Suprascapular Block

The fibers of C5 and C6 nerve roots and some contribution from the C4 nerve root form the suprascapular nerve that passes through the suprascapular notch under the coracoclavicular ligament.

Indication

A suprascapular block is useful for the diagnosis and treatment of pain and surgery involving the shoulder girdle and shoulder joint pain. It may also be used for treatment of "frozen shoulder" adhesive capsulitis or complex regional pain syndrome type I.

Technique Preparation

Arrange sterile towels, sterile gloves, gauze pads, marking pen, antiseptic solution, syringes, and needles for local infiltration and nerve block placement.

Dose

20-40 ml syringes of local anesthetic. Needles

25 g 1.5 in. needle for skin infiltration and a 22 g 5 cm short bevel insulated stimulation needle.

Agents

3% chloroprocaine, 2% lidocaine, 0.5% ropivacaine, 0.5% bupivacaine. Surface Anatomy and Landmarks

Basic landmarks for performance of a suprascapular nerve block include the spine of the scapula, and the scapula is then palpated laterally to identify the acromion. With the patient in the sitting position, 25-gauge 3.5 in. needle is inserted at the junction of the spine of the scapula and the acromion in an inferior direction toward the scapula. Once it encounters the body of the scapula, the needle is walked off superiorly and laterally until it enters the suprascapular notch. Once a paresthesia is elicited, the needle should not be advanced any further. If a paresthesia is not encountered, the needle is then advanced another half an inch until it crosses the coracoclavicular ligament. After negative aspiration, 10 cc of a local anesthetic solution is slowly injected.

Table 20.7 Infraclavicular branches (at the level of the cords).

Nerve

Motor

Sensory

Joint

Lateral pectoral

Pectoralis major m.

Medial pectoral

Pectoralis minor and part of pectoralis major m.

Medial brachial

Skin over the upper medial side

cutaneous

of arm

Medial antebrachial

Skin over medial portion of

cutaneous

forearm

Upper subscapular

Superior portion of the subscapularis m.

Lower subscapular

Inferior portion of the subscapularis and teres major m.

Thoracodorsal

Latissimus dorsi m.

Axillary

Teres minor, deltoid m.

Skin overlying the inferior deltoid

Shoulder joint

Musculocutaneous

Coracobrachialis, biceps brachii,

Branches form the lateral

Elbow joint, proximal

brachialis m.

antebrachial cutaneous n. covering the skin

radioulnar joint

Ulnar

Flexor carpi ulnaris, ulnar portion of flexor digitorum profundus, and most small muscles of the hand

Medial skin over hand, fifth digit, and medial half of the fourth digit

Median

All flexor muscles in the forearm

Skin over the anterior (palmar)

Radioulnar joint (distal and

except for flexor carpi ulnaris,

hand into digits first-third, lateral

proximal)

ulnar portion of flexor digitorum

half of the fourth digit

profundus, and the five hand

muscles

Radial

Triceps brachii, brachioradialis,

Skin over lateral posterior hand

Elbow joint, radioulnar joint

anconeus, extensor muscles of

and lateral thumb; branches to

(distal and proximal)

the forearm

the lower lateral brachial and posterior antebrachial cutaneous covering lateral skin over the lower arm, forearm, and elbow

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