Suprascapular nerve block

A suprascapular nerve block may be used as a means of relieving shoulder pain and it may be helpful when other attempts at analgesia and injection have failed.

The technique should only be applied in skilled hands. Appropriate informed consent, aseptic technique and aftercare instructions should be used. Of particular note consideration should be given to the small risk of passing the needle through the suprascapular notch and causing a pneumothorax. Some practitioners keep the patient under observation for an hour after injection to allow time for any such complication to become apparent. For similar reasons bilateral suprascapular nerve block injections are also not performed on the same day.

The patient is seated with his back to the operator. The mid-point of the spine of the scapular is identified either by direct palpation or by projecting a line that bissects the lower angle of the shoulder blade onto the spine of the scapula. A point two centimetres above this is then indentified. A green needle, or specialised nerve block needle is then inserted at this point in a downward direction inclined posteriorly by about 15 degrees. Insertion of the needle to a depth of 3-5cm usually encounters the superior surface of the spine of the scapula and the needle is withdrawn slightly. A large volume injection is then administered, often with 10mls of local anaesthetic such as bupivacaine 0.5%, and some operators also mix in a small dose of steroid. It is hoped that this large injection then bathes the suprascapular nerve as in runs on the superior surface of the spine of the scapular.