Subscapularis motor point block for spastic shoulders in patients with cervical cord injury
Study design: Case series.Objectve: The objective was to study the effect of phenol blocks to the motor points of the subscapularis muscle in patients with cervical cord injury (CCI).Setting: Spinal cord injury units of a national hospital in Tokyo.Methods: The participants were seven patients with traumatic CCI, mean age 55.8 years (SD4.0), whose injury level were at the fifth cervical level and the American Spinal Injury Association (ASIA) impairment scale was A in 2, C in 1 and D in 4. They were at least 5 months post-acute injury, and complained of pain and limited range of motion (ROM) of their shoulder joint that were unresponsive to usual rehabilitative interventions and medications. Before and after the phenol block to the motor points of the subscapularis muscle, we compared passive and active ROM of the shoulder (flexion, abduction and external rotation), spasticity of the subscapularis as assessed with the modified Ashworth scale, pain as evaluated with a visual analog scale, and eating item of the Functional Independence Measure.Results: There were significant improvements in passive ROM in flexion (23.7°), abduction (19.4°) and external rotation (16.8°; P<0.05). Visual analog scale for shoulder pain was reduced from 6.0 to 3.4 (P<0.05). The modified Ashworth scale for shoulder spasticity, however, did not significantly change. The eating Functional Independence Measure item score improved significantly (P<0.05).Conclusions: This study suggests that subscapularis motor point block for pain and limited ROM with spastic shoulder is a useful technique in patients with CCI.