Suprascapular nerve block. A new approach for the management of frozen shoulder.

A new approach for the management of frozen shoulder associated with reflex sympathetic dystrophy is presented. A suprascapular nerve block was performed by needle insertion behind the lateral end of the clavicle at its junction with the insertion of the trapezius muscle; the needle was directed downwards and backwards. The suprascapular nerve was identified by its response to nerve stimulation. Three ml of 0.25% bupivacaine with 1:200,000 adrenaline was injected. The block was repeated twice weekly for a total of 2-4 treatments. Evaluation of the efficacy of the block was achieved by comparing subjective pain scores and passive range of movement before the first block and after the final one. Highly significant improvements were obtained. The choice of blockade of the suprascapular nerve is a new concept for the management of the frozen shoulder of reflex sympathetic dystrophy. This is based on the fact that the nerve contains a high proportion of sympathetic fibres supplying the shoulder joint. The new approach proved to be simple, highly successful, and reproducible.