Transcapular Nerve Block Injections

The suprascapular (or transcapular) nerve starts in the cervical spine, travels outward to the shoulder, under the trapezius muscle, across the shoulder blade, and into the supraspinitus and infraspinitus muscles. Damage or injury to this nerve can be due to cysts, trauma, arthritis, degenerative disease, or repetitive injuries such as overhead lifting, overhead work such as painting, or sports. Patients may experience numbness, weakness, or pain in the upper back, neck, or upper chest if there is suprascapular nerve damage. Those with rotator cuff syndrome or rotator cuff tears may find that they have injuries to their suprascapular nerve as well.  Nerve block injections of the suprascapular nerve can improve pain, and range of motion for a period of up to twelve weeks at a time.

As with all types of chronic nerve pain, there are many treatment options available including cryotherapy (extreme cold), medications and nerve blocking injections. Nerve Block injections involve injection of a numbing solution into a selective nerve in an attempt to treat and manage pain. The injection can include a steroid (to reduce inflammation) and/or lidocaine or marcaine (to reduce pain). Nerve block injections are used to effectively “turn off” such nerves, and thus reduce any associated inflammation. The effect of these injections lasts between one and four weeks and can be repeated as required. With some conditions however, patients report a total reduction in pain since the initial over- activity of the nerve has been counteracted. In some instances, the patient may experience a more long term loss of pain as a result of localized anesthesia.

The types of medications used are not predetermined, since many options are available. Of course, ultrasound or fluoroscopy (image-guided injections) may work best, since surface anatomy may not be enough to target the extremely small surface area of the nerves in question.

Remember, nerve blocks are not the best treatment for all pain types. Even when they are appropriate, they are usually more effective as part of a more comprehensive treatment strategy.

Depending on the circumstances, complete destruction of the nerve (as opposed to temporary numbing through a local anesthetic) could be considered. This is referred to as a rhizotomy. Aside from the obvious complications of nerve destruction, permanently damaging a nerve may inadvertently and inevitably damage the soft tissue adjacent to that nerve as well.



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