Background:Frozen shoulder is prevalent among diabetic patients, and usually has aggressive course, with more tendency to be bilateral and resistant to treatment. Suprascapular nerve block (SSNB) is used with increasing frequency by anesthetists and rheumatologists in the management of frozen shoulder. We previously introduced a protocol of nine injections for SSNB with better short term outcome than single SSNB injection (1). Long term outcome of SSNB in management of frozen shoulder is still not detected.Objectives:To evaluate the long term effect of multiple (nine) ultrasound guided supra-scapular nerve block in treatment of diabetic frozen shoulder.Methods:A retrospective cohort study followed up 40 diabetic patients who received a course of ultrasound guided multiple supra-scapular nerve block (9 injections) on 2014. In this study we retrospectively assessed the patients from previously recorded data at a mean duration of 6 years after completing the 9 injection course SSNB clinically by measuring the shoulder active range of motion (using a goniometer in three planes: abduction, internal, and external rotation). Visual analogue scale and Functional assessment by shoulder pain and disability index (SPADI).Results:Thirty four patients (85% of original cohort) completed the long term follow up.The patients were 19 (55.9%) females, 60.6 y mean age, and the mean of disease duration was 85.6 months. The majority of patients (33 patients 97.05%) continues improvement and gained within normal complete range of motions in all directions and excellent grades of shoulder function (Table 1).Table 1.Clinical ParametersAt base lineAt 4 monthsLast follow up at (72months±4)**P valueSPADI pain score (100)(68.8 ± 0.5)a(10.3 ± 7.4)b(0.9±1.9)c0.00*SPADI disability score (100)(69.2 ± 7.7)a(6.25 ± 2.25)b(0.4±0.8)c0.00*SPADI total (100)(69.1 ± 8.5)a(8.15 ± 5.4)b(1.1±0.9)c0.00*Patient global assessment (100)(90.2 ± 8.2)a(8.2 ± 4.2)b(0.4±2.1)c0.00*Night pain (100)(55.4±10.2)a(10.3 ± 4.9)b(2.3±1.1)c0.00*Abduction (180°)(77.5 ± 4.7)a(170.3 ± 10.3)b(174.2±6.2)b0.00*External rotation (100 °)(46 ± 12.6)a(80.1 ± 10.2)b(86.4±10.3)b0.00*Internal rotation (70 °)(34.5 ± 2.4)a(55.4 ± 10.1)b(60.2±9.5)b0.00** P <0.05 there was a statistical significant difference•A,b,c--- the alphabet of different symbols ---means a significant statistical difference between groupsSPADI: shoulder pain and disability indexConclusion:The multiple injection courses for supra-scapular nerve block has an excellent long term efficacy as treatment of diabetic frozen shoulder. This method should be the treatment of choice in patients of diabetic frozen shoulder who do not respond to physiotherapy.References:[1]Mortada, M. A., Ezzeldin, N., Abbas, S. F., Ammar, H. A. & Salama, N. A. Multiple versus single ultrasound guided suprascapular nerve block in treatment of frozen shoulder in diabetic patients. J. Back Musculoskelet. Rehabil. 30, 537–542 (2017).Disclosure of Interests:None declared
Ultrasound-guided proximal suprascapular nerve block: A cadaveric study
