Effectiveness of Combination of Ultrasonography‐Guided Pulsed Radiofrequency Neuromodulation With Steroid at the Suprascapular Nerve in Chronic Shoulder Pain

Abstract

BackgroundSuprascapular nerve (SSN) block is a useful tool for pain control of different chronic shoulder pain syndromes. If the short‐term effect of nerve block using local anesthetics is not sufficient, pulsed radiofrequency (PRF) neuromodulation of the SSN may provide long‐term pain relief.Aim of InvestigationThe aim of this study was to determine the effectiveness of ultrasonography‐guided PRF of the SSN for management of chronic shoulder pain.Subjects and MethodThirty patients with chronic shoulder pain underwent diagnostic ultrasonography‐guided SSN block. After confirmation of positive results (>50% pain relief) via diagnostic testing, PRF of the SSN was performed in 27 patients, followed by application of dexamethasone; however, 2 patients had negative results with diagnostic block and 1 patient dropped out after positive results with diagnostic block. Pain was recorded using the VAS, and active range of motion of the affected shoulder was measured by goniometry (flexion, extension, adduction, abduction, external rotation, internal rotation). Assessments were done on day 0 and after 4, 8, 12, and 24 weeks.Statistical TestOne‐way analysis of variance testing.ResultsThe VAS score decreased significantly (P < 0.05) immediately after injection, and pain reduction was sustained for up to 24 weeks. Active range of motion in all directions also increased significantly (P < 0.5) after the procedure.ConclusionPRF of the SSN under ultrasonography guidance is a safe and effective treatment modality for management of chronic shoulder pain. The effect of a combination of PRF and a short‐acting corticosteroid lasts up to 24 weeks, thereby assisting patients in undergoing relatively painless physiotherapy.

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.…”

“…Prognostication blocks were performed in nine of the studies involving pRF (Ergonenc & Beyaz, 2018;Hackworth, 2013;C. C. Huang et al, 2010;Jang et al, 2013;Keskinbora & Aydinli, 2009;Kim et al, 2012;Liliang et al, 2009;Shah & Racz, 2003;Sinha et al, 2020).…”

“…These instruments were either self-reported by patients or applied during assessments by clinicians. The Shoulder Pain and Disability Index (SPADI) (Ergonenc & Beyaz, 2018;Eyigor et al, 2010;Gofeld et al, 2013;Korkmaz et al, 2010;Liliang et al, 2009;Okmen & Okmen, 2017;Sir & Eksert, 2019;Wu et al, 2014;Yan & Zhang, 2019), the Oxford Shoulder Score (OSS) (Jang et al, 2013;Kane et al, 2008;Keskinbora & Aydinli, 2009;Ozyuvaci et al, 2011;Taverner & Loughnan, 2014), the Constant-Murley Score (CMS) (Gofeld et al, 2013;Kane et al, 2008), the Nottingham Health Profile (NHP) (Okmen & Okmen, 2017), the Pain Self Efficacy Questionnaire (PSEQ) (Taverner & Loughnan, 2014), the Simple Shoulder Test (SST) (Yoshimura et al, 2018), range of movement (passive and active) (Bone et al, 2013;Ergonenc & Beyaz, 2018;Eyigor et al, 2010;Fernandes et al, 2011;Gurbet et al, 2005;Kim et al, 2012;Korkmaz et al, 2010;Lipov et al, 2013;Nakamura et al, 2013;Osako et al, 2016;Picelli et al, 2018;Pieran, 2010;Shah & Racz, 2003;Simopoulos et al, 2012;Sinha et al, 2020;Wu et al, 2014), the Disability Assessment Scale (DAS) (Picelli et al, 2018), the Fugl-Mey...…”

“…Most of the subjects had failed to obtain pain relief from oral analgesics, physiotherapy and intra-articular corticosteroid injection and most were also not appropriate candidates for surgical intervention (Shah & Racz, 2003;Simopoulos et al, 2012). Although some case series and reports included subjects with persistent postsurgical pain (Eckmann et al, 2019;Osako et al, 2016;Sinha et al, 2020), rigorous RCTs on this population should be considered because of the prevalence of this diagnosis (Bjørnholdt et al, 2015;Parada et al, 2015). Persistent postsurgical shoulder pain is shown to be present in 22% of the population following shoulder replacement surgery (Bjørnholdt et al, 2015).…”

“…Innervation to the shoulder joint is complex and a prognostic block may have a role in predicting response to a radiofrequency procedure. Prognostic blocks were performed before both pRF (Ergonenc & Beyaz, 2018;Hackworth, 2013 Jang et al, 2013;Keskinbora & Aydinli, 2009;Kim et al, 2012;Liliang et al, 2009;Shah & Racz, 2003;Sinha et al, 2020) and aRF (Chang et al, 2015;Eckmann et al, 2019;Simopoulos et al, 2012) in some of the studies included in this review. The cut-off values for the duration and amount of pain relief following prognostic blocks have not been standardized (Bone et al, 2013).…”