Suprascapular Nerve Injection

Acute or chronic capsulitis of the glenohumeral joint

Causes and findings:
• Trauma, osteoarthritis or rheumatoid arthritis
• Idiopathic or secondary to neurological disease, diabetes, stroke, etc. 'frozen shoulder'
• Pain in deltoid area possibly radiating down to hand in severe cases
• Painful limitation in the capsular pattern - most: loss of lateral rotation; less: loss of abduction; least: loss of medial rotation, with a hard end-feel

Equipment:
Syringe - 1ml
Needle - 21G 1.75 inches (40 mm) green
Kenalog 40 - 20 mg
Lidocaine - Nil
Total volume - 0.5ml

Anatomy:
The suprascapular nerve passes through the suprascapular notch into the supraspinous fossa, runs laterally to curl around the neck of the spine of the
scapula and ends in the infraspinous fossa. It supplies the supraspinatus and infraspinatus, and sends articular branches to the shoulder and acromioclavicular
joints. It is worth injecting here when intracapsular injections have not been successful.

Technique:
• The patient sits supported with arm in neutral position
• Identify lateral end of spine of scapular, move one-third along medially and mark a spot one finger superiorly in suprascapular fossa
• Insert needle perpendicular to fossa and touch bone
• Inject solution as a bolus

Aftercare:
Mobility at the shoulder is maintained within pain-free range. Stretching and mobilization are started when pain permits.

Comments:
Symptoms of paraesthesia or burning when inserting the needle indicate that it is within the nerve. Withdraw slightly before injecting. A small randomized trial suggests that suprascapular nerve block is a safe and effective alternative treatment for frozen shoulder in primary care126. Some clinicians advise the use of a longer-lasting anaesthetic alone or with corticosteroid. This injection might also be useful in patients with rotator cuff tears who are not fit for surgery.