|LETTER TO EDITOR
|Ahead of print publication
Ultrasound-guided suprascapular nerve block versus intra-articular steroid injection in adhesive capsulitis of shoulder: Comments on treatment options
Yeow Leng Tan1, Jun Yin Lee2
1 Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
2 Department of Pharmacy, Singapore General Hospital, Singapore
|Date of Web Publication||30-Aug-2019|
Yeow Leng Tan,
Department of Rehabilitation Medicine, Singapore General Hospital, Outram Road
Source of Support: None, Conflict of Interest: None
|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 [Epub ahead of print] [cited 2019 Sep 22]. Available from: http://www.indianjrheumatol.com/preprintarticle.asp?id=265828
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.”
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%). 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. 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. 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.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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. [Full text]
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.
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.
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.