Abril - 2017

ernandes

348

ssoc

ras

2017; 63(4):347-354

Adhesive capsulitis is a crippling, chronic and extreme-

ly painful disease that affects movement of the shoulder

joint. The impairment of everyday activities such as bath-

ing, getting dressed and driving interferes significantly with

an individual’s QoL.

There are numerous treatments, in-

cluding suprascapular nerve blocks (SSNB),

7-9

which is an

effective and safe procedure in the treatment of chronic

diseases affecting the shoulder. The suprascapular nerve is

the most important sensory nerve in the shoulder and

is susceptible to blocking with local anesthetics. The large

number of sympathetic fibers that this nerve supplies to

the shoulder joint capsule was one of the reasons for

choosing to treat adhesive capsulitis with SSNB.

Studies of adhesive capsulitis patients most often

involve symptoms such as pain and range of motion scales

to analyze treatment results.

9,10

QoL and FC simultaneous

assessment is not included in these studies, so this paper

may contribute to patients’ perception of their health

status and treatment efficacy.

The general aim of this study was to evaluate patient-

-reported measures of QoL and FC in adhesive capsulitis

before and after SSNB treatment. In addition, the influ-

ence of clinical and sociodemographic variables on both

QoL and FC outcome and on the instruments’ various

domains, and the correlation between the respective in-

struments were analyzed.

ethod

A prospective clinical study was performed with a cohort

of adhesive capsulitis patients. The participants were

patients selected during routine visits at a specialized

clinic located in an orthopedic hospital.

Adhesive capsulitis was clinically diagnosed when there

was constant pain lasting more than four weeks, with

limitation on active and passive movements of the shoul-

der: anterior elevation to 130° (Figure 1), external rotation

to 50° (Figure 2) and internal rotation to L5 (Figure 3).

Inclusion criteria were a clinical diagnosis of adhesive

capsulitis; existence of shoulder X-ray exams with three views

(true AP, axillary profile and scapular profile) andMRI scan

in the previous 30 days; not under any concomitant adhesive

capsulitis treatment, no subacromial space injection in the

previous 15 days; and glycosylated hemoglobin less than or

equal to 7% in case of associated diabetes. Exclusion criteria

were concomitant pathologies such as complete lesion of

the rotator cuff, instability, glenohumeral arthrosis and

locked dislocation of the shoulder; stroke sequelae (hemiple-

gia or paresis); recent breast surgery; current chemotherapy

or radiotherapy treatment; adhesive capsulitis with bilateral

involvement and previous surgery on the affected shoulder.

Before each SSNB, the Constant score was calculat-

ed. The Constant test is a clinical method of functional-

ly evaluating the shoulder. It combines an analysis of in-

dividual parameters with a 100-point scoring system: the

higher the score, the better the functional index.

The

cutoff point for interrupting blocks and making an over-

all assessment of patients’ quality of life and FC using

the WHOQOL-BREF and DASH was a constant score of

55 points or higher. The test was administered at the be-

ginning of every clinical visit before any other procedure.

The SSNBs were performed on an outpatient basis

following Dangoisse’s technique

without the aid of a

peripheral nerve stimulator or imaging techniques: 8 mL

of bupivacaine hydrochloride 0.5%, with epinephrine

FIGURE 1

Anterior elevation limitation of the right shoulder.

FIGURE 2

External rotation limitation of the right shoulder.