Suprascapular Nerve Anatomy
The suprascapular nerve, due to its superficial location in the supraspinous fossa, is readily accessible nerve and safe to block. The suprascapular nerve block has been utilized for a number of years to address various causes of shoulder pain. Early advocates of the SSNB reported its usefulness in treating shoulder pain secondary to rotator cuff degenerative tears. Subsequent studies expanded its indications to include conditions such as glenohumeral degenerative joint disease, adhesive capsulitis, and postoperative shoulder pain following arthroscopic surgery.
The suprascapular nerve originates from the upper trunk of the brachial plexus with major contributing fibres from the C5 and C6 nerve roots. It travels posteriorly and laterally toward the supraspinous fossa and enters via the suprascapular notch. Once it reaches the notch, it travels inferior to the superior transverse scapular ligament and laterally toward the base of the coracoid process where it splits into sensory and motor fibres. The suprascapular nerve supplies sensory fibres to about 70% of the shoulder joint, including the superior and posterosuperior regions of the shoulder joint and capsule, and the acromioclavicular joint. In addition it supplies motor branches to the supraspinatus and infraspinatus muscles.
Procedure
Patients who get temporary relief from suprascapular nerve block may be suitable for suprascapular pulsed radiofrequency. Up to two treatments may be required to provide longer-term reduction in pain symptoms.
The procedure is performed under x-ray guidance to ensure the accuracy of needle placement. Specialized equipment including radiofrequency machine, probe, and RF needle is utilized to heat the nerve up to a temperature of 42°C. Generally local anaesthetic is injected around the nerve following pulsed radiofrequency. The local anaesthetic is responsible for immediate pain relief, whereas radiofrequency takes 4 to 6 weeks to provide sustained pain relief.
Before Your Procedure
- Have nothing to eat or drink for six hours before your procedure (you may drink a small amount of water only up until you leave home on the morning of your procedure)
- Arrange for an adult to escort you home by car (you cannot drive for 24 hours after your procedure)
- Arrange for an adult to be present with you for 24 hours following your procedure
- Notify your Doctor if you are taking any blood thinning or diabetic medications
Following Your Procedure
- You will usually be discharged after two to three hours
- Do not drive or operate heavy machinery for twenty-four hours following the procedure
- You may have minor bruising and pain around the injection site
- Please confirm your appointment to follow up with your Doctor in to four to six weeks following the procedure
- There are no limitations to your physical activity level following this procedure
Complications & Side Effects
- Pain and bruising over the injections site
- Potential risk of blood vessel, nerve and spinal cord injury
- Potential risk of introduction of infection
- No or partial response to the procedure
