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Abstract
Adhesive Capsulitis, or frozen shoulder syndrome (FSS), is a condition characterized by limitation of motion of the shoulder joint with pain at the extremes of motion. It was first described by Putman in 1882 and later by Codman in 1934 (David and Thornhill, 2005). Suprascapular nerve block has shown some promise as an alternative treatment for patients with shoulder pain& disability (shanahan et al., 2003). Its use is effective in disability and glenohumeral joint contracture of adhesive capsulitis (Dahan et al., 2002). A program of physical therapy combined with home exercises with other modalities can help to restore the shoulder motion and function (Pajareya et al., 2004).
The aim of this study is to compare the effectiveness of suprascapular nerve block versus physical therapy in management of pain and disability in patient with chronic adhesive capsulitis of the shoulder joint.
This study was carried on 40 patients suffering from chronic adhesive capsulitis for ≥ 3 months. They were 16 male (40%) and 24 females (60%) Their ages were ranged between 32-71 years and their disease duration ranged between 3-11 months. The inclusion criteria of patients were:
1. Age >18
2. Pain and stiffness in the one shoulder for ≥3 months
3. Restriction of passive motion by ≥ 30° in two or more planes
All patients were subjected to :
1. Full history taking
2. Complete clinical examination
3. Complete shoulder joint evaluation with the stress on:
• Range of motion (ROM)
• Visual analogue scale (VAS)
• Shoulder pain and disability index (SPADI), as base line assessment
4. Laboratory investigations:
CBC, ESR and blood sugar level.
5. Shoulder imaging:
Plain x-ray
Then the patients were classified into two groups
A) Group 1: The active group: included 20 patients:
They underwent:
1. Suprascapular nerve block by 5ml (2cm xylocaine 2℅ + 3cm Bupivacaine 0.5%) every 12 hours as long as pain score ≤ 3.
2. Home exercise program.
B) Group 2: The placebo group: included 20 patients:
They underwent:
1. Injection with normal saline (5ml) infiltration at the shoulder region.
2. A program of physical therapy will be done for the placebo group in the form of:-
• Ultrasound and moist heat followed by
• Passive and active range of motion exercise.
• Passive and active stretching exercises for the shoulder joint.
For all the studied patients follow up through full assessment of the affected shoulder joint ( ROM, VAS, SPADI) at week 1, 4 and 12 after injection and physical therapy.
The data were collected and tabulated after statistical analysis and the following results were obtained
1. There was non significant (NS) difference between the two groups as regards the age , sex, affected shoulder, pain referral, precipitating factors, treatment options and x-ray findings (p > 0.05).
2. On comparing the studied groups at week (1) after suprascapular nerve block and physical therapy it was observed that there was significant difference in active and passive ( flexion, abduction, external and internal rotation) (p < 0.05), but non significant difference of active and passive extension.
3. Significant difference between both active and placebo groups at week (4) after suprascapular nerve block and physical therapy in all shoulder movements (P < 0.05).
4. At week (12) after suprascapular nerve block and physical therapy there was:
• Significant difference in active and passive flexion and abduction and extension and external rotation (p< 0.05).
• Non significant difference in both active and passive internal rotation (p > 0.05).
5. When comparing pain subscale, disability subscale, total SPADI and VAS in the studied groups at week 1, 4 and 12 after suprascapular nerve block and physical therapy it shows significant difference (p <0.001).
6. It was found a non significant correlation between SPADI, VAS and number of injection (p >0.05).
7. There was significant difference when comparing the VAS in both active and placebo groups at week 1, 4 and 12 after suprascapular nerve block and physical therapy (p < 0.001).
8. There was significant difference when comparing the SPADI in both active and placebo groups at week 1, 4 and 12 after suprascapular nerve block and physical therapy (p < 0.001).
Conclusion
1. This study provides evidence that suprascapular nerve block is a safe, effective and well tolerated treatment for patients with adhesive capsulitis.
2. SSNB is an easy technique which can be performed in out patient clinic and it is safe and effective more than steroid injection. Also it is easier than other treatment options like manipulation under anesthesia.
3. Repeated injection every 12 hours make the patients more comfortable with reduction of pain intensity so they can do the exercises with improvement of their range of motions.
4. SSNB followed by exercises is more effective and considered superior to physical therapy including heating followed by exercises in reducing pain and improving disability and range of motions.
Recommendation:
This protocol is advisable to be done for patients with secondary adhesive capsulitis together with the treatment of the primary causes.