Block of the Suprascapular Nerve in Reduction of Acute Anterior Shoulder Dislocation: Case Reports

Abstract

Block of the suprascapular nerve in the treatment of shoulder pain has been suggested by Bonica 1953, Gordh 1969, Moore 1962, and others.The nerve innervates the two spinatus muscles, parts of the shoulder joint capsule, and also the acromioclavicular joint. The nerve passes the suprascapular notch. Using a thin lumbar puncture needle, 10–15 ml of 1% mepivacaine (Carbocain®) without adrenaline is slowly deposited into and through the notch.Pain relief has been obtained within a few minutes in ten of the twelve patients. Pain was troublesome in two patients, one with a subclavicular dislocation. A reduction technique, using traction of the arm along the neck of the scapula in simultaneous manipulation of the head of the humerus, was successful in all patients.If anaesthesia is necessary at all, if one of the other methods is unsuitable or contra‐indicated, the suprascapular nerve block is suggested as an alternative to general anaesthesia or supraclavicular plexus anaesthesia.ZUSAMMENFASSUNGBlockade des N.suprascapularis wurde zur Behandlung von Schulterschmerzen von Bonica (1953), Gordh (1969), Moore (1962) und anderen vorgeschlagen.Der Nerv innerviert die beiden Mm.spinati, Teile des Schultergelenks, sowie das Acromioclaviculargelenk. Der Nerv zieht durch die supra‐scapuläre Kerbe. Mittels einer dünnen Lumbal‐punkturnadel werden 10‐15 ml einer 1 %igen Mepivacain ‐ (Carbocain®)‐Lösung ohne Adrenalin langsam in und durch die Kerbe deponiert.Shmerzleichterung wurde innerhalb weniger Minuten bei 10 von 12 Patienten erzielt. Bei zwei Patienten, einer davon mit subclaviculärer Dislokation, war der Schmerz besonders störend. Eine Technik des Einrenkens, bei der Zug am Arm entlang dem Hals der Scapula bei gleichzeitigen Manipulationen am Humeruskopf angewandt wurde, war bei allen Patienten erfolgreich.Falls überhaupt eine Anaesthesie notwendig ist und eine der anderen Methoden sich als ungeeignet oder kontraindiziert erweisen sollte, wird die Blockade des N.suprascapularis als Alternativmethode zur Allgemeinnarkose oder supraclaviculären Plexusanaesthesie vorgeschlagen.

Suprascapular Nerve Block

“…The usual depth of needle at which bone contact is made is between 3 and 6.3 cm. 34,41,92 When inserted more than 5 cm, the needle is likely to be at the suprascapular notch or above the scapula border. To reduce the risk of pneumothorax, the needle should be withdrawn and redirected at a slightly different angle until the bone is reached.…”

Continuous suprascapular nerve block for analgesia of scapular fracture

“…Suprascapular nerve block has been used to relieve the pain of acute and chronic bursitis, arthritis and partial capsular tear of the shoulder, as well as for reduction of acute anterior shoulder dislocations. [3][4][5][6] We believe that this is the first report of the use of suprascapular nerve block for FIGURE ! Following injection of 10 ml of contrast the entire length of the supraspinatous fossa was opacified.…”

Suprascapular nerve block: an alternative method of placing a catheter for continuous nerve block

“…5, 6 Ritchie et al demonstrated that a suprascapular nerve block is an effective and safe modality for postoperative pain relief, 7 whereas Neal et al found that a suprascapular nerve block as an adjunct to a primary interscalene block adds minimal analgesic value after nonarthroscopic shoulder surgery. 8 Roark describes an alternative transcutaneous method to perform a suprascapular nerve block at the spinoglenoid notch for rotator cuff surgery.…”