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Egyptian Rheumatology and Rehabilitation
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Suprascapular nerve block followed by Codman’s manipulation and exercise in the rehabilitation of idiopathic frozen shoulder

Egyptian Rheumatology and Rehabilitation volume 41, pages 172–178 (2014)Cite this article

Abstract

Background

Frozen shoulder is characterized by inflammation of the synovial lining and capsule, with subsequent generalized contracture of the glenohumeral joint causing shoulder pain and a gradual loss of both passive and active range of motion. Pain relief through suprascapular nerve block (SSNB) followed by manipulation and home exercises may be a suitable treatment option in such patients.

Objective

The aim of this study was to evaluate the role of SSNB followed by Codman’s shoulder manipulation and home exercises in the management of idiopathic frozen shoulder.

Patients and methods

Twenty patients with idiopathic unilateral frozen shoulder underwent SSNB followed by Codman’s manipulation of the glenohumeral joint and a home exercise program. Differences in range of motion, visual analog scale for pain, and Shoulder Disability Questionnaire were assessed before manipulation and at 1, 6, and 12 weeks after manipulation.

Results

The mean age of the patients was 52.1 years. Active range of motion increased significantly for flexion, abduction, internal rotation, and external rotation. Significant decrease in visual analog scale and Shoulder Disability Questionnaire scores between baseline and follow-up assessments was observed.

Conclusion

Manipulation under SSNB is a safe, effective, and minimally invasive procedure for relieving pain, improving range of motion, and decreasing disability in patients with idiopathic frozen shoulder.

References

  1. Codman EA. The shoulder. Boston: Mass: Thomas Todd; 1934. 216–224.

    Google Scholar 

  2. Anton HA. Frozen shoulder. Can Fam Physician 1993; 39:1773–1778.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Thierry D. Adhesive capsulitis. Emedicine 2005; 11:7.

    Google Scholar 

  4. Harryman DT, Lazurus MD, Rozencwaig R. The stiff shoulder. In: Rockwood CA, Matsen FA, Wirth MA, Lippitt SB, editors. The shoulder. 3rd ed. Philadelphia: Saunders; 2004.

    Google Scholar 

  5. McGinty JB, Burkhart SS, Johnson DH, Jackson RW, Richmond JC. Operative arthroscopy. 3rd ed. Lippincott Williams and Wilkins, 2002. p. 558–569

  6. Dias R, Cutts S, Massoud S. Frozen shoulder: clinical review. Br Med J 2005; 331:1453–1456.

    Article  Google Scholar 

  7. Fernandes MR. Arthroscopic treatment of refractory adhesive capsulitis of the shoulder. Rev Col Bras Cir 2014; 41:30–35.

    Article  Google Scholar 

  8. Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions –systematic review. Br J Sports Med 2011; 45:49–56.

    Article  CAS  Google Scholar 

  9. Lorbach O, Anagnostakos K, Scherf C, Seil R, Kohn D, Pape D. Non operative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections. J Shoulder Elbow Surg 2010; 19:172–179.

    Article  Google Scholar 

  10. Børglum J, Bartholdy A, Hautopp H, Krogsgaard MR, Jensen K. Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review. Acta Anaesthesiol Scand 2011; 55:242–247.

    Article  Google Scholar 

  11. Iqbal MJ, Anwar W, Rahman N, Kashif S, Khan A. Suprascapular nerve block in the treatment of frozen shoulder. J Surg Pak 2012; 17:27–31.

    Google Scholar 

  12. Yasar E, Vural D, Safaz I, Balaban B, Yilmaz B, Goktepe AS, Alaca R. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or suprascapular nerve block? A randomized controlled trial. Clin Rehabil 2011; 25:60–68.

    Article  Google Scholar 

  13. Dahan THM, Fortin L, Pelletier M, Petit M, Suissa S. Double trial randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol 2000; 27:1464–1469.

    CAS  PubMed  Google Scholar 

  14. Dangoisse MJ, Wilson DJ, Glynn CJ. MRI and clinical study of an easy and safe technique of suprascapular nerve blockade. Acta Anaesthesiol Belg 1994; 45:49–54.

    CAS  PubMed  Google Scholar 

  15. Hamdan TA, Al-Essa KA. Manipulation under anesthesia for the treatment of frozen shoulder. Int Orthop 2003; 27:107–109.

    Article  CAS  Google Scholar 

  16. Cheng PL. Simulation of Codman’s paradox reveals a general law of motion. J Biomech 2006; 39:1201–1207.

    Article  Google Scholar 

  17. Kivimaki J, Pohjolainen T, Malmivaara A, Kannisto M, Guillaume J, Seitsalo S, Nissinen M. Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized, controlled trial with 125 patients. J Shoulder Elbow Surg 2007; 16:722–726.

    Article  Google Scholar 

  18. Van der Heijden GJ, Leffers P, Bouter LM. Shoulder Disability Questionnaire design and responsiveness of a functional status measure. J Clin Epidemiol 2000; 53:29–38.

    Article  Google Scholar 

  19. Movafegh A, Rezazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg 2005; 102:263–267.

    Article  Google Scholar 

  20. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analogue scale. Ann Emerg Med 2001; 38:633–638.

    Article  CAS  Google Scholar 

  21. Winters JC, Sobel JS, Groenier KH, Arendzen HJ, Meyboom-de Jong B. Comparison of physiotherapy, manipulation and corticosteroid injection for treating shoulder complaints in general practice: randomized, single blind study. BMJ 1997; 314:1320–1325.

    Article  CAS  Google Scholar 

  22. Buchbinder R, Hoving J, Green S, Hall S, Forbes A Nash P. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomized double blind, placebo controlled trial. Ann Rheum Dis 2004; 63:1460–1469.

    Article  CAS  Google Scholar 

  23. Aroll B, Goodyear-Smith F. Corticosteroid injections for painful shoulder: a meta-analysis. Br J Gen Pract 2005; 55:224–228.

    Google Scholar 

  24. Loew M, Heichel TO, Lehner B. Intra-articular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg 2005; 14:16–21.

    Article  Google Scholar 

  25. Castellarin G, Ricci M, Vedovi E, Vecchini E, Sembenini P, Marangon A. Manipulation and arthroscopy under general anesthesia and early rehabilitative treatment for frozen shoulders. Arch Phys Med Rehabil 2004; 8:1236–1240.

    Article  Google Scholar 

  26. Abdelshafi ME, Yosry M, Elmulla AF, Al-Shahawy EA, Adou Aly M, Eliewa EA. Relief of chronic shoulder pain: a comparative study of three approaches. Middle East J Anesthesiol 2011; 21:83–92.

    PubMed  Google Scholar 

  27. Ozkan K, Ozcekic AN, Sarar S, Cift H, Feyza Ozkan U, Unay K. Suprascapular nerve block for the treatment of frozen shoulder. Saudi J Anaesth 2012; 6:52–55.

    Article  Google Scholar 

  28. Shanahan EM, Ahern M, Smith M, Wetherall M, Bresnihan B, FitzGerald O. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis 2003; 62:400–406.

    Article  CAS  Google Scholar 

  29. Shrestha BR, Maharjan SK, Shrestha S. Comparative study between tramadol and dexamethasone as an admixture to bupivacaine in supraclavicular brachial plexus block. J Nepal Med Assoc 2007; 46:158–164.

    CAS  Google Scholar 

  30. Colombo G, Padera R, Langer R, Kohane DS. Prolonged duration local anesthesia with lipid–protein–sugar particles containing bupivacaine and dexamethasone. J Biomed Mater Res A 2005; 75:458–464.

    Article  Google Scholar 

  31. Hollis R, Lahav A, Hugh S, West JR. Manipulation of the shoulder using Codman’s paradox. Orthopedics 2006; 29:14–19.

    Article  Google Scholar 

  32. Birklein F, Schmelz M. Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS). Neurosci Lett 2008; 437:199–202.

    Article  CAS  Google Scholar 

  33. Schaible HG. Peripheral and central mechanisms of pain generation. Handb Exp Pharmacol 2007; 177:3–28.

    Article  CAS  Google Scholar 

  34. Chan CW, Peng PW. Suprascapular nerve block: a narrative review. Reg Anesth Pain Med 2011; 36:358–373.

    Article  Google Scholar 

  35. Khan JA, Devkota P, Acharya BM, Pradhan NMS, Shreshtha SK, Singh M, Mainali L. Manipulation under local anesthesia in idiopathic frozen shoulder –a new effective and simple technique. Nepal Med Coll J 2009; 11:247–253.

    CAS  PubMed  Google Scholar 

  36. Mitra R, Harris A, Umphrey C, Smuck M, Fredericson M. Adhesive capsulitis: a new management protocol to improve passive range of motion. PM R 2009; 1:1064–1068.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ain Shams University, 211 Abdel-Hamid Keshk Street, Cairo, Egypt

    Mohja A. El-Badawy MD & Mahmoud Mohamed Fathalla

Authors
  1. Mohja A. El-Badawy MD
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  2. Mahmoud Mohamed Fathalla
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Correspondence to Mohja A. El-Badawy MD.

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El-Badawy, M.A., Fathalla, M.M. Suprascapular nerve block followed by Codman’s manipulation and exercise in the rehabilitation of idiopathic frozen shoulder. Egypt Rheumatol Rehabil 41, 172–178 (2014). https://doi.org/10.4103/1110-161X.147360

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