Suprascapular Nerve Block for Shoulder Pain

Key facts

Who it is for

Why two small nerves can switch off a whole shoulder

The shoulder joint gets its pain supply from a few nerves. The suprascapular nerve (from C5–C6) carries roughly 70% of it: the back and top of the joint capsule, the acromioclavicular joint and the bursa under the acromion. It runs across the top of the shoulder blade through a small notch. The axillary nerve supplies most of the rest, the front and lower capsule, as it wraps around the back of the humerus. Blocking one or both interrupts the pain signal from the joint without numbing the whole arm.

Ultrasound guidance. We place the probe over the top of the shoulder blade and follow the nerve into the supraspinous fossa or the suprascapular notch, where it lies beside its artery under a ligament. A fine needle is advanced in view, and 5–10 mL of anesthetic (with steroid, for a treatment block) is placed around the nerve. The axillary nerve is found at the back of the shoulder next to the posterior circumflex humeral artery and blocked with 5 mL. Seeing the needle the whole way keeps it away from the lung, which sits below the notch, and lets us use a small volume so the anesthetic does not spread to the brachial plexus and weaken the arm.

Test or treatment. An anesthetic-only block is a test. If your shoulder pain drops by at least 50% for the hours the drug works, and you can lift and reach in ways that normally hurt, these nerves are carrying your pain and you qualify for a longer-lasting procedure on them. A block with steroid is a treatment; in randomized trials it gave 4–12 weeks of reduced pain and better movement in chronic shoulder pain and frozen shoulder.

Why not an interscalene block? The interscalene block, which numbs the whole brachial plexus in the neck, is a surgical anesthesia block used for shoulder operations. It paralyzes the phrenic nerve on that side in nearly 100% of patients, taking half of the diaphragm out of action for hours, and it numbs and weakens the entire arm. That is acceptable for one operation with an anesthesiologist present; it is not a repeatable outpatient treatment for chronic pain, and we do not use it for that purpose. The suprascapular block gives the pain relief without the arm weakness or the breathing effect.

What happens on procedure day

1. Check-in and a short review: your pain score today, which movements hurt most, your blood-thinner list and, if diabetic, your morning glucose. We examine the shoulder and the neck so we know the pain is not radiating from a cervical nerve.
2. You sit with your arm relaxed in your lap, or lie on your side. The skin over the top and back of the shoulder blade is cleaned with chlorhexidine.
3. Ultrasound locates the suprascapular nerve and artery in the notch or fossa. A small lidocaine wheal numbs the skin.
4. With the needle in view, we advance to the nerve and inject 5–10 mL of anesthetic, with steroid if this is a treatment block. You feel pressure and sometimes a brief ache deep in the shoulder. If the axillary nerve is included, we repeat at the back of the shoulder with about 5 mL.
5. A bandage goes on. Within 10–20 minutes the deep shoulder ache typically fades. For a diagnostic block we ask you to reach overhead, behind your back and across your chest, then rate your pain.
6. You are observed for 15–20 minutes and go home with a pain diary. Most people drive themselves; if your arm feels heavy or weak, wait until it recovers or have a driver.

After the procedure

Day 0. The shoulder feels lighter and less painful for 2–8 hours. Mild weakness of the muscles that turn the arm outward (supraspinatus and infraspinatus) can occur for the same period; do not lift anything heavy overhead until it passes. Rate your pain every hour on the diary while doing normal activities. Ice the injection site for 15 minutes if it aches.

Days 1–3. After a diagnostic block your usual pain returns; the hours of relief are the result we needed. After a steroid block, soreness at the site and a brief flare are common before relief builds. Diabetics should check glucose twice daily for three days.

Week 1–2. Steroid benefit is usually clear by day 7. This is the window to work on motion: for frozen shoulder, do the stretching program daily while the pain is down; for arthritis or cuff disease, resume the strengthening exercises from physical therapy. Relief lasts longer in patients who use it to move.

When we judge the response. The same day for a diagnostic block, from your diary. At 2–3 weeks for a steroid block. Call the same day for fever over 100.4°F, spreading redness, new shortness of breath (very rare), or arm weakness lasting beyond 24 hours.

What the evidence shows

Suprascapular nerve block has better trial evidence than most peripheral blocks for chronic pain. A randomized, placebo-controlled trial in patients with chronic shoulder pain from arthritis and rotator cuff disease found significant improvements in pain, disability and range of motion for 12 weeks after a single steroid block. Randomized trials in adhesive capsulitis show faster pain relief and better motion than physical therapy alone, and results comparable to injection into the joint. Systematic reviews rate the block as safe, with serious complications rare when ultrasound is used. The evidence for what comes next is newer: case series and small trials of pulsed and conventional radiofrequency of the suprascapular nerve report relief of 6–12 months in patients who responded to a diagnostic block, and peripheral nerve stimulation of the suprascapular and axillary nerves has early trial data showing sustained relief. These are options for patients who cannot or do not want to have shoulder surgery; they do not repair a torn cuff or replace a worn joint. Gulf Coast Pain & Spine performs these blocks under ultrasound in Houston and Webster, and in Pearland when that office opens in November 2026.

Alternatives and what comes next

Before a nerve block: most shoulders should have had 6–12 weeks of physical therapy, activity modification, anti-inflammatory medication and an ultrasound-guided steroid injection into the joint or bursa; for frozen shoulder, an intra-articular steroid injection plus stretching is the standard first step. If the pain comes from the neck, a selective nerve root block is the right test instead.

After a positive suprascapular block that keeps wearing off, the longer-lasting options are radiofrequency ablation of the suprascapular (and sometimes axillary) nerve, which typically gives 6–12 months and can be repeated, and peripheral nerve stimulation, a thin lead placed next to the nerve for 60 days or permanently, for patients who need more durable relief. Surgical options (arthroscopic repair, shoulder replacement) remain the definitive treatment for a repairable tear or advanced arthritis in patients fit for surgery, and a nerve block does not change that. If a well-placed block gives no relief, the shoulder joint nerves are not the source, and we look at the neck, the acromioclavicular joint or a muscular cause. Ask which approach we recommend for your shoulder.

Safety and preparation

• Blood thinners: this is a superficial, ultrasound-guided block classified as low risk under ASRA guidance, so aspirin, clopidogrel, warfarin and DOACs can usually continue. Tell us what you take; if your INR is high or you take two antiplatelet drugs, we may adjust. Never stop a blood thinner on your own.
• Diabetes: a steroid block raises blood sugar for 1–7 days. We do the block with anesthetic only, or postpone the steroid, if your morning glucose is above roughly 200–250 mg/dL.
• Infection or fever: fever above 100.4°F or skin infection over the shoulder postpones the block. A hot, swollen shoulder needs joint infection ruled out first.
• Allergies (contrast, steroid, local anesthetic): no contrast dye is used. Tell us about any reaction to lidocaine, bupivacaine or a steroid injection so we can substitute.
• Pregnancy: no X-ray is used and an anesthetic-only block is considered safe; we avoid steroid unless clearly needed. Tell us if you are or could be pregnant.
• Sedation and driving: no sedation is needed and most patients drive themselves. If your arm feels weak or heavy afterward, wait until it recovers before driving.
• Planned shoulder surgery: tell us if a replacement or repair is scheduled; most surgeons want no steroid injection within about 3 months of surgery because of infection risk.

Risks and side effects

Frequently asked questions

Related care

Related treatments

Related conditions