Comparação entre bloqueio do nervo supraescapular e injeção intra-articular de corticoide no tratamento da capsulite adesiva: uma revisão sistemática e metanálise

Abstract

Introduction: Adhesive capsulitis (AC) is a debilitating condition affecting 2-5% of the general population. Suprascapular nerve block (SSNB) has emerged as a therapeutic alternative to intra-articular corticosteroid injection (IACI), but comparative evidence remains controversial. Objective: To compare the efficacy of SSNB versus IACI in the treatment of AC through a systematic review and meta-analysis. Methods: A systematic search was conducted in the EMBASE, SCOPUS, LILACS, SciELO, Web of Science, EBSCO, and Google Scholar databases between May and August 2025. The study was registered in the Prospective International Registry of Systematic Reviews, no. CRD420251059963. Randomized controlled trials comparing SSNB with IACI in patients with AC were included. The outcomes assessed were the global, pain, and disability scores of the Shoulder Pain and Disability Index (SPADI) questionnaire, and the range of motion. We used a random-effects model with a 95% confidence interval. Heterogeneity was assessed using the I² statistic. Results: Four studies were included, totaling 305 participants (125 SSNB, 136 IACI). The meta-analysis demonstrated a non-significant trend for SSNB towards global SPADI at 3-4 weeks (MD = 7.28; 95% CI: -15.27 to 0.70; p = 0.07; I² = 95%). In the pain score at 3-4 weeks, SSNB showed significant superiority and low heterogeneity (MD = -6.38 points; 95% CI: -11.65 to -1.10; p = 0.02; I² = 18%). For range of motion, SSNB was superior in abduction at 3-4 weeks (MD = 9.90°; 95% CI: 0.81 to 18.99; p = 0.03; I² = 82%) and internal rotation at 12 weeks (MD = 4.25°; 95% CI: 2.07 to 6.43; p = 0.0001; I² = 11%). Heterogeneity was high in most analyses (I² > 70%). Conclusion: SSNB showed superiority over IACI in the treatment of adhesive capsulitis, particularly regarding pain control and improvement in range of motion. Both techniques appear effective and safe for the treatment of frozen shoulder.