Articular N. block for shoulder pain,: In Malaysia Society of Interventional Pain Practitioners

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I will talk about the anatomy of the articular branches of the shoulder joint
and nerve block techniques for chronic shoulder pain.
In shoulder joint pain, every pain practitioners talk about the benefits of the ultrasound-guided suprascapular nerve block.

It has become an important procedure in chronic shoulder pain.
It covers acute and chronic pain.
It has been used for the
control of postoperative pain after open and arthroscopic shoulder surgery.
In chronic pain, it may be both diagnostic and, more commonly, a therapeutic procedure.
Many chronic illnesses have been reported to use suprascapular nerve block,

including rheumatoid arthritis, osteoarthritis, frozen shoulder, and persistent rotator cuff lesion.

Pulsed radiofrequency of the suprascapular nerve have been used in intractable cases.

When I read the articles about the suprascapular nerve block,

it looked like I may fall into the illusion of magical treatment for chronic shoulder pain.

But I am a very skeptical and stubborn pain physician.

I believe it has been overestimated.

I am going to argue against a single suprascapular nerve block and break the hallucination.

My first counterstrike logic is that the suprascapular nerve does not cover all the glenohumeral articular surface.
According to an anatomic study,

The suprascapular nerve covers only the upper posterior quadrant of the glenohumeral joint articular surface.

It covers only the area of the supraspinatus and infraspinatus tendon and underlying joint capsule.

The anterior superior part is supplied by the articular sensory branch of the subscapular nerve.

It covers the area of the rotator cuff interval, superior anterior labrum, biceps, subscapularis, and underlying joint capsule.

The anterior inferior quadrant is supplied by the subscapular nerve and axillary nerve branches.

The posterior inferior quadrant is supplied by the axillary nerve.

There are many pathologic etiologies of chronic shoulder pain.

For example, inflammation and fibrosis of the frozen shoulder occur in the coracohumeral ligament and anterior-inferior joint capsule.

This area is not covered by the suprascapular nerve. This area is innervated from the subscapular nerve and axillary nerve.

If the nerve block is effective to relieve the pain,

I must block the appropriate nerve or all the nerves that cover the area.

Most of the shoulder pathologies take part in the upper half of the glenohumeral joint.

It is worthy of studying the articular sensory branch of the suprascapular
and upper subscapular nerve.

Let me review the suprascapular nerve first.

The suprascapular nerve arises from c5 and C6 nerve roots.

It originates from the superior trunk of the brachial plexus and moves toward the suprascapular notch.
It passes underneath the transverse scapular ligament.
It is the schematic drawing of the suprascapular fossa that I want to talk about.

After entering the suprascapular notch,

the main suprascapular nerve gives off the medial trunk and lateral trunk.

The lateral branch becomes the main branch, passes the spinoglenoid notch, and supplies the infraspinatus fossa.

The medial trunk arises from the main suprascapular nerve

after entering the suprascapular notch and supplying the supraspinatus muscle.

The articular branches originate from the lateral trunk and main nerve before the transverse scapular ligament.


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