Ultrasound-guided pulsed radiofrequency neuromodulation of the suprascapular nerve in partial rotator cuff tears

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society

BACKGROUND

There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.

METHODS

Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.

RESULTS

This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.

CONCLUSIONS

In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.

Comparative Randomized Study Between Pulsed Radiofrequency and Suprascapular Nerve Block for the Treatment of Chronic Shoulder Pain

OBJECTIVES

The primary objective of this study was to compare pain intensity after pulsed radiofrequency (RF) or suprascapular nerve block for the treatment of chronic shoulder pain. The secondary objectives were to compare the shoulder range of motion and supplementary analgesic requirement.

METHODS

This randomized and prospective study included 40 patients, with chronic shoulder pain allocated into 2 groups. One group underwent pulsed RF, and the other group was submitted to block (B) of the suprascapular nerve, guided by ultrasound. They were assessed for 12 weeks regarding pain intensity, the need for analgesia supplementation, and shoulder range of motion. Side effects were recorded.

RESULTS

Pain intensity on movement was lower in the RF group after 2, 4, and 8 weeks. At rest, pain intensity was lower in group RF than in group B after 12 weeks. Pain intensity was lower than before the procedure at all times evaluated, in both groups. There was no difference between groups in the range of motion. There was a need for tramadol supplementation in 1 patient in group RF and 2 in group B. Adverse effects observed were local pain (RF: 1), hematoma (RF: 1; B: 1), and lipothymia (B: 2).

DISCUSSION

Pulsed RF on the suprascapular nerve promoted an analgesic effect for 12 weeks. Regarding the intensity of pain on movement and at rest, there was a trend toward a better effect with RF than with nerve blockage treatment. In both groups, there was a reduction in pain intensity without serious adverse effects.

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

BACKGROUND AND OBJECTIVES

Chronic shoulder pain is a frequent cause of suffering and impaired quality of life. Treatment includes non-pharmacological and pharmacological therapies, and interventional procedures such as suprascapular nerve blocks and radiofrequency. This prospective study aims to evaluate the efficacy of ultrasound-guided pulsed radiofrequency of suprascapular nerve for chronic shoulder pain in a clinical setting.

METHODS

Therapeutic efficacy was evaluated through pain intensity using numeric pain rating scale at baseline, immediately, 3, and 6 months after, and patient...s motor function improvement. The secondary outcome was patient satisfaction.

RESULTS

A total of 34 patients were enrolled and all patients presented a reduction in the numeric pain rating scale immediately after treatment. Pain reduction from baseline to 6 months after the procedure was 34.4% and 36.9% static and dynamic, respectively. The median percentage reduction was statistically significant immediately, 3 and 6 months after. There was also an improvement in range of motion, 39.6% in abduction, 24.1% in flexion, and 29.5% in extension. Ninety percent of patients reported patient...s global impression of change superior to six.

CONCLUSION

This study concludes that ultrasound-guided pulsed radiofrequency of suprascapular nerve reduces pain intensity for at least 6 months, accompanied by improvement of motor function and higher levels of patients... satisfaction. Therefore, this technique represents a valid analgesic approach to chronic shoulder pain.

Iatrogenic Injury to the Suprascapular Nerve Following Reverse Shoulder Arthroplasty: A Case Report

The location and course of the suprascapular nerve (SSN) to the glenohumeral joint places this nerve at risk when operating around the shoulder. Iatrogenic injury to the suprascapular nerve has been described in several different procedures including, rotator cuff repairs, posterior capsulorraphy, Bankart repairs, SLAP lesion repairs, Latarjet procedures, and shoulder arthroplasty. We present a case of iatrogenic suprascapular nerve injury due to superior glenoid baseplate screw placement following primary reverse shoulder arthroplasty (RSA), a novel approach to diagnosis of nerve injury, and treatment.

Effects of evidence-based nursing combined with enhanced recovery after surgery on shoulder joint function and neurological function after arthroscopic rotator cuff injury repair

To explore the effect of Enhanced Recovery After Surgery (ERAS) nursing combined with limbs training on shoulder joint range of motion and neurological function of patients with rotator cuff injury after surgery.60 patients who underwent arthroscopic rotator cuff repair were randomly divided into experimental group and control group, with 30 cases in each group. The experimental group received ERAS nursing combined with rehabilitation training, while the control group received routine nursing. The prognostic effects of nursing care and shoulder joint range of motion between the two groups were compared.There were differences in general indicators between the two groups (P = .001). There was no significant difference in the evaluation indexes of the two groups of patients (P > .05). The visual analog scale score and the degree of swelling of the affected limb of the experimental group were lower than those of the control group (P = .001; .001). After 1, 6, 12 weeks of treatment, the Constant-Murley, American Shoulder and Elbow Surgeons and University of California-Los Angeles scores of the experimental group were higher than those of the control group (P = .001; .001; .001). After 2, 4 weeks of treatment, the National Institutes of Health Stroke Scale scores of the experimental group were lower than those of the control group (P = .001). The self-efficacy evaluation of the experimental group was significantly better than that of the control group (P = .001); the complication rate was lower than that of the control group (P = .006).Compared with simple postoperative nursing recovery, ERAS nursing combined with limbs training can improve the exercise capacity of the shoulder joint and the recovery of neurological function, reduce the occurrence of complications.

Treatment effect and mechanism of Fu's subcutaneous needling among patients with shoulder pain: A retrospective pilot study

Fu's subcutaneous needling (FSN) is a new acupuncture therapy developed from acupuncture and Traditional Chinese Medicine models. The aim of this study was to investigate the effect of FSN on shoulder pain. In this retrospective comparative study, patient case files with shoulder pain (Group A) treated with FSN were analyzed and compared with the same number of patients with shoulder pain (Group B) treated with conventional acupuncture and physical therapy. Motion-related pain (MRP), pain under pressure (PUP), and Range of motion (ROM) were collected before and after intervention. In the 68 patients, there were 39 males and 29 females, aged 21-53 years old (mean ± SD = 36.4 ± 8.15) with onset time ranging from 1 day to 7 days (mean ± SD = 3.15 ± 1.73). MRP, PUP, and ROM scores were improved after FSN intervention (p < .05). There were significant differences between group A and group B in MRP, PUP, and ROM scores after FSN intervention and 1 week follow-up (p < .05). No adverse events, such as fainting and sharp pain, occurred during the treatment process. FSN can be an effective rehabilitation intervention for improving shoulder pain and shoulder range of motion.

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

BACKGROUND AND OBJECTIVE

Studies have reported relief of chronic shoulder pain with non-ablative pulsed neuromodulatory (pRF) or ablative radiofrequency (aRF) procedures on innervation of the shoulder joint but interpretation of these reports is hampered by inconsistent indications, anatomic targets and follow-up. This systematic review was conducted to synthesize the existing literature on procedures employing pRF or aRF for treating chronic shoulder pain.

DATABASES AND DATA TREATMENT

MEDLINE and other medical literature databases were reviewed up to 31 December 2019 for publications on pRF or aRF procedures on shoulder joint innervation to relieve chronic pain. Data on analgesic and functional outcomes measured at any time point following the interventions were extracted. Existing knowledge on innervation of the shoulder joint with relevance to RF procedures was also synthesized.

RESULTS

In all, 42 publications, 7 randomized controlled trials (RCTs) and 35 observational studies, case series or reports were identified. Thirty-six of these publications were on pRF procedure and 29 of these reported procedures exclusively targeting the suprascapular nerve. A meta-analysis of the seven RCTs evaluating pRF indicated no analgesic benefit or functional improvement with this treatment over conventional medical management. Case series and reports on aRF indicate a potential for analgesic benefit but the quality of this evidence was low.

CONCLUSIONS

RF treatments targeting the sensory innervation of the shoulder joint affected by degenerative conditions have the potential to reduce pain but the current evidence does not suggest analgesic or functional benefit (GRADE certainty of evidence-low). Studies of high methodological quality are required to further investigate the role of these interventions.

SIGNIFICANCE

This is a comprehensive review of literature on pulsed (non-ablative) and ablative radiofrequency (RF) procedures for chronic shoulder pain. The systematic review and meta-analysis of 7 trials found that pulsed RF for chronic shoulder pain provided similar analgesia and functional improvement as conservative medical management at three months after the procedures. The case series and reports on ablative RF for shoulder pain indicate possible analgesic benefit but their quality was low. This review highlights the need for studies of a high quality on ablative RF treatments for chronic shoulder pain.

Suprascapular Nerve Pulsed Radiofrequency for Chronic Shoulder Pain in a Pediatric Patient

Pulsed radiofrequency of the suprascapular nerve has shown efficacy in adults with chronic shoulder pain, but its use in pediatrics is relatively new. We present a case of a successful use of pulsed radiofrequency to treat refractory chronic shoulder pain in an adolescent patient. Case Report. We present a 53 kg, 14-year-old female, with a medical history of septic arthritis of the left shoulder within the first month of life leading to persisting pain during childhood. She presented with a complaint of progressive pain starting at age 12, refractory to analgesics including opioids and intra-articular injection of local anesthetic and steroids. After pulsed radiofrequency of the suprascapular nerve, significant pain relief and improvement of the range of motion was obtained. These results were maintained at the 1-, 3-, and 6-month follow-up visits with the pain being reported as mild and manageable with nonsteroidal anti-inflammatory drugs. Conclusion. There is limited data today of the use of pulsed radiofrequency for pediatric chronic pain. We successfully used this intervention in a 14-year-old patient with chronic shoulder pain extrapolating from adult experience and as a last resort after all other treatments had failed.