Frozen shoulder is a common and debilitating condition characterised by pain and restricted movement at the glenohumeral joint. Various treatment modalities have been explored to alleviate symptoms, with suprascapular nerve block (SSNB) emerging as a promising intervention. This meta-analysis aimed to assess the effectiveness of SSNB in treating frozen shoulder. The study protocol was registered with PROSPERO (CRD42023475851). We searched the Medline, Embase and Cochrane Library databases in November 2023. Randomised controlled trials (RCTs) comparing SSNB against alternative interventions were included. The primary outcome was any functional patient-reported outcome measure (PROM). Secondary outcomes were the Visual Analog Scale (VAS) for pain, range of motion (ROM), and complications. Risk of bias was assessed using the Cochrane risk-of-bias v2.0 tool. 12 RCTs were identified (702 patients, mean age 55 years). 8 RCTs were deemed “low” risk-of-bias and 4 raised “some concerns”. Comparator interventions included intra-articular steroid injection, hydrodistension, physiotherapy and placebo injection with 0.9% saline. 7 studies compared SSNB to intra-articular steroid injection, with SSNB resulting in greater improvement in the Shoulder and Pain Disability Index (SPADI) (mean difference −4.75; 95% CI −8.11 to −1.39; P=0.006) and external rotation (mean difference 11.64; 95% CI −0.05 to 23.33; P= 0.05). In 3 studies SSNB demonstrated better VAS (mean difference −0.31; 95% CI −0.53 to 1.79; P=0.004) compared to physiotherapy (+/- placebo injection). 1 study favoured hydrodistension over SSNB in improving ROM and VAS. There was no significant difference in outcomes between SSNB administered under ultrasound-guidance or using a landmark technique. SSNB can be administered in the outpatient clinic with promising outcomes compared to intra-articular steroid injection or physiotherapy based on level 1 evidence. It can therefore be considered as a first-line treatment option.
Nayar et al. (Wed,) studied this question.