الفهرس 
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Abstract
One of the main goals of treatment is to restore shoulder function through manipulation and therapeutic exercises in which the patient must cooperate and take an active part. The most important factor limiting patient’s cooperation in exercise is pain. Hence, regional nerve block, attributable to its role in pain relief, can be used before the exercise program (Borglum et al. 2011).
Recently, the ultrasound-guided injection technique and the sono-anatomy of the suprascapular region relevant to the suprascapular nerve (SSN) block suggested that the ultrasound scan showed the presence of the suprascapular notch covered by the superior transverse scapular ligament (Peng and Narouze 2009).
Among various nerve block techniques, suprascapular nerve block (SSNB) is an effective and simple method for the management of shoulder pain, with no significant complications reported in over 2000 procedures apart from rare vasovagal episodes (Iqbal et al. 2012).
In addition, Ozkan et al. (Ozkan et al. 2012) reported that SSNB may effectively increase patient’s pain tolerability, which in turn helps patients to tolerate physical therapy. After SSNB, shoulder pain diminishes and an effective therapeutic exercise program can be performed. The suprascapular nerve provides sensory fibers to 70% of the shoulder joint and has afferent, efferent, and sympathetic fibers (Ozkan et al. 2012).
This study included 40 patients clinically diagnosed as having adhesive capsulitis, (clinical history of pain and restriction of passive and active ROM of the shoulder for at least 3 months) attending the outpatient clinic of the Physical Medicine, Rheumatology and Rehabilitation department, Sohag University Hospital.
20 patients (group A) were subjected for Suprascapular nerve block and the other 20 (group B) were subjected for intra-articular steroid injection, both were US guided.
Following history taking, complete general and musculoskeletal examination of the patients, the first group (A) was subjected for ultrasound guided Suprascapular nerve block (SSNB) with 10 ml solution prepared for injection (9 ml of 0.5% bupivacaine for nerve block and 1 ml of 0.4% dexamethasone sodium phosphate to increase the duration of nerve blockade) while second group (B) was subjected for ultrasound guided intra-articular steroid injection (4 ml of 2% lidocaine and 1 ml of methylprednisolone acetate ”Depo-Medrol” ) followed by manipulation of the shoulder joint and a home exercise program for both groups. Differences in range of motion, visual analogue scale for pain, and UCLA shoulder rating score were assessed before injection and at 1, 6, and 12 weeks of injection.
This study was used to evaluate differences in efficacy of the injection techniques for frozen shoulder. All variables that were repeatedly measured showed significant differences in shoulder ROM with time, but there was no significant difference according to the injection method (Table 10), (Figure 37).
Also was used to evaluate patient satisfaction and pain control for the patients, with significant differences in pain decrease with time and patient satisfaction, but there was no significant difference according to the injection method (Table 11), (Figure 38).
This study provides evidence that suprascapular nerve block and intra-articular steroid injection are safe, effective and well tolerated treatment for patients with Frozen Shoulder. We have not established its efficacy in other settings or with other conditions such as arthritis or shoulder pain from seronegative arthritis.
They can be performed in an outpatient department and provides the clinician with alternative or additional approaches to oral drug treatment and manipulation under general anaesthesia. Further, it may prove to be a useful treatment for patients who are unfit or unwilling to consider surgical intervention.
Conclusion
This study provides evidence that suprascapular nerve block and intra-articular steroid injection are safe, effective and well tolerated treatment for patients with Frozen Shoulder. We have not established its efficacy in other settings or with other conditions such as arthritis or shoulder pain from seronegative arthritis.
They can be performed in an outpatient department and provides the clinician with alternative or additional approaches to oral drug treatment and manipulation under general anasthesia. Further, it may prove to be a useful treatment for patients who are unfit or unwilling to consider surgical intervention.