Effectiveness of suprascapular nerve block associated with physiotherapy compared with physiotherapy for treatment of adhesive capsulitis: a randomized control trial.
Frozen shoulder; Adhesive capsulitis; Nerve block; Physiotherapy
Background: Adhesive capsulitis (AC) is one of the primary causes of shoulder girdle dysfunction, whose main characteristics are pain and restricted mobility originating in the glenohumeral joint. There is no consensus concerning adequate treatment, with various clinical and surgical approaches proposed. Objective: The objective
of the present study was to compare the results of AC treatment in patients submitted to suprascapular nerve block (SSNB) associated with physiotherapy (PT) and those who only underwent physiotherapy.
Methods: Patients with AC were randomized into two groups: a block (SSNB + PT) and control group, only with
physiotherapy (PT). Four serial blocks were used with 6 ml of 0.25% bupivacaine, at 15-day intervals. Both groups were analyzed using a visual analog scale (VAS), UCLA score and range of motion (ROM) measured with
digital goniometry (iHandy Level), before treatment (Dzero), at 2, 4 and 6 months. Analyses with 95% confidence
interval and p < 0.05 were considered statistically significant.
Results: A total of 182 patients, 68 men and 114 women, were assessed. Sixty-nine patients were submitted to nerve block and physiotherapy (SSNB+PT) and 113 were controls (only PT). The t-test showed no statistical difference between the two groups at Dzero, 2, 4 and 6 months (p > 0.05). ANOVA demonstrated that the time factor was statistically significant in improving the parameters analyzed, irrespective of the block (SSNB) occurring (p < 0.05). After 6 months, 15 patients were submitted to surgery. Patients who at the start of the study (Dzero) exhibited flexion arc <130º, were more likely to evolve to surgery, and those who in the second month of study had an external rotation ROM <40º, and/or internal rotation ROM below T12 and/or VAS above 5 and/or UCLA below 20 were also more likely to require surgery