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ghost dog

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Aug 23, 2008
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I have a case for everyone:

Lady with moderate supraspinatus tendinosis of the shoulder and full thickness tear. Ortho doesn't want to touch her, and she hasn't responded to physio.

She has had minimal response to meds / long acting opioids / elavil / NSAIDs etc. I just started her on Lyrica.
To complicate matters, she is about to undergo radiation therapy to her upper chest / lung for a questionable cancer.
She has severe pain.

The advisability of attempting ( i.e. in the setting of rad Tx ) a suprascapular nerve block ? The primary concern here would be that of
increased risk of bleeding.
 
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Ligament

Interventional Pain Management
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Jan 8, 2002
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I have a case for everyone:

Lady with moderate supraspinatus tendinosis of the shoulder and full thickness tear. Ortho doesn't want to touch her, and she hasn't responded to physio.

She has had minimal response to meds / long acting opioids / elavil / NSAIDs etc. I just started her on Lyrica.
To complicate matters, she is about to undergo radiation therapy to her upper chest / lung for a questionable cancer.
She has severe pain.

The advisability of attempting ( i.e. in the setting of rad Tx ) a suprascapular nerve block ? The primary concern here would be that of
increased risk of bleeding.
Nothing to worry about IMHO. Do her a favor and proceed.
 
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epidural man

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Jun 3, 2007
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lobelsteve

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Yup.

But XRT for questionable cancer? Do they have CT, PET, Bx up there?
No idea if they just blast away for suspected malignancy- but sounds aggressive.
 

ghost dog

10+ Year Member
Aug 23, 2008
830
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Yup.

But XRT for questionable cancer? Do they have CT, PET, Bx up there?
No idea if they just blast away for suspected malignancy- but sounds aggressive.
It's a complex case, which I oversimplified for the sake of my interventional question.

This lady presented with another shoulder MRI abnormality : pleura
mass (i.e. in addition to her rotator cuff path). A bone scan was then performed which was then worrisome for bone mets at the right upper ribs. However, she also has some fairly persuasive MSK findings - a positive empty can sign.

Should be interesting to follow her and see how she does with rad TX, and suprascapular blockade.
 

mille125

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Dec 8, 2006
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It's a complex case, which I oversimplified for the sake of my interventional question.

This lady presented with another shoulder MRI abnormality : pleura
mass (i.e. in addition to her rotator cuff path). A bone scan was then performed which was then worrisome for bone mets at the right upper ribs. However, she also has some fairly persuasive MSK findings - a positive empty can sign.

Should be interesting to follow her and see how she does with rad TX, and suprascapular blockade.

i would proceed
 

nvrsumr

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I think I missed something... suprascapular nerve block for RTC tear rather than subacromial bursa steroid injection?
 

Jcm800

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Jul 13, 2008
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agree. why do a nerve block for a day of pain relief.
Agree, if sub acromial doesn't help, then supra scapular block and prf of that nerve...shocked at how well it works
 

ghost dog

10+ Year Member
Aug 23, 2008
830
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Kazakhstan
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This is where I am in the Tx pathway at present (i.e. supra scapular block pending).
Update: pt seen by rad onc, who determined that this "mass" was in fact old and related to past rad TX for an old breast cancer. Therefore pt not rad TX candidate.

Pt obtained dramatic relief with suprascapular block.
 
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