Thermal Radiofrequency Denervation of the Suprascapular Nerve for Chronic Shoulder Pain

Abstract

Background Chronic shoulder pain is an increasing problem in the ageing population. For patients with inoperable problems, management of persistent pain is often inadequate with current non-operative measures. Suprascapular nerve (SSN) block and pulsed radiofrequency (RF) treatment of the SSN gives relief for up to 12 weeks. It is considered that continuous thermal radiofrequency treatment (CTRF) of the SSN may give longer pain relief. Methods Sixty-two patients with chronic shoulder pain were assessed for CTRF treatment of the SSN using a standard technique with a Neurotherm RF lesion generator under image intensification as a day case. Results The mean age of the patients was 74 years. The majority of patients had a significant rotator cuff lesion. Mean visual analogue scores scores fell significantly from 9.1 to 4.5 at 6 months following treatment (p = 0.0001) and 85% patients reported > 50% pain relief at 6 months. Half the patients reported an improvement in sleep and mobility. No serious adverse effects were reported. Conclusions CTRF to the SSN significantly reduced shoulder pain for up to 6 months without adverse effects and gave longer relief than pulsed RF or SSN block. It may be repeated with a similar effect being achieved. The limitations of the present study is the use of a medium-sized series with 6-month follow-up.

A systematic review and meta‐analysis of radiofrequency procedures on innervation to the shoulder joint for relieving chronic pain

“…Taverner & Loughnan, 2014;Wu et al, 2014;Yan & Zhang, 2019) and one was a retrospective study in which pRF and injection of LA on the SSN were offered to both the groups with steroids being injected in one group (Gabrhelik et al, 2010) (Table 1). There were 11 prospective case series (Bone et al, 2013;Brown et al, 1988;Ergonenc & Beyaz, 2018;Gurbet et al, 2005;Jang et al, 2013;Kane et al, 2008;Keskinbora & Aydinli, 2009;Liliang et al, 2009;Luleci et al, 2011;Shabat et al, 2013;Sinha et al, 2020) Simopoulos et al, 2012;Sir & Eksert, 2019;Taverner et al, 2013) and eight case reports (Eckmann et al, 2019;Hackworth, 2013;Huang et al, 2010;Kim et al, 2012;Lipov et al, 2013;Ozyuvaci et al, 2011;Shah & Racz, 2003;Sluijter et al, 2008) (Table 2). In all, 36 of these publications were on pRF procedures and 29 of these publications reported procedures exclusively done on the suprascapular nerve.…”

“…In all, 36 of these publications were on pRF procedures and 29 of these publications reported procedures exclusively done on the suprascapular nerve. The other six publications, all case series or reports, were on aRF (Bone et al, 2013;Brown et al, 1988;Chang et al, 2015;Eckmann et al, 2019;Nakamura et al, 2013;Simopoulos et al, 2012). We also extracted data from nine conference abstracts (Cannon et al, 2012;Dua et al, 2016;Fernandes et al, 2011;Londono et al, 2014;Nakamura et al, 2013;Osako et al, 2016;Pieran, 2010;Vander Cruyssen et al, 2018;Yoshimura et al, 2018) that met the eligibility criteria for this review.…”

“…There are two types of RF procedures: ablative and pulsed. Ablative RF (aRF) requires temperatures of 70-80°C and results in neuronal destruction (Bone et al, 2013). Pulsed RF (pRF) is usually deployed at temperatures of 40-45°C, thereby avoiding loss of neuronal function but resulting in presumed neuromodulatory effects that contribute to analgesia (Chua et al, 2011).…”

Arthroscopic suprascapular neurotomy for the painful irreparable rotator cuff tear

“…Patients who are not suited to major surgical intervention are frequently seen by pain specialists who have been able to perform pulsed radiofrequency of the suprascapular nerve under landmark or ultrasound techniques with varying success (Table 1). 7–12 The results of these series, however, are limited by medium-term follow-up.…”

“…6 Patients who are not suited to major surgical intervention are frequently seen by pain specialists who have been able to perform pulsed radiofrequency of the suprascapular nerve under landmark or ultrasound techniques with varying success (Table 1). [7][8][9][10][11][12] The results of these series, however, are limited by mediumterm follow-up. The potential advantages to the arthroscopic technique include the ability to define the extent of the cuff tear, to classify the severity of glenohumeral arthritis and to divide the suprascapular nerve under direct vision without injuring the suprascapular artery.…”