Ultrasound-guided pulsed radiofrequency treatment for distal suprascapular neuropathy

Abstract

Rationale: Suprascapular neuropathy is a rare cause of shoulder pain, and patients usually presents with posterosuperior shoulder pain and weakness on forward flexion and external rotation. Suprascapular neuropathy associated with rotator cuff pathology has received attention as an emerging cause of this condition. Suprascapular nerve (SSN) block can be used in these patients, and pulsed radio frequency (PRF) can be applied to achieve a long-term effect. Several studies have reported on PRF treatment of the SSN for shoulder pain, but most applied treatment to the nerve trunk under the transverse scapular ligament. This report describes a patient with suprascapular neuropathy treated with selective application of PRF to the distal SSN under ultrasound guidance. Patient concerns: A 68-year-old woman suffered from right posterior shoulder pain after traumatic full thickness rotator cuff tear. Her pain was not diminished despite of 2 surgeries. Diagnoses: She was diagnosed with entrapment of the distal SSN in the spino-glenoid (SGN) notch and suprascapular neuropathy. Interventions: She underwent surgery to decompress the entrapped SSN in the SGN. After that, we applied PRF on the distal SSN under ultrasound guidance for persistent pain. This treatment was repeated 3 times. Outcomes: PRF treatment resulted in a slight reduction in the visual analogue scale (VAS) pain score from 7–8/10 to 5–6/10 at the 2 weeks follow-up, and to 2–3/10 at the 1 month follow-up. The reduction in pain was maintained at the 1 year follow-up. Lessons: PRF treatment of the SSN is typically approached from the main branch in the suprascapular notch. We selectively applied PRF to the distal SSN close to the SGN. This technique was safe and effective.

Sports‐related peripheral nerve injuries of the upper limb

“…60 Minimally invasive interventions such as pulsed radiofrequency and peripheral nerve stimulation have been proposed as adjuvants for pain control, however, further research is needed to clarify their potential role in the management, especially in athletic populations. 75,76 In patients with overt muscle atrophy and/or space-occupying lesions, as well as those who fail to improve with an appropriate course of conservative care, operative decompression of the nerve is recommended. Superior surgical outcomes are associated with operative intervention within 6 months of initial symptom onset.…”

“…Shoulder stretching and joint mobilizations to reduce capsular tightness are also recommended, particularly in overhead athletes 60 . Minimally invasive interventions such as pulsed radiofrequency and peripheral nerve stimulation have been proposed as adjuvants for pain control, however, further research is needed to clarify their potential role in the management, especially in athletic populations 75,76 . In patients with overt muscle atrophy and/or space‐occupying lesions, as well as those who fail to improve with an appropriate course of conservative care, operative decompression of the nerve is recommended.…”