1. 2017;20;E233-E239Ultrasound-Guided Block of the Suprascapular Nerve in Breast Cancer Survivors with Limited Shoulder Motion – Case Series
   Cohort Assessment
   Sibel Caglar Okur, MD, Ozden Ozyemisci-Taskiran, MD, Yasemin Pekindogan, MD, Murat Mert, MD, and Nil Syiner Caglar, MD.

BACKGROUND: Suprascapular nerve block is performed in the management of chronic shoulder pain and frozen shoulder.

OBJECTIVE: To investigate the effects of ultrasound-guided suprascapular nerve block in restoration of shoulder motion in breast cancer survivors.

STUDY DESIGN: A cohort study.

SETTING: A training and research hospital, outpatient setting.

METHODS: A total of 18 breast cancer survivors with limited shoulder motion, pain, and difficulty in positioning the upper extremity for radiation treatment following surgery were enrolled in this study. Ultrasound-guided suprascapular nerve blocks were performed while the patients were seated in a chair without a backrest. After visualization of the suprascapular nerve under the transverse suprascapular ligament, 20 mg of triamcinolone and 4 mL of 0.5% bupivacaine were injected. Shoulder range of motion, pain, disability, and upper extremity circumference measurements were assessed in all participants before and 10 days after the block.

RESULTS: A significant decrease was observed in severity of pain and disability 10 days after the block. The ranges of shoulder abduction, flexion, and external rotation were improved significantly. All patients were able to receive radiation therapy without delay.

LIMITATIONS: Absence of a control group and absence of randomization reduces the strength of our findings. Small sample size and absence of long-term follow-up are other limitations of this study.

CONCLUSIONS: This is the first study investigating the effect of ultrasound-guided suprascapular block on shoulder limitation in breast cancer survivors. The results demonstrate that it may be a promising treatment approach for rapid recovery of shoulder motion in women with breast cancer before radiation treatment.

Key words: Breast cancer, upper extremity, shoulder pain, range of motion, disability, ultrasound, injection, triamcinolone, local anesthetics