Corticosteroid Injection vs Nerve Block for Shoulder Arthritis

Recruiting in Palo Alto (17 mi)

Overseen by Allison Rao, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Minnesota

Disqualifiers: Uncontrolled diabetes, Allergy to steroid, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

The purpose of this study is to evaluate conservative pain relief measures for patients suffering from glenohumeral arthritis or rotator cuff arthropathy. Conservative management of osteoarthritis is often first line treatment, and while a corticosteroid injection is frequently used, suprascapular nerve blocks have not often been described as an analgesic option in this population.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment for shoulder arthritis?

Research shows that a suprascapular nerve block, which is a type of nerve block, can significantly reduce shoulder pain and improve movement in patients with rheumatoid arthritis, a condition that can cause shoulder pain similar to arthritis. ^{1 2 3 4 5}

Are corticosteroid injections and nerve blocks safe for shoulder conditions?

Corticosteroid injections can be effective for shoulder problems but may cause serious complications if injected into a nerve, such as permanent nerve damage. Nerve blocks, like the suprascapular nerve block, are generally safe with rare side effects. However, corticosteroid injections close to surgery may increase the risk of infection. ^{6 7 8 9 10}

How does the corticosteroid injection treatment differ from other treatments for shoulder arthritis?

Corticosteroid injections for shoulder arthritis are unique because they are directly injected into the joint or surrounding area to reduce inflammation and pain, offering targeted relief. This differs from nerve blocks, which involve numbing specific nerves to alleviate pain, and may not directly address inflammation. ^{2 5 9 11 12}

Research Team

Allison Rao, MD

Principal Investigator

University of Minnesota

Eligibility Criteria

This trial is for patients with shoulder arthritis, specifically glenohumeral osteoarthritis or rotator cuff arthropathy, who are considering injection treatments for pain relief. Participants must have a confirmed diagnosis and be candidates for conservative management.

Inclusion Criteria

I have been diagnosed with shoulder arthritis or rotator cuff issues and am being offered an injection.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either intraarticular corticosteroid injection or suprascapular nerve block for shoulder pain relief

Immediate intervention

1 visit (in-person)

Follow-up

Participants are monitored for changes in pain and shoulder function using various assessment tools

3 months

Multiple assessments at 24 hours, 3 days, 1 month, and 3 months post-intervention

Treatment Details

Interventions

• Corticosteroid Injection (Corticosteroid)
• Nerve Block (Procedure)

Trial Overview The study compares two types of injections to manage shoulder pain: intraarticular corticosteroid injections (IACI), which are common treatments, against suprascapular nerve blocks (SSNB), which are less commonly used but may offer pain relief.

Participant Groups

Group I: suprascapular nerve block (SSNB) with bupivacaine and triamcinolone Experimental Treatment 1 Intervention

Patients with glenohumeral osteoarthritis, rheumatoid arthritis, or rotator cuff arthropathy who are poor surgical candidates or who are not interested in pursuing surgery randomized to suprascapular nerve block (SSNB)

Group II: intraarticular methylprednisolone acetate injection (IACI) Experimental Treatment 1 Intervention

Patients with glenohumeral osteoarthritis, rheumatoid arthritis, or rotator cuff arthropathy who are poor surgical candidates or who are not interested in pursuing surgery randomized to intraarticular corticosteroid injection (IACI).

Who Is Running the Clinical Trial?

University of Minnesota

Lead Sponsor

Trials

1,459

Recruited

1,623,000+

Shashank Priya

University of Minnesota

Chief Executive Officer since 2023

PhD in Materials Engineering from Penn State

Charles Semba

University of Minnesota

Chief Medical Officer since 2021

MD from the University of Minnesota Medical School

Findings from Research

In a study of 59,644 patients undergoing ambulatory shoulder surgery, the use of nerve blocks did not significantly reduce the risk of adverse postoperative outcomes, such as unplanned admissions or readmissions, compared to those without nerve blocks.

While nerve blocks were associated with a statistically significant increase in healthcare costs (about $325 more), this increase may not be clinically relevant, indicating that the benefits of nerve blocks in terms of safety and efficacy may not justify the additional costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Peripheral Nerve Blocks for Ambulatory Shoulder Surgery: A Population-based Cohort Study of Outcomes and Resource Utilization. Hamilton, GM., Ramlogan, R., Lui, A., et al.[2020]

In a randomized, double-blind, placebo-controlled trial involving 83 participants with chronic shoulder pain due to rheumatoid arthritis or degenerative disease, suprascapular nerve block significantly improved pain, disability, and range of movement compared to a placebo injection.

The treatment was found to be safe, with no significant adverse effects reported, making it a promising option for managing shoulder pain in patients with these conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Shanahan, EM., Ahern, M., Smith, M., et al.[2022]

The interscalene brachial plexus block technique was found to be the most effective in reducing postoperative pain and opioid consumption after arthroscopic shoulder surgery, based on a meta-analysis of 36 trials involving 3,124 patients.

However, this technique was associated with a higher frequency of adverse effects compared to other methods, such as the suprascapular nerve block, which had fewer complications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and adverse effects of peripheral nerve blocks and local infiltration anesthesia after arthroscopic shoulder surgery: A Bayesian network meta-analysis. Liu, Z., Li, YB., Wang, JH., et al.[2022]

In a study of 82,561 patients undergoing various shoulder arthroscopic procedures, the use of regional nerve blocks increased significantly over 9 years, but there was no overall difference in postoperative opioid prescription filling between patients who received nerve blocks and those who did not.

However, for patients with a history of preoperative opioid use, those who received a nerve block had significantly lower rates of opioid prescriptions filled in the first two weeks after surgery, suggesting that nerve blocks may help reduce early postoperative opioid consumption in this specific group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure. Trasolini, NA., Bolia, IK., Kang, HP., et al.[2022]

In a double-blind study of 29 rheumatoid arthritis patients, a suprascapular nerve block (SSNB) using bupivacaine alone provided significant pain relief and improved range of motion compared to the standard mixture of bupivacaine and methylprednisolone.

The study found that adding methylprednisolone to the SSNB did not offer any additional benefits, with significant improvements in stiffness and active abduction observed with bupivacaine alone at specific time points.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. Gado, K., Emery, P.[2019]

In a study of 60 patients with non-specific shoulder pain, both suprascapular nerve block and steroid injection were effective in reducing pain and improving shoulder function, with significant improvements noted in both groups after treatment.

However, suprascapular nerve block had the advantage of no complications, making it a safer alternative to steroid injections for treating shoulder pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block versus steroid injection for non-specific shoulder pain. Taskaynatan, MA., Yilmaz, B., Ozgul, A., et al.[2022]

Corticosteroid injections are effective for treating shoulder issues, providing relief for patients.

However, there is a significant risk associated with these injections, as improper administration directly into a nerve can lead to severe complications like permanent axillary palsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurovascular Complications Resulting From Corticosteroid Injections. McFarland, R., Dugdale, TW., Gerbino, P., et al.[2016]

Corticosteroid injections given within 1 month after shoulder arthroscopy are associated with a significantly higher risk of postoperative infection, with odds ratios of 2.63 for private payers and 11.2 for Medicare patients.

No increased infection rates were observed for corticosteroid injections administered at 2, 3, or 4 months post-surgery, suggesting that timing is crucial for the safety of these injections.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk. Kew, ME., Cancienne, JM., Christensen, JE., et al.[2020]

The TIFFS study is a randomized clinical trial designed to compare the effectiveness of corticosteroid injections given as either glenohumeral joint (GHJ) injections or suprascapular nerve blocks (SSNB) in treating frozen shoulder, with a minimum of 40 patients participating.

The primary outcome will be measured using the Oxford Shoulder Score (OSS) at three months post-injection, which will help determine which injection method provides better relief of shoulder pain and improved function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized clinical trial of glenohumeral joint steroid injection versus suprascapular nerve block in patients with frozen shoulder: a protocol for the Therapeutic Injections For Frozen Shoulder (TIFFS) study. Jump, CM., Mati, W., Maley, A., et al.[2023]

In a study involving 67 patients with chronic shoulder pain, both CT-guided and anatomical landmark approaches for suprascapular nerve blocks resulted in significant reductions in pain and disability over 12 weeks, demonstrating their efficacy.

There were no significant differences in outcomes between the two methods, and both approaches were found to be safe with high patient satisfaction scores for pain relief.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block in chronic shoulder pain: are the radiologists better? Shanahan, EM., Smith, MD., Wetherall, M., et al.[2022]

In a randomized controlled trial involving 77 patients with frozen shoulder, a single corticosteroid injection into the rotator interval (RI) resulted in significantly better improvements in pain, passive range of motion, and function compared to injections into the intra-articular (IA) or subacromial (SA) spaces.

The RI group showed faster and more significant improvements starting at 4 weeks post-injection, while the SA group did not demonstrate significant changes in passive range of motion or function, highlighting the effectiveness of targeting the RI for treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effect of Corticosteroid Injection Into Rotator Interval for Early Frozen Shoulder: A Randomized Controlled Trial. Sun, Y., Liu, S., Chen, S., et al.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

Peripheral Nerve Blocks for Ambulatory Shoulder Surgery: A Population-based Cohort Study of Outcomes and Resource Utilization. [2020]

2. England pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Efficacy and adverse effects of peripheral nerve blocks and local infiltration anesthesia after arthroscopic shoulder surgery: A Bayesian network meta-analysis. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in patients with rheumatoid arthritis. [2019]

6. Japan pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block versus steroid injection for non-specific shoulder pain. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Neurovascular Complications Resulting From Corticosteroid Injections. [2016]

8. United States pubmed.ncbi.nlm.nih.gov

The Timing of Corticosteroid Injections After Arthroscopic Shoulder Procedures Affects Postoperative Infection Risk. [2020]

9. England pubmed.ncbi.nlm.nih.gov

A randomized clinical trial of glenohumeral joint steroid injection versus suprascapular nerve block in patients with frozen shoulder: a protocol for the Therapeutic Injections For Frozen Shoulder (TIFFS) study. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Preoperative corticosteroid joint injections within 2 weeks of shoulder arthroscopies increase postoperative infection risk. [2020]

11. England pubmed.ncbi.nlm.nih.gov

Suprascapular nerve block in chronic shoulder pain: are the radiologists better? [2022]

12. United States pubmed.ncbi.nlm.nih.gov

The Effect of Corticosteroid Injection Into Rotator Interval for Early Frozen Shoulder: A Randomized Controlled Trial. [2019]