J Korean Orthop Assoc.  2017 Dec;52(6):521-528. 10.4055/jkoa.2017.52.6.521.

The Proximal Approach in an Ultrasound-Guided Suprascapular Nerve Block

• Ko KP
• Kang DH
• Shin BK

• KMID: 2421345
• DOI: http://doi.org/10.4055/jkoa.2017.52.6.521

Abstract

PURPOSE
The purpose of this study was to analyze any effectiveness, advantages, and the procedure of an ultrasound-guided suprascapular nerve block via the proximal approach in patients suffering from shoulder pain.
MATERIALS AND METHODS
A total of 51 patients treated with nerve block between November 2015 and November 2016 were analyzed. We identified the suprascapular nerve that branches off the superior trunk of the brachial plexus, and found the suprascapular nerve, which is located in the fascial layer between the inferior belly of the omohyoid muscle and the serratus anterior muscle. We then performed a nerve block. We evaluated the visual analogue scale (VAS) of pre- and post-nerve block, and the visualization of the nerve, depth from the skin to the nerve, angle of needle entry, as well as complications. Moreover, we measured the visualization of the nerve, depth from the skin to the nerve in a classic approach, and compared it with the proximal approach.
RESULTS
There was significant improvement (p < 0.05) in the mean VAS, from 7.1 to 3.4, without any major complications. Compared with the classic approach, we were able to identify the suprascapular nerve much better (classic 25.5%/proximal 96.1%), and the mean distance from the skin to the nerve (classic 38 mm/proximal 12 mm) was significantly short (p < 0.05), and the mean angle of needle entry was 19 degrees in the proximal approach.
CONCLUSION
In an ultrasound-guided suprascapular nerve block by proximal approach, the nerve and needle tip can be more easily identified, which increases accuracy; with a small amount of local anesthetic, more effective pain control can be achieved. Hence, this approach is an effective alternative pain control method for patients suffering from shoulder pain.

Keyword

shoulder; ultrasound; suprascapular nerve block; proximal approach; omohyoid muscle

MeSH Terms

Brachial Plexus
Humans
Methods
Needles
Nerve Block*
Shoulder
Shoulder Pain
Skin
Ultrasonography

Figure

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  Figure 1 Scans tracing the suprascapular nerve. (A) C5 and C6 roots are shown between the anterior scalene muscle and middle scalene muscle. (B) C5 and C6 roots converge to form the superior (Sup.) trunk of the brachial plexus. (C) The suprascapular nerve, which is the first branch of the Sup. trunk, emerges out from the Sup. trunk (arrow). (D) The suprascapular nerve passes beneath the inferior belly of the omohyoid muscle (arrow). (E) The suprascapular nerve is located in the fascial layer between the omohyoid muscle and the serratus anterior muscle (arrow).

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  Figure 2 Position of patient and placement of probe. (A) Patients are taken in a ‘crass position’ with the head rotated to the contralateral side. (B) The probe is placed just above the distal clavicle.

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  Figure 3 Anatomic relation between the suprascapular nerve and the inferior belly of the omohyoid muscle at the supraclavicular fossa and placement of the probe (black bars, probe; arrows, needle). (A) Surface anatomy. The medial marking indicates jugular notch and lateral marking indicates mid shaft of the clavicle. (B) The probe is placed just above the distal clavicle to identify the suprascapular nerve passing beneath the inferior belly of the omohyoid muscle.

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  Figure 4 A 25-gauge needle is inserted from the lateral side of the probe with an ‘in-plane’ technique until the needle tip reached the suprascapular nerve (arrow). Triangles indicate the needle.

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  Figure 5 A dotted line arrow is the depth from the skin to the suprascapular nerve via the proximal approach. The angle of needle entry is the angle between longitudinal axis of the needle (triangles) and the probe when the needle tip reaches the suprascapular nerve.

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  Figure 6 A dotted line arrow depicts the depth from the skin to the suprascapular nerve (suprascapular notch) via the classic approach.

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