Ultrasound-guided pulsed radiofrequency for chronic shoulder pain: a prospective study

Suprascapular Nerve Pulsed Radiofrequency as an Effective Pain Relief Strategy in Supraspinatus Muscle Tendon Tears

INTRODUCTION

The supraspinatus muscle tendon is the most frequently rotator cuff muscle torn. Reliable shoulder pain relief strategies are needed for patients with severe pain, refractory to conservative management, and without surgical indication.

MATERIALS AND METHODS

We conducted a retrospective analysis in a Portuguese reference Rehabilitation Centre during the 1st of January 2020 and the 30th of June 2021, including all patients with partial or complete supraspinatus tendon tear, older than 50 years, who presented with severe pain and who were submitted to suprascapular nerve pulsed radiofrequency.

RESULTS

We included 32 patients in our retrospective analysis, mainly female (53%) with a mean age of 66.50 years old. Most of the patients reported right shoulder pain (21 patients, 66%). The mean baseline pain, reported on the numeric rating scale, was 8.00 ± 0.88. Compared to baseline, mean pain reduced 4.00 ± 3.19 at three months (p<0.001), 3.59 ± 3.13 at six months (p<0.001) and 2.94 ± 2.78 at 12 months (p<0.001). From the 3rd to the 12th month there was an increase of 1.06 ± 2.77 in mean pain (p=0.038). There was no difference (p>0.05) in average pain at 0, 3, 6, or 12 months between patients who were simultaneously submitted to an intra-articular shoulder injection.

DISCUSSION

Our analysis revealed 36% average shoulder pain reduction for, at least, 12 months following suprascapular nerve pulsed radiofrequency, with a peak pain reduction of 50% at three months. Slow fading of pain reduction in the following nine months was seen, however, compared to baseline, pain reduction was always statistically significant. Cortico-anaesthetic intra-articular shoulder injections seem not to add benefit in shoulder pain reduction when performed simultaneously with suprascapular nerve pulsed radiofrequency.

CONCLUSION

Suprascapular nerve pulsed radiofrequency seems to be an effective strategy for shoulder pain reduction, in patients with severe pain, refractory to other management modalities. Nonetheless, larger prospective studies, analyzing shoulder functionality and quality of life lost scores, besides pain reduction, should be pursued.

Pain: a neglected symptom in hemophilia

Repetitive bleeding attacks may cause joint pain and arthropathy in patients with hemophilia (PWH). Despite being a common symptom, pain is not a well-studied topic in this disease. The aim of this cross-sectional, observational study was to assess the frequency and intensity of pain and analyze the success rates ofpain treatment methods. Adult hemophilia patients were included in the study. The Multidimensional Hemophilia Pain Questionnaire (MHPQ) was used to assess pain. In addition to the MHPQ, demographic data were collected. Fifty adult hemophilia patients were included in the study. Thirty-one (62%) of the patients reported pain due to hemophilia in the last year. Twenty-six of them (81.2%) reported pain during bleeding attacks. The most successful pain coping strategy was clotting factor replacement. None of the participants used opioids or adjuvant analgesics. None of them used a physical therapy modality or interventional pain therapy method. While 67.6% of the patients were very dissatisfied or dissatisfied with their global pain treatment, only 16.1% of the patients were satisfied or very satisfied. Patients with higher pain during bleeding episodes were more likely to continue their prophylaxis. There was no significant difference between plasma-derived or recombinant-derived factor prophylaxis in terms of pain complaints. Pain is a frequent and important symptom of hemophilia, but most of the patients are not treated sufficiently. A multidisciplinary approach is needed to improve the life quality of the patients. In addition to successful bleeding prophylaxis, administration of a proper and adequate analgesic regimen and combined physical therapy modalities may decrease pain intensity and prevent the development of arthropathy.

Eхperience of endoscopic decompression of the suprascapular nerve

Background: Suprascapular nerve neuropathy is a commonly spread pathology, caused by a traction force trauma or compression in the scapular notch area. In the case of a conservative treatment failure, a standard surgical procedure is neurolysis (decompression) of the suprascapular nerve in the scapular notch. This procedure can be done in an open manner or endoscopically. Aims: to evaluate the results of endoscopic decompression of the suprascapular nerve in the scapular notch area at a 6 months follow-up. Methods: We operated 10 patients with the clinical picture of posttraumatic suprascapular nerve neuropathy in the period from 2015 to 2021. The mean age of patients was 52.311.8. All the patients underwent the shoulder joint and subacromial space arthroscopy, and decompression of the suprascapular nerve in the scapular notch area. Results: According to the VAS-scale, the severity of pain syndrome before the surgery was 6 cm, while in 6 months after the surgery it decreased to 2 cm. According to the DASH scale, the dysfunction of the of shoulder joint before the surgery was 70 points, in 6 months after the surgery it decreased to 10 points. The range of motion in the shoulder joint before the surgery was: flexion 15514,4, abduction 14042, external rotation 125,6; 6 months after the surgery we observed: flexion 17415,6, abduction 17514,4, external rotation 489. Conclusion: The obtained results let us characterize the method of endoscopic decompression of the suprascapular nerve as a low-traumatic and effective technique, which promotes restoration of the function of the suprascapular nerve and shoulder joint, and elimination of pain syndrome from the shoulder area.