Subscapularis motor point block for spastic shoulders in patients with cervical cord injury

Abstract

Study design: Case series. Objectve: The objective was to study the effect of phenol blocks to the motor points of the subscapularis muscle in patients with cervical cord injury (CCI). Setting: Spinal cord injury units of a national hospital in Tokyo. Methods: The participants were seven patients with traumatic CCI, mean age 55.8 years (SD4.0), whose injury level were at the fifth cervical level and the American Spinal Injury Association (ASIA) impairment scale was A in 2, C in 1 and D in 4. They were at least 5 months post-acute injury, and complained of pain and limited range of motion (ROM) of their shoulder joint that were unresponsive to usual rehabilitative interventions and medications. Before and after the phenol block to the motor points of the subscapularis muscle, we compared passive and active ROM of the shoulder (flexion, abduction and external rotation), spasticity of the subscapularis as assessed with the modified Ashworth scale, pain as evaluated with a visual analog scale, and eating item of the Functional Independence Measure. Results: There were significant improvements in passive ROM in flexion (23.71), abduction (19.41) and external rotation (16.81; Po0.05). Visual analog scale for shoulder pain was reduced from 6.0 to 3.4 (Po0.05). The modified Ashworth scale for shoulder spasticity, however, did not significantly change. The eating Functional Independence Measure item score improved significantly (Po0.05). Conclusions: This study suggests that subscapularis motor point block for pain and limited ROM with spastic shoulder is a useful technique in patients with CCI.

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review

“…Alcohol concentration used in three case series/studies 40,42,44 ranged from 68 to 100%, with volumes between 7.5 and 10 ml. Uchikawa et al 37 injected subscapularis motor points and Koyama et al 41 injected motor points of the psoas muscle. All other studies targeted peripheral nerves in the lower extremities for neurolysis.…”

“…As SCI participants comprised ⩾ 50% of the samples, and we were unable to obtain patient level data, data pertaining to the entire subject group were included. Ghai et al, 35 Yasar et al 39 and Uchikawa et al 37 used MAS as a primary outcome measure, otherwise selection of outcome measures was variable between studies. The three case studies [42][43][44] did not report formal outcome measures and instead provided qualitative descriptions.…”

“…Chemodenervation in spinal cord injury J Lui et al individuals with SCI have been reported in four level 4 pre-post studies [35][36][37][38] and six level 5 studies (5 case series/studies, [40][41][42][43][44] one retrospective chart review 39 ). Results from these studies are summarized in Table 3.…”

“…Nine studies investigated the use of BoNT, [26][27][28][29][30][31][32][33][34] and 10 studies investigated phenol/alcohol [35][36][37][38][39][40][41][42][43][44] for management of spasticity in SCI with chemodenervation. The literature search did not identify any randomized or non-RCTs looking at management of spasticity in a sample population with ⩾ 50% SCI participants, precluding the use of PEDro and Downs and Black Scale for quality assessment.…”

“…Results from these studies are summarized in Table 3. Seven [35][36][37][38][39]41,43 of the 10 studies involved phenol injections ranging from 0.3 to 10 ml and 5 to 6% concentration. Alcohol concentration used in three case series/studies 40,42,44 ranged from 68 to 100%, with volumes between 7.5 and 10 ml.…”