Comparison of two interventional techniques for the treatment of chronic shoulder pain

  • Mario Andrés Arcila Lotero Universidad CES, Medellín, Colombia
  • María Adelaida Mejía Aguilar Instituto Colombiano del Dolor, Medellín, Colombia
  • Roberto Carlo Rivera Díaz a. Universidad CES, Medellín, Colombia. b. Instituto Colombiano del Dolor, Medellín, Colombia
  • Liliana Patricia Montoya a. Universidad CES, Medellín, Colombia. b. Public Health Observatory, Universidad CES, Medellín, Colombia
Keywords: Chronic Pain; Shoulder Pain; Nerve Block; Ultrasonography; Osteoarthritis



The prevalence of chronic shoulder pain is 20%, and treatment involves pharmacological and non-pharmacological means, as well as analgesic interventional procedures. The use of intra-articular injections and ultrasound-guided blocks has increased with favorable results, but there are few comparisons to determine their effective use in patients with chronic pain due to shoulder arthrosis refractory to pharmacological treatment.


To compare the clinical efficacy and safety of 2 interventional techniques in patients with chronic shoulder pain secondary to arthrosis.


Retrospective cohort analytical study to compare the clinical efficacy and safety of 2 interventional techniques in terms of pain relief, improvement time, and adverse effects in patients coming to Instituto Colombiano del Dolor (Colombian Pain Institute) between June 2011 and April 2012, followed during a period of at least 16 weeks.


The analysis included 62 patients with chronic shoulder pain secondary to osteoarthritis. Suprascapular nerve blocks were performed in 29 patients, and tricompartmental blockade was used in 33 patients, and both procedures were performed under ultrasound guidance. A statistically significant reduction in pain intensity was found during the 16-week period in both groups (P < 0.0001), and there were no complications.


Both analgesic techniques provided significant pain reduction over the 16-week period, with a superior clinical trend in favor of the suprascapular nerve block, and they were found to be safe therapeutic options because of the low rate of complications.


1. Philadelphia PanelPhiladelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for shoulder pain. Phys Ther 2001;81:1719-1730.
2. Abejón D, Madariaga M, del Saz J, et al. Bloqueo tricompartimental del hombro doloroso: estudio preliminar. Rev Soc Esp Dolor 2009;16:399-404.
3. Wertheim HM, Rovenstime FA. Supraescapular nerve block. Anesthesiology 1941;2:541-545.
4. Chan CW, Peng PW. Supraescapular nerve block: a narrative review. Reg Anesth Pain Med 2011;36:358-373.
5. Allen ZA, Shanahan EM, Crotty M. Does supraescapular nerve block reduce shoulder pain following stroke: a double-blind randomised controlled trial with masked outcome assessment. BMC Neurol 2010;10:83.
6. Schultz JS. Clinical evaluation of the shoulder. Phys Med Rehabil Clin N Am 2004;15:351-371.
7. Hodgson RJ, O'Connor PJ, Hensor EM, et al. Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears. Br J Radiol 2012;85:1482-1487.
8. Thornton AL, McCarty CW, Burgess MJ. Effectiveness of low-level laser therapy combined with an exercise program to reduce pain and increase function in adults with shoulder pain: a critically appraised topic. J Sport Rehabil 2013;22:72-78.
9. Herin F, Vezina M, Thaon I, et al. ESTEV GroupPredictors of chronic shoulder pain after 5 years in a working population. Pain 2012;153:2253-2259.
10. Rahman MN, Rani MR, Rohani JM. Investigation of work-related musculoskeletal disorders in wall plastering jobs within the construction industry. Work 2012;43:507-514.
11. Yue P, Liu F, Li L. Neck/shoulder pain and low back pain among school teachers in China, prevalence and risk factors. BMC Public Health 2012;12:789.
12. Bales J, Bales K. Swimming overuse injuries associated with triathlon training. Sports Med Arthrosc 2012;20:196-199.
13. Rivera RC, Arcila MA, Giraldo DJ. Ultrasound-guided tricompart-mental blockade of the shoulder. Rev Colomb Anestesiol 2013;41:245-249.
14. Cadogan A, Laslett M, Hing WA, et al. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord 2011;12:119.
15. Levine BD, Motamedi K, Seeger LL. Imaging of the shoulder: a comparison of MRI and ultrasound. Curr Sports Med Rep 2012;11:239-243.
16. Teefey SA. Shoulder sonography: why we do it. J Ultrasound Med 2012;31:1325-1331.
17. Tekavec E, Joud A, Rittner R, et al. Population-based consultation patterns in patients with shoulder pain diagnoses. BMC Musculoskelet Disord 2012;13:238.
18. Hartvigsen J, Davidsen M, Hestbaek L, et al. Patterns of musculoskeletal pain in the population: a latent class analysis using a nationally representative interviewer-based survey of 4817 Danes. Eur J Pain 2013;17:452-460.
19. Sarzi-Puttini P, Atzeni F, Di Franco M, et al. Dysfunctional syndromes and fibromyalgia: a 2012 critical digest. Clin Exp Rheumatol 2012;30 (6 suppl 74):143-151.
20. Siegenthaler A, Moriggl B, Mlekusch S, et al. Ultrasound-guided suprascapular nerve block, description of a novel supraclavicular approach. Reg Anesth Pain Med 2012;37:325-328.
21. Choudur HN, Ellins ML. Ultrasound-guided gadolinium joint injections for magnetic resonance arthrography. J Clin Ultrasound 2011;39:6-11.
22. Gokalp G, Dusak A, Yazici Z. Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach. Skeletal Radiol 2010;39:575-579.
23. Harmon D, Hearty C. Ultrasound-guided suprascapular nerve block technique. Pain Physician 2007;10:743-746.
24. Arcila MA, Rivera RC, Campuzano D, et al. Efficacy and safety of ultrasound-guided suprascapular nerve block in patients with chronic shoulder pain. Rev Colomb Anestesiol 2013;41:104-108.
25. Gialanella B, Prometti P. Effects of corticosteroids injection in rotator cuff tears. Pain Med 2011;12:1559-1565.
26. Shah N, Lewis M. Shoulder adhesive capsulitis: systematic review of randomized trials using multiple corticosteroid injections. Br J Gen Pract 2007;57:662-667.
27. Cadogan A, Laslett M, Hing W, et al. Clinical predictors of a positive response to guided diagnostic block into the subacromial bursa. J Rehabil Med 2012;44:877-884.
28. Borglum J, Bartholdy A, Hautopp H, et al. Ultrasound-guided continuous suprascapular nerve block for adhesive capsulitis: one case and a short topical review. Acta Anaesthesiol Scand 2011;55:242-247.
29. Mariano ER, Afra R, Loland VJ, et al. Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Anesth Analg 2009;108:1688-1694.
30. Antonakakis JG, Sites BD, Shiffrin J. Ultrasound-guided posterior approach for the placement ofa continuous interscalene catheter. Reg Anesth Pain Med 2009;34:64-68.
31. Chua NH, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review. Acta Neurochir (Wien) 2011; 153:763-771.
32. Gofeld M, Restrepo-Garces CE, Theodore BR, et al. Pulsed radio-frequency of suprascapular nerve for chronic shoulder pain: a randomized double-blind active placebo-controlled study. Pain Pract 2013;13:96-103.
33. Luleci N, Özdemir U, Dere K, et al. Evaluation of patients' response to pulsed radiofrequency treatment applied to the suprascapular nerve in patients with chronic shoulder pain. J Back Musculoskelet Rehabil 2011;24:189-194.
34. Rha DW, Park GY, Kim YK, et al. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil 2013;27:113-122.
35. Esenyel CZ, Ozturk K, Demirhan M, et al. Accuracy of anterior glenohumeral injections: a cadaver study. Arch Orthop Trauma Surg 2010;130:297-300.
36. Kim JS, Yun JS, Kim JM, et al. Accuracy of the glenohumeral injection using the superior approach: a cadaveric study of injection accuracy. Am J Phys Med Rehabil 2010;89:755-758.
37. Rutten MJ, Maresch BJ, Jager GJ, et al. Injection ofthe subacromial-subdeltoid bursa: blindo or ultrasound-guided? Acta Orthop 2007;78:254-257.
38. Cunnington J, Marshall N, Hide G, et al. A randomized, double blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis. Arthritis Rheum 2010;62:1862-1869.
39. Porat S, Leupold JA, Burnett KR, et al. Reliability of non-imaging-guided glenohumeral joint injection through rotator interval approach in patients undergoing diagnostic MR arthrography. Am J Roentgenol 2008;191:96-99.
40. Soneji N, Peng PW. Ultrasound-guided pain interventions-a review of techniques for peripheral nerves. Korean J Pain 2013;26:111-124.
41. Bloom JE, Rischin A, Johnston RV, et al. Image-guided versus blind glucocorticoid injection for shoulder pain. Cochrane Database Syst Rev 2012;8:CD009147.
42. Peng PW, Wiley MJ, LiangJ, et al. Ultrasound-guided suprascapular nerve block: a correlation with fluoroscopic and cadaveric findings. Can J Anaesth 2010;57:143-148.
43. Philip WH, Peter C. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part III: shoulder. Reg Anesth Pain Med 2011;36:592-605.
44. Peng P, Narouze S. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy and procedures. Part I: non-axial structures. Reg Anesth Pain Med 2009;34:458-474.
45. Yasar E, Vural D, Safaz I, et al. Which treatment approach is better for hemiplegic shoulder pain in stroke patients: intra-articular steroid or supraescapular nerve block? A randomized controlled trial. Clin Rehabil 2011;25:60-68.
46. Eyigor C, Eyigor S, Korkmaz OK, et al. Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder a prospective, randomized, single-blinded study. Clin J Pain 2010;26:386-392.
47. Abdelshafi ME, Yosry M, Elmulla AF, et al. Relief of chronic shoulder pain: a comparative study of three approaches. Middle East J Anesthesiol 2011;21:83-92.
48. Taskaynatan MA, Yilmaz B, Ozgul A, et al. Suprascapular nerve block versus steroid injection for non-specific shoulder pain. Tohoku J Exp Med 2005;205:19-25.
49. Shanahan EM, Ahern M, Smith M, et al. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis 2003;62:400-406.
50. Gorthi V, Moon YL, KangJH. The effectiveness of ultrasonography-guided suprascapular nerve block for perishoulder pain. Orthopedics 2010;16:238-241.
51. Peng PH, Cheng P. Ultrasound-guided interventional procedures in pain medicine. A Review of Anatomy, Sonoanatomy, and Procedures. Part III: Shoulder. Reg Anesth Pain Med 2011;36:592-605.
How to Cite
Arcila Lotero MA, Mejía Aguilar MA, Rivera Díaz RC, Montoya LP. Comparison of two interventional techniques for the treatment of chronic shoulder pain. Colomb. J. Anesthesiol. [Internet]. 2018Jan.1 [cited 2022Aug.8];46(1):26-1. Available from:


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How to Cite
Arcila Lotero MA, Mejía Aguilar MA, Rivera Díaz RC, Montoya LP. Comparison of two interventional techniques for the treatment of chronic shoulder pain. Colomb. J. Anesthesiol. [Internet]. 2018Jan.1 [cited 2022Aug.8];46(1):26-1. Available from: