Suprascapular Nerve Block

Other Names

• Suprascapular nerve block (SSNB)
• Suprascapular nerve blockade

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Background

Suprascapular nerve and its branches of the left shoulder

Key Points

• Typically use the linear transducer, can use curvilinear, with average depth of 3-4 cm
• Transducer should be parallel to the spine of the scapula over suprascapular fossa or notch
• Identify the suprascapular nerve and artery deep to supraspinatus, close to the suprascapular notch

History

• First described in 1941 by Wertheim and Rovenstein

Anatomy

• Anatomy of the Suprascapular Nerve
  • Originates from C5, C6 nerve roots
  • Passes through the suprascapular notch which is the target of the block
  • Motor: supraspinatus, infraspinatus
  • Sensory: coracoclavicular, coracohumeral ligaments, AC joint, glenohumeral joint (posterior, superior aspects), subacromial bursa
  • Suprascapular nerve supplies approximately 70% of the sensory input to the shoulder joint

Palpation vs Ultrasound Guidance

• Palpation guided approaches have been described
  • This approach is not recommended or discussed here
• Ultrasound guided approach is recommended
  • Ultrasound guidance has shown better efficacy at 1 month with fewer complications

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Indications

• Glenohumeral Arthritis
• Shoulder Dislocation
  • Tezel et al found to be an effective alternative to procedural sedation
  • Use in shoulder dislocation has been described in case reports as well
• Adhesive Capsulitis
  • Pain and range of motion scores improve following SSNB
  • SSNB + intra-articular injection is superior to intra-articular injection alone
• Rotator Cuff Tear, Rotator Cuff Tendonitis
• Postoperative
  • Following arthroscopic shoulder surgery
• Diagnostic
  • Suprascapular Nerve Injury

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Contraindications

• None
  • Consider alternative block or analgesia on an as needed basis

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Procedure

Ultrasound of the suprascapular nerve.

Ultrasound visualization with labels

Probe position and ultrasound view labeled

Equipment

• Ultrasound
  • Can use either linear or curvilinear probe depending on preference and patient body habitus
• Local anesthetic
• In most patients, a 2 inch needle should be sufficient

Preparation

• Ultrasound
  • Place probe posteriorly and identify landmarks prior to starting procedure

Technique

• Posterior approach (recommended)
  • Patient is seated, ipsilateral arm at side
  • Alternatively, ipsilateral hand can rest on contralateral shoulder
  • This can be performed in lateral decubitus position or prone
• Superior approach
  • Performed with patient seated or supine
• Transducer and Needle Position
  • Anatomical coronal oblique plane
  • Probe is parallel to the spine of the scapula, over the suprascapular fossa or notch
  • Needle approach can be medial to lateral OR lateral to medial
• Ultrasound
  • Identify the suprascapular notch, suprascapular nerve
  • Use doppler to identify the suprascapular artery
  • Target: suprascapular notch
  • Alternative target: floor of the suprascapular fossa
  • Guide needle to target
  • Typically only need about 5 mL to achieve a complete block

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Aftercare

• Patient should be counseled on
  • Duration of anesthetic
  • Loss of motor function of infraspinatus and supraspinatus

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Complications

• Pneumothorax
  • Reported incidence is less than 1%
  • If possible, can reposition arm to opposite shoulder to protract scapula away from chest wall
  • This can help reduce the likelihood of fenestrating the pleural cavity
• Intravascular injection
• Residual motor block
• Local trauma

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See Also

Internal

• Procedures Main
• Regional Anesthesia Main

External

• https://www.sportsmedreview.com/blog/the-suprascapular-nerve-block/

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