Ultrasound-Guided Suprascapular Nerve Block at Spinoglenoid Notch and Glenohumeral Joint Hydrodilation

Abstract

Hydrodilation of the glenohumeral joint is commonly employed as a nonsurgical intervention for the frozen shoulder. Accuracy and pain during the procedure can be regarded as difficulties in performing this procedure. Ultrasonography (USG) guided injection and suprascapular nerve block can improve the accuracy and can decrease pain during the hydrodilation procedure. We present the step-by-step method for performing USG-guided injections for suprascapular nerve block and hydrodilation.

© 2022 The Authors.

Figures

Fig 1

Patient’s position during the procedure and the anatomical landmark. (A) The operator is standing behind the patient and in line with the ultrasound monitor to accomplish an ergonomic position. The ultrasound monitor is placed in front of the patient. (B) Patient is in the lateral decubitus with affected palm to nonaffected shoulder with padding to protect the prominent area of the body. The injection site is 2 cm below the spina scapula for the SSP nerve block at the spinoglenoid notch, and we use a posterior approach for glenohumeral joint injection, starting 2 cm below the posterolateral acromion and shifting to the medial side. (C) Then we prepare and clean the affected shoulder using a sterile technique.

Fig 2

Drug and instrument preparation. Two tubes of 5 cc triamcinolone acetonide, two vials of aquabidest, four ampules of 2% lidocaine, 23 G spinal needle (3.5 inch), 0.5% bupivacaine, and a precursor.

Fig 3

(A) Identify the SSP nerve at the supraglenoid notch using USG at 2 cm below the spine scapula. (B) Identification of the suprascapular nerve (∗) below the transvers scapular ligament (red arrow) at spinoglenoid notch. (C) Inserting an echogenic 23 G (3.5 inches) spinal needle (blue arrow) from medial to lateral. Injection (20 mg triamcinolone acetonide, 4 cc 2% lidocaine, and 4 cc 0.5% bupivacaine as a cocktail) was performed, and we waited for 1-2 min.

Fig 4

(A) Create an anatomical landmark approximately 1-2 cm below the posterolateral acromion and shift to the medial, short axis probe position. (B) Echogenic needle insertion in plane position from the lateral to the medial, penetrating the infraspinatus muscle and posterior capsule, and injecting the steroid (40 mg triamcinolone acetonide), as well as 15-20 cc aquabidest.

Fig 5

Post-procedure assessment: manual exercise. Evaluate and compare the active motion of the shoulder joint, such as forward flexion (A and B) and external rotation (C and D), with the motion prior to injection.