeutic efficacy beyond 8 weeks between USNB and intra-articular corticosteroids remains to be studied. Combined treatment methods of IASI and USNB should be considered as a treatment option in adhesive capsulitis. In addition, sonographic guidance of IASI should be used in the treatment of adhesive capsulitis. We congratulate Verma et al. and team for their publication of this insightful article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Verma DK, Neyaz O, Nanda S, Handa G. Comparison of outcome of ultrasound-guided suprascapular nerve block versus intra-articular steroid injection in adhesive capsulitis of shoulder: A randomized control trial. Indian J Rheumatol 2019;14:113-8.  Back to cited text no. 1
  [Full text]  
2.
Daley EL, Bajaj S, Bisson LJ, Cole BJ. Improving injection accuracy of the elbow, knee, and shoulder: Does injection site and imaging make a difference? A systematic review. Am J Sports Med 2011;39:656-62.  Back to cited text no. 2
    
3.
Wang W, Shi M, Zhou C, Shi Z, Cai X, Lin T, et al. Effectiveness of corticosteroid injections in adhesive capsulitis of shoulder: A meta-analysis. Medicine (Baltimore) 2017;96:e7529.  Back to cited text no. 3
    
4.
Jung TW, Lee SY, Min SK, Lee SM, Yoo JC. Does combining a suprascapular nerve block with an intra-articular corticosteroid injection have an additive effect in the treatment of adhesive capsulitis? A comparison of functional outcomes after short-term and minimum 1-year follow-up. Orthop J Sports Med 2019;7:2325967119859277.  Back to cited text no. 4
    




 

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