Suprascapular nerve block in chronic shoulder pain: are the radiologists better? | Annals of the Rheumatic Diseases

Subscribe
Log In More

Log in via Institution
Log in via OpenAthens

Log in using your username and password
For personal accounts OR managers of institutional accounts

Username *

Password *

Forgot your log in details?Register a new account?
Forgot your user name or password?
Basket
Search More

Search for this keyword

Advanced search

Close More
Main menu

Latest content

Current issue

Archive

Authors

Podcasts

About
Subscribe
Log in More

Log in via Institution
Log in via OpenAthens

Log in using your username and password
For personal accounts OR managers of institutional accounts

Username *

Password *

Forgot your log in details?Register a new account?
Forgot your user name or password?
BMJ Journals

Responses

Extended reports

Suprascapular nerve block in chronic shoulder pain: are the radiologists better?

Free

Compose a Response to This Article

Compose Response

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

No

Please describe the competing interests

PLEASE NOTE:

A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.

I agree to and have read the terms and conditions for rapid responses and BMJ Privacy Notice *

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

Methylprednisolone confers no extra benefit in suprascapular nerve block
Robert W Marshall
Published on: 5 October 2004

Published on: 5 October 2004
Methylprednisolone confers no extra benefit in suprascapular nerve block
- Robert W Marshall, Specialist Registrar in Rheumatology
- Other Contributors:
  Richard G. Hull
Dear Editor,
We read with interest the article by Shanahan et al [1] on suprascapular nerve blocks and the accompanying editorial by Hall and Buchbinder [2]. It is gratifying to know that in this context the indirect method of needle placement produces a similar outcome to the radiologically-guided method. However, we would like to point out an important methodological flaw in the study.
The pat...
Show More

Dear Editor,
We read with interest the article by Shanahan et al [1] on suprascapular nerve blocks and the accompanying editorial by Hall and Buchbinder [2]. It is gratifying to know that in this context the indirect method of needle placement produces a similar outcome to the radiologically-guided method. However, we would like to point out an important methodological flaw in the study.
The patients who received injections via the landmark approach were injected with 40mg of methylprednisolone and 10 mls of 0.5% bupivacaine, whereas those who underwent CT-guided injection received 40mg of methylprednisolone and 3 mls of 0.5% bupivacaine. Previous studies have shown that suprascapular nerve blocks produce effective analgesia for a variety of painful shoulder conditions, including frozen shoulder [3], rotator cuff lesions [4], and rheumatoid arthritis [5]. Fundamentally, however, in a double-blind study of 58 rheumatoid shoulders, suprascapular nerve block with bupivacaine alone has been shown to be as effective as bupivacaine plus methylprednisolone at improving pain, stiffness, and range of movement [6]. The authors of this study concluded that the addition of methylprednisolone conferred no additional benefit.
Thus, if one concludes from this that the local anaesthetic is the active ingredient, Shanahan’s two patient groups were given different doses of the same drug (10 mls compared with 3 mls). Consequently the study may have underestimated the effect of the CT-guided approach.
References
(1). Shanahan EM, Smith MD, Wetherall M et al. Suprascapular nerve block in chronic shoulder pain: are the radiologists better? Ann Rheum Dis 2004;63:1035-1040
(2). Hall S, Buchbinder R. Do imaging methods that guide needle placement improve outcome? Ann Rheum Dis 2004;63:1007-1008
(3). Dahan TH, Fortin L, et al. Double blind randomized clinical trial examining the efficacy of bupivacaine suprascapular nerve blocks in frozen shoulder. J Rheumatol. 2000 Jun;27(6):1464-9.
(4). Vecchio PC, Adebajo AO, Hazleman BL. Suprascapular nerve block for persistent rotator cuff lesions. J Rheumatol. 1993 Mar;20(3):453-5.
(5). Emery P, Bowman S, et al. Suprascapular nerve block for chronic shoulder pain in rheumatoid arthritis. BMJ. 1989 Oct 28;299(6707):1079-80.
(6). Gado K, Emery P. Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. Ann Rheum Dis. 1993 Mar;52(3):215-8.
Show Less

Conflict of Interest:
None declared.
- Back to top