Abstract
BACKGROUND: Suprascapular nerve block (SSNB) is a recognized treatment for chronic shoulder pain, including pain from rotator cuff tears. While it is purported that image-guided SSNB improve injection accuracy over landmark-guided techniques, the impact on clinical outcomes remains unclear. This systematic review compared image-guided vs. landmark-guided SSNB in patients with rotator cuff tears, evaluating efficacy, pain relief, functional improvement, complications, and duration of relief. METHODS: We searched PubMed, MEDLINE, Cochrane Library, Embase, and CINAHL (inception to April 2025) for prospective or retrospective studies comparing image-guided (ultrasound, fluoroscopy, computed tomography, or arthroscopic) to landmark-guided SSNB. Two reviewers independently screened titles/abstracts and full texts, with discrepancies resolved by consensus. Data on pain outcomes, functional scores, complications, and duration of pain relief were extracted. Risk of bias was assessed for each study. RESULTS: Thirty studies were included, comprising 25 randomized controlled trials, 2 nonrandomized prospective studies, and 3 retrospective studies, totaling 2,205 patients. Both image-guided and landmark-guided techniques significantly reduced pain and improved shoulder function, with pain reduction typically ranging from 3.2 to 5.5 points on a 0-10 visual analog scale at 48 hours postoperatively. There was no consistent evidence indicating superior clinical outcomes with image-guided techniques in terms of pain relief, functional improvement, complication rates, or duration of analgesia. CONCLUSION: Both image-guided and landmark-guided SSNB techniques provide effective pain relief and functional improvement in patients with rotator cuff-related shoulder pain. Despite potential procedural advantages of image guidance, such as reduced needle repositioning and higher first-attempt success rates, these benefits did not translate into consistently superior clinical outcomes. This systematic review suggests landmark-guided SSNB offer similar outcomes to image-guided techniques, with implications for resource and expertise availability.