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Smith N, Liew Z, Johnson S, Ellard DR, Underwood M, Kearney R. A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain. Br J Pain 2021; 15:460-473. [PMID: 34840794 PMCID: PMC8611295 DOI: 10.1177/2049463721992091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Suprascapular nerve block (SSNB) injections are growing in popularity as a treatment option for people with chronic shoulder pain. The optimal method of injection and aftercare is unknown. This review describes the current methods and drugs used for performing SSNB injections in the non-surgical management of adults with chronic shoulder pain in order to inform future research in this area. Systematic searches of CINAHL, MEDLINE (OVID), AMED, Embase databases and the Cochrane Library were undertaken from inception to June 2020. Data on the method and drugs used for injection and aftercare were extracted and summarised for areas of commonality and discrepancy. We included 53 studies in this review. In total, eight different injection methods were reported within the included studies. Indirect surface land-marked methods were the most common method reported in 21 studies. Direct surface land-marked methods were reported in 12 studies. Ultrasound-guided methods used alone were reported in 16 studies. Both fluoroscopy and computed tomography methods used alone were reported in one study each. Electromyography was used in combination with other injection methods in nine studies. Wide variation in the composition of the injectate was observed between studies. Local anaesthetic was used within injectate preparations in all studies. Local anaesthetic used alone was reported in 20 studies, combined with steroid in 29 studies and combined with various other components in 5 studies. Physiotherapy following injection was reported in 26 studies. Reported details of physiotherapy varied considerably. This review identified substantial variation in the methods and drugs used to perform SSNB injection in clinical trials. Current literature demonstrates a wide range of methods used for SSNB injection administration. Consensus research defining standardised practice for SSNB injection is now needed to guide future clinical practice and research.
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Affiliation(s)
- Neil Smith
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
- Sandwell and West Birmingham Hospitals
NHS Trust, Physiotherapy Department, West Bromwich, UK
| | - Ziheng Liew
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - Samantha Johnson
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
| | - Rebecca Kearney
- Warwick Clinical Trials Unit, The
University of Warwick, Coventry, UK
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Wynne-Jones G, Myers H, Hall A, Littlewood C, Hennings S, Saunders B, Bucknall M, Jowett S, Riley R, Wathall S, Heneghan C, Cook J, Pincus T, Mallen C, Roddy E, Foster N, Beard D, Lewis J, Rees JL, Higginbottom A, van der Windt D. Predicting pain and function outcomes in people consulting with shoulder pain: the PANDA-S clinical cohort and qualitative study protocol. BMJ Open 2021; 11:e052758. [PMID: 34535486 PMCID: PMC8451291 DOI: 10.1136/bmjopen-2021-052758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION People presenting with shoulder pain considered to be of musculoskeletal origin is common in primary care but diagnosing the cause of the pain is contentious, leading to uncertainty in management. To inform optimal primary care for patients with shoulder pain, the study aims to (1) to investigate the short-term and long-term outcomes (overall prognosis) of shoulder pain, (2) estimate costs of care, (3) develop a prognostic model for predicting individuals' level and risk of pain and disability at 6 months and (4) investigate experiences and opinions of patients and healthcare professionals regarding diagnosis, prognosis and management of shoulder pain. METHODS AND ANALYSIS The Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S) study is a longitudinal clinical cohort with linked qualitative study. At least 400 people presenting to general practice and physiotherapy services in the UK will be recruited. Participants will complete questionnaires at baseline, 3, 6, 12, 24 and 36 months. Short-term data will be collected weekly between baseline and 12 weeks via Short Message Serevice (SMS) text or software application. Participants will be offered clinical (physiotherapist) and ultrasound (sonographer) assessments at baseline. Qualitative interviews with ≈15 dyads of patients and their healthcare professional (general practitioner or physiotherapist).Short-term and long-term trajectories of Shoulder Pain and Disability Index (using SPADI) will be described, using latent class growth analysis. Health economic analysis will estimate direct costs of care and indirect costs related to work absence and productivity losses. Multivariable regression analysis will be used to develop a prognostic model predicting future levels of pain and disability at 6 months using penalisation methods to adjust for overfitting. The added predictive value of prespecified physical examination tests and ultrasound findings will be examined. For the qualitative interviews an inductive, exploratory framework will be adopted using thematic analysis to investigate decision making, perspectives of patients and clinicians on the importance of diagnostic and prognostic information when negotiating treatment and referral options. ETHICS AND DISSEMINATION The PANDA-S study has ethical approval from Yorkshire and The Humber-Sheffield Research Ethics Committee, UK (18/YH/0346, IRAS Number: 242750). Results will be disseminated through peer-reviewed publications, social and mainstream media, professional conferences, and the patient and public involvement and engagement group supporting this study, and through newsletters, leaflets and posters in participating sites. TRIAL REGISTRATION NUMBER ISRCTN46948079.
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Affiliation(s)
| | - Helen Myers
- Clinical Trials Unit, Keele University, Keele, UK
| | - Alison Hall
- School of Medicine, Keele University, Keele, UK
| | - Chris Littlewood
- School of Medicine, Keele University, Keele, UK
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - S Hennings
- Clinical Trials Unit, Keele University, Keele, UK
| | | | | | - Sue Jowett
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | | | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Johanna Cook
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Tamar Pincus
- Psychology, Royal Hollaway University of London, London, UK
| | | | | | - Nadine Foster
- School of Medicine, Keele University, Keele, UK
- STARS Education and Research Alliance, The University of Queensland, Saint Lucia, Queensland, Australia
| | - David Beard
- Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- Central London Community Healthcare NHS Trust, London, UK
| | - J L Rees
- Nuffield Dept of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Ravichandran H, Janakiraman B, Gelaw AY, Fisseha B, Sundaram S, Sharma HR. Effect of scapular stabilization exercise program in patients with subacromial impingement syndrome: a systematic review. J Exerc Rehabil 2020; 16:216-226. [PMID: 32724778 PMCID: PMC7365732 DOI: 10.12965/jer.2040256.128] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/29/2020] [Indexed: 01/25/2023] Open
Abstract
Scapular stabilization approaches have been a mainstay of therapeutic training programs in the recent past for patients with subacromial im-pingement syndrome, whereas its contributions solely in the clinical outcome of reducing shoulder pain and disability are largely unclear. This systematic review aims to evaluate and summarize the best evi-dence regarding the role of scapular stabilization interventions in allevi-ating shoulder dysfunction among subjects with subacromial impinge-ment syndrome. Six reviewers involved in this systematic review. Liter-ature was retrieved systematically through searching 5 electronic data-bases (PubMed, MEDLINE, CINAHL, Cochrane, and Google Scholar). Articles published from the year 2010 up to and including 2019 were in-cluded. The literature search included clinical trials those intervened subjects with scapular exercises or scapular stabilization exercises or scapular rehabilitation, as an intervention for subacromial impingement syndrome. Seven studies, totaling 228 participants were included in this systematic review. Articles included in this review were graded ac-cording to Lloyd-Smith hierarchy of evidence scale and critically ap-praised with a tool developed by National, Heart, Lung and Blood Insti-tute (United States), named as quality assessment of controlled inter-vention studies tool. There was a significant effect on the scapular sta-bilization exercise program on improving pain and disability among sub-jects with subacromial impingement syndrome. This systematic review provides sufficient evidence to suggest that scapular stabilization exer-cises offers effectiveness in reducing pain and disability among sub-jects with subacromial impingement syndrome. However, more trials with larger sample are needed to provide a more definitive evidence on the clinical outcomes of scapular stabilization exercises among pa-tients with impingement.
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Affiliation(s)
- Hariharasudhan Ravichandran
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Balamurugan Janakiraman
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Asmare Yitayeh Gelaw
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Berihu Fisseha
- Department of Physiotherapy, School of Medicine, College of Health Sciences, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Subramanian Sundaram
- Department of Physiotherapy, Sree Balaji College of Physiotherapy, Chennai, India
| | - Hidangmayum Richa Sharma
- Department of Physiotherapy, Sakra Institute of Rehabilitation Sciences, Sakra World Hospital, Bangalore, India
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