Salt E.1,2, Van der Windt D.A.1, Chesterton L.1, Mainwaring F.2, Ashwood N.2, Foster N.E.1
1Keele University, Research Institute for Primary Care & Health Sciences, Staffordshire, United Kingdom, 2Burton Hospital NHS Foundation Trust, Burton on Trent, United Kingdom
Background: Suprascapular nerve blocks (SSNBs) are offered to patients with chronic, complex shoulder pain where other conservative treatment has failed or surgery is not appropriate or desirable. SSNBs are usually given under ultrasound (US) guidance by doctors. Physiotherapists (PTs) have been able to use injections in their clinical practice for many years in the United Kingdom (UK), but providing SSNBs is not standard practice. As an innovative service development, musculoskeletal shoulder specialist PTs were trained to provide palpation-guided SSNBs at one acute hospital trust in the West Midlands, UK.
Purpose: The purpose was to evaluate the clinical outcomes of patients treated with SSNBs by PTs, and provide a comparison to those treated by an anaesthetist.
Methods: In this service evaluation, we collected data before the SSNB injection and at 6 weeks follow-up from patients being treated by PTs or an anaesthetist. Patient reported outcomes measures included pain (numerical rating score (NRS), function (patient specific functional score (PSFS), and quality of life (EQ5D)). The paired samples t-test was used to compare baseline and follow-up scores within each patient group and descriptive analyses compared the results between those treated by PTs and those treated by the anaesthetist.
Results: 48 patients with chronic shoulder pain (with pain >3 months) who had failed to respond to previous treatment were included. 40 patients (mean age 56.6 (SD 11.9); female 63%) received a SSNB using a palpation-guided technique by a PT, whereas 8 patients (mean age 58.6 (SD 11.1); female 88%) received their SSNB using US guidance by an anaesthetist. Mean baseline pain NRS in the PT group was 7.7 (SD 1.1) and in the anaesthetist group was 7.8 (SD 1.4). At 6 weeks follow-up, the mean change over time for the PT group was: reduction in pain (NRS) 2.2 (SD 2.6) p 0.001; improvement in function (PSFS) -1.1 (SD 2.2) p=0.005. Similar changes were found in the anaesthetist group (NRS 1.3 (SD 3.0); PSFS -1.4 (2.1). Very small changes, that were not significantly different, were found in quality of life (EQ5D) scores. None of the patients involved in the study reported any harm associated with the intervention.
Conclusion(s): The results of this service evaluation provide some evidence that patients with chronic shoulder pain treated by PTs using palpation-guided SSNBs achieved outcomes that were similar to those from an anaesthetist using US-guided SSNBs. Research is needed to fully understand the clinical and cost-effectiveness of PTs offering this new service.
Implications: Whilst it is not common practice for PTs to offer SSNB injections for patients with chronic, complex shoulder pain, PTs who already offer injections might be well placed to extend their role to include these, leading to future service re-design and potentially cost-savings.
Funding acknowledgements: none
Topic: Musculoskeletal: upper limb
Ethics approval: Ethical approval is not required for a service evaluation. The project was registered and approved by the hospital trust.
All authors, affiliations and abstracts have been published as submitted.
