Suprascapular, axillary, lateral pectoral and subscapular nerve blocks, and neurolysis

Shoulder pain is a prevalent musculoskeletal condition currently ranked as the third most common musculoskeletal concern in primary care. The principal etiology of shoulder pain is subacromial impingement syndrome (SIS); however, a diagnosis of SIS may be due to numerous causes including rotator cuff tendinopathy and subacromial bursitis. Treatment of chronic shoulder pain is dependent on the underlying pathology; however, current treatments include pharmacotherapies, physical therapy, intra-articular injections, surgical intervention, and more recently, neurolysis. The utilization of neurolytic approaches, like radiofrequency ablation, may offer potential benefits to those with chronic shoulder pain, though, successful use requires a discrete understanding of shoulder anatomy, patient selection, and pain-specific nerve block approaches. Articular nerve involvement is region-specific; therefore, proper neurolytic targeting begins with an understanding of the rotator cuff and its major innervations including the suprascapular nerve, axillary nerve, lateral pectoral nerve, and subscapular nerve. To ensure accurate patient selection, diagnostic nerve blocks are employed, with the appropriate block approach being dependent on nerve involvement. Both diagnostic blocks and radiofrequency ablation utilize the same technical approaches and positioning which include prone positioning, supine positioning, and lateral decubitus positioning. Ultimately, neurolytic approaches to shoulder pain offer a relatively safe alternative treatment strategy for a condition that has a high incidence of refractory pain.