Suprascapular catheter for proximal humerus fracture in a patient with cervical spine injuries

INTRODUCTION

• The proximal humerus receives sensory innervation from the brachial plexus, primarily by the axillary and suprascapular nerves.1

• Concomitant cervical spine injuries requiring collars/ immobilization can make supraclavicular (SCB) and interscalene (ISB) blocks challenging and potentially dangerous.

• We present a case of effective analgesia for proximal humerus fracture using combined infraclavicular brachial plexus block (ICB) with suprascapular nerve block (SSB) in a patient with cervical spine injury.

• A 72 year old female presented after a motor vehicle collision with a proximal humerus fracture and a C4 extension teardrop vertebral body fracture.

• The spine surgery team required the patient to wear a cervical collar at all times to minimize neck manipulation, including for nerve block procedures.

• Acute pain service was consulted for persistent shoulder pain attributed to her injury.

• The cervical collar interfered with probe positioning for ISB/SCB. Instead, we performed SSB and ICB with liposomal bupivacaine, resulting in excellent analgesia for 2 days, and sensory return the following day.

• Three days after the initial blocks, patient underwent reverse total shoulder arthroplasty. We placed a continuous SSB catheter and single-shot ICB postoperatively. The catheter remained for 7 days, at which time it was bolused with 10 ml of 0.2% ropivacaine and removed uneventfully.

• Patient reported average pain scores of 4/10 throughout follow up and endorsed satisfaction with analgesia beyond the duration of the single-shot ICB.