Therapeutic Effect of Shoulder Anterior Capsular Block Versus Suprascapular Nerve Block in Patients With Frozen Shoulder

The study will include 50 patients with frozen shoulder with no healthy volunteer , Patients in this study will be randomized into two groups according to the treatment performed .

Shoulder anterior capsular block group

Description:

Ultrasound guided injection For the SHAC block, with the patient in a beach-chair position and with the arm in extension, the subscapularis muscle is stretched posteriorly and becomes easily visible. With external rotation and abduction, the coracobrachialis and the biceps brachii muscles are displaced, allowing the visualization of the interfascial space between the deep lamina of the deltoid muscle fascia and the superficial lamina of the subscapularis fascia.Once the injection into the fascial space is achieved, the investigators can proceed towards the glenohumeral pericapsular space by crossing the subscapularis muscle with the needle. By injecting the pericapsular space, the investigators reach the terminal articular branches indistinctly from their origin. Furthermore, through the Weitbrecht foramen, a natural capsular foramen between the upper and middle glenohumeral ligaments, we also reach the intra-articular space .

Suprascapular nerve block group

Description:

Patients will be placed in lateral position by using A high - frequency linear ultrasound probe will be placed approximately 2 cm medial to the medial border of the acromion and about 2 cm cranial to the superior margin of the scapular spine the needle will be inserted .The tip of the needle will be placed at the floor of the supraspinatus fossa where the nerve has passed

• A volume of (10ml) of 2% lidocaine (2ml), 3% Mepivacaine (2ml) , 1 ml methyl-prednisolone acetate (40 mg) and dextrose 5% (5ml) will be injected to both groups.
• All patients in both groups will receive immediate stretching exercises and post injection 3 times weekly followed by home exercises

Inclusion criteria

• Age above 18 years.

• Both sexes, males and females.
• History of complaint >6 weeks
• Restricted shoulder movement unilaterally in at least 2 planes including abduction, external rotation, and internal rotation and restricted passive movement.

Exclusion criteria

• Patient refusal.

• -Allergy to local anaesthetics.
• -Infection at the site of injection .
• -Coagulopathy
• -Prolonged opioid medication
• -Pregnancy
• -Acute trauma, fracture of the shoulder
• People who had received an intra-articular shoulder injection within the last 6 months.
• Patients with tendon tear