|Year : 2014 | Volume
| Issue : 1 | Page : 48-49
Invited commentary: Chronic shoulder pain and suprascapular nerve
Ridvan Alimehmeti1, Alda Kika2
1 Department of Neurosurgery University Hospital Center "Mother Theresa", University of Medicine, Tirana, Albania
2 Deparment of Informatics, Faculty of Natural Sciences, University of Tirana, Tirana, Albania
|Date of Web Publication||10-Dec-2013|
Service of Neurosurgery, University Hospital Center "Mother Theresa" Dibra Street, 370 Tirana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Alimehmeti R, Kika A. Invited commentary: Chronic shoulder pain and suprascapular nerve. Med J DY Patil Univ 2014;7:48-9
This is an interesting study that proves the efficacy of suprascapular nerve block (SSNB) with anesthetic and cortisone solutions for chronic shoulder pain (CSP) relief.
Rest, pain killers and antiinflammatory drugs, physical therapy, and appropriate splinting are the mainstays of initial treatment for shoulder pain. In case of persistence of pain more invasive procedures are followed such as: Scapulohumeral intrarticular injection, SSNB, radiofrequency (RF), or SSN decompressive surgery.
A Pubmed search with words: "chronic shoulder pain and suprascapular nerve" yielded 42 articles of which 14 pertinent to SSNB for CSP (totally 387 cases), 10 articles dealing with pulsed (270 cases) and continuous (9 cases) RF of SSN; 10 articles on surgical release of SSN. The rest of the articles were not especially pertinent to the CSP and SSN.
SSNB is repeatable, fast acting but not as long lasting effect as RF treatment. If done to infiltrate the segment of SSN from suprascapular and spinoglenoid notches it is reported to be more effective than injection of only suprascapular notch.  For a complete nervous block of the scapulohumeral joint, apart from SSN, the articular branch of axillary nerve is injected.  Fluoroscopy, ultrasonography or computerized tomography is used to guide the correct positioning of the needle for injection. The needle access is reported as direct and indirect, anterior and posterior, lateral and medial, upper and lower. 
Pulsed RF does not leave any nerve damage like continuous RF. Pulsed RF is more frequently reported in literature than continuous RF for the treatment of CSP. RF is reported to give good result in approximately 74% of the cases in one year follow-up. 
A cadaveric study of 120 shoulders showed that in 2.5% of cases suprascapular artery travels with SSN through suprascapular notch. This anatomic anomaly may constitute a possible unrecognized mechanism in which shoulder pain is generated.  A magnetic resonance study demonstrated the presence of enlarged spinoglenoid notch veins compressing SSN.  Glenoid cysts are reported as another cause of SSN compression. 
It would be of interest to know if clinical and electromyography examination of the patients included in this study would reveal entrapment of the SSN in the long term.
SSN entrapment is rarely reported as the cause of CSP and its diagnosis is done of exclusion. Even in SSN entrapment, injection of anesthetic and cortisone over the suprascapular notch is the first choice of treatment. If the long-term follow-up of the patients included in this study would have recurrence of pain, we suggest excluding the diagnosis of SSN entrapment. In the presence of SSN entrapment, surgery should be considered. Open or endoscopic release of SSN is reported. 
Hypothetically, denervation neurotomy of suprascapular sensory fibers and articular branch of axillary nerve (as the vehicles for shoulder pain) under intraoperative neurophysiologic monitoring for fiber selection in order to spare muscular fibers, might be the last resort of treatment. Neurotomy would offer the advantage of motor fibers sparing over RF of SSN for CSP.
| References|| |
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