Management Of Chronic Shoulder Pain Research Articles

Radiofrequency of suprascapular nerve as an analgesic strategy for chronic pain management. Systematic review and meta-analysis

IntroductionChronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects. MethodsWe performed a systematic review of clinical trials retrieved from Medline, Embase and the CENTRAL databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I2 test. ResultsWe identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of −0.9 (95% CI [−1.1, 0.33], p = 0.29; I2 88%, p < 0.001) and −1.17 (95% CI [−2.49, 0.14], p = 0.08; I2 97%, p < 0.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of −0.31 (95% CI [−0.91, 0.29], p = 0.31; I2 80%, p < 0.001) and −1.54 (95% CI [−3.26, 0.19], p = 0.08; I2 98%, p < 0.001), respectively. No RFS-related adverse events were described. ConclusionThe evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low.

Cooled Radiofrequency Ablation of the Glenohumeral Joint in lateral Position: A Case Report

Background: Shoulder pain due to adhesive capsulitis is a prevalent musculoskeletal condition, necessitating innovative treatments. Radiofrequency ablation (RFA) offers an effective approach to alleviate chronic shoulder pain. This case report focuses on Cooled Radiofrequency ablation of articular branches of the glenohumeral joint, performed with hybrid technique using fluoroscopy and ultrasonography, while the patient remains in a lateral position. Case Presentation: A 56-year-old female presented with chronic right shoulder pain and restricted motion diagnosed with right shoulder adhesive capsulitis. Diagnostic blocks of sensory articular nerves provided significant pain relief, leading to Glenohumeral joint sensory articular nerve denervation via Cooled Radiofrequency Ablation. The procedure was performed with the patient in a lateral position, as lying prone was intolerable due to pain. The patient showed substantial pain relief and improved range of motion post-procedure. Discussion: Cooled radiofrequency ablation (CRFA) has shown promise in treating Adhesive Capsulitis and Glenohumeral joint osteoarthritis. While the traditional approach involves changing the patient's position from prone to supine, this case report introduces a novel lateral position technique. Benefits include improved patient comfort, strict asepsis maintenance, reduced procedure time, and decreased radiation exposure. However, challenges in C-arm positioning were encountered. Additionally, hydrodilatation of the glenohumeral joint was performed, resulting in further pain reduction and range of motion improvement. Conclusion: This case report demonstrates the efficacy and safety of Cooled Radiofrequency Ablation for the Glenohumeral joint, utilizing a lateral position approach. The findings support its potential advantages over traditional methods, offering a valuable addition to the management of chronic shoulder pain. Further research and clinical experience will refine its role in addressing this common and debilitating condition.

Comparison of pain relief of the cervical radiculopathy between high thoracic erector spinae plane block and cervical epidural injection.

The high thoracic erector spinae plane block (ESPB) has been used for the management of chronic shoulder pain or arthroscopic shoulder surgery. No study has evaluated the analgesic efficacy of ESPB in patients with cervical radiculopathy although it is a favored and easy technique compared to neuraxial block. The purpose of this study was to compare the treatment outcome of cervical radiculopathy using high thoracic ESPB or cervical interlaminar epidural injection (CEPI). This study included 82 patients with neck and arm pain who received CEPI (CEPI group) using 4 ml of 0.1% ropivacaine or high thoracic ipsilateral ESPB (ESPB group) at the T2 or T3 level using 20 ml of 0.1% ropivacaine 20 ml. The degree of pain relief and disability were assessed using an 11-point numerical scale (NRS) and neck disability index (NDI), respectively. The CEPI and ESPB groups demonstrated an equal number of patients with excellent pain relief (NRS reduction ≥ 50%). Significant reduction of NRS was found in both groups, and the effect of time was statistically significant in the groups (P < 0.001). The number of patients who showed an excellent improvement in NDI (NDI reduction ≥ 30%) was 20 (48.8%) and 22 (53.7%) in the CEPI and ESPB groups, respectively. Both the CEPI and ESPB demonstrated significant relief in neck and arm pain with improvement in disability.

A Retrospective Comparison of the Efficacy of Embolization with Imipenem/Cilastatin and Microspheres in the Management of Chronic Shoulder Pain.

To compare the efficacy of embolization with imipenem/cilastatin and microspheres in chronic shoulder pain. This retrospective study included 29 patients who underwent embolization for chronic shoulder pain between June 2017 and March 2022 with calibrated MSs from 100 to 250µm or IMP/CS. The main objective was the clinical success evaluated by the Minimum Clinically Important Difference (MCID) at 3months after the procedure, validated if the patient responded yes to 2 questions: (1) Is the pain less severe than before the procedure? (2) Are you satisfied with the procedure? The decrease in visual analogue pain scale scores and the safety of the procedure were evaluated. Embolization was achieved in all patients. In the MS group, 4/15 patients (26.7%) experienced clinical success at 3months according to MCID versus 10/14 patients (71.4%) in the IMP/CS group (p = 0.02). The mean VAS decreases were respectively - 28.6% ± 34.6 in the MS group and - 36.8% ± 27.8 in the IMP/CS group at 1 month (p = 0.50), - 29.9% ± 29.0 and - 39.6% ± 23.0 at 3months (p = 0.33) and - 30.6% ± 32.8 and - 46.6% ± 28.4 at 6months after the procedure (p = 0.26). Eleven patients (73.3%) in the MS group and 3 patients (21.4%) in the IMP/CS group had complications (p = 0.01). Among them, 2/15 patients (13.3%) had transient skin ischaemia in the MS group. Embolization with IMP/CS may be more effective and safer than MSs in the management of chronic shoulder pain.

Peripheral Nerve Stimulation: A Review of Techniques and Clinical Efficacy.

Chronic pain is a common source of morbidity in many patient populations worldwide. There are growing concerns about the potential side effects of currently prescribed medications and a continued need for effective treatment. Related to these concerns, peripheral nerve stimulation has been regaining popularity as a potential treatment modality. Peripheral nerve stimulation components include helically coiled electrical leads, which direct an applied current to afferent neurons providing sensory innervation to the painful area. In theory, the applied current to the peripheral nerve will alter the large-diameter myelinated afferent nerve fibers, which interfere with the central processing of pain signals through small-diameter afferent fibers at the level of the spinal cord. Multiple studies have shown success in the use of peripheral nerve stimulation for acute post-surgical pain for orthopedic surgery, including post total knee arthroplasty and anterior cruciate ligament surgery, and chronic knee pain. Many studies have investigated the utility of peripheral nerve stimulation for the management of chronic shoulder pain. Peripheral nerve stimulation also serves as one of the potential non-pharmacologic therapies to treat back pain along with physical therapy, application of transcutaneous electrical neurostimulation unit, radiofrequency ablation, epidural steroid injections, permanently implanted neurostimulators, and surgery. Studies regarding back pain treatment have shown that peripheral nerve stimulation led to significant improvement in all pain and quality-of-life measures and a reduction in the use of opioids. Further studies are needed as the long-term risks and benefits of peripheral nerve stimulation have not been well studied as most information available on the effectiveness of peripheral nerve stimulation is based on shorter-term improvements in chronic pain.

Role of Interventional Radiology in Management of Chronic Shoulder Pain

Abstract Background: The shoulder pain is a frequent musculoskeletal condition in the overall population, with incidence of 6.7 –66.7 percent. Aim of the work: The aim of this research was to estimate the interventional radiology role in management of chronic shoulder pain. The Patients and Methods: This prospective study included (60) patients with chronic shoulder pain. Regional injection had been done guided by ultrasound, fluoroscopy &/or CT for e.g: hydrodilatation of the gleno-humeral capsule, hydro-dissection of the subacromial bursa, neurolysis of suprascapular & subaxillary nerves. Results: The full technique has a significant higher improvement in VAS, ROM and SPADI than partial technique. High volume injection has a significant higher improvement in VAS, ROM and SPADI than Low volume injection. Intra-articular injection has a significant higher improvement in VAS, ROM and SPADI than Extra-articular injection. Conclusion: We can conclude that interventional radiology has an effective role in chronic shoulder pain treatment.

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain.

Suprascapular nerve block (SSNB) injections are growing in popularity as a treatment option for people with chronic shoulder pain. The optimal method of injection and aftercare is unknown. This review describes the current methods and drugs used for performing SSNB injections in the non-surgical management of adults with chronic shoulder pain in order to inform future research in this area. Systematic searches of CINAHL, MEDLINE (OVID), AMED, Embase databases and the Cochrane Library were undertaken from inception to June 2020. Data on the method and drugs used for injection and aftercare were extracted and summarised for areas of commonality and discrepancy. We included 53 studies in this review. In total, eight different injection methods were reported within the included studies. Indirect surface land-marked methods were the most common method reported in 21 studies. Direct surface land-marked methods were reported in 12 studies. Ultrasound-guided methods used alone were reported in 16 studies. Both fluoroscopy and computed tomography methods used alone were reported in one study each. Electromyography was used in combination with other injection methods in nine studies. Wide variation in the composition of the injectate was observed between studies. Local anaesthetic was used within injectate preparations in all studies. Local anaesthetic used alone was reported in 20 studies, combined with steroid in 29 studies and combined with various other components in 5 studies. Physiotherapy following injection was reported in 26 studies. Reported details of physiotherapy varied considerably. This review identified substantial variation in the methods and drugs used to perform SSNB injection in clinical trials. Current literature demonstrates a wide range of methods used for SSNB injection administration. Consensus research defining standardised practice for SSNB injection is now needed to guide future clinical practice and research.

Ultrasound Guided Radiofrequency Ablation of the Suprascapular Nerve Versus Injection Block Technique: A Comparative Study in Patients with Chronic Shoulder Pain

AbstractBackground: Chronic shoulder pain affects the quality of life and limits daily activities. Suprascapular nerve block is an effective technique in management of chronic shoulder pain. Suprascapular injection technique had several drawbacks particularly repeated injections that may affect the patients' outcomes. RFA is considered a safe technique especially with ultrasound guidance, having a long duration of action with absence of any complications or organ damage.Aim of Study: This study aimed to examine the effective-ness of radiofrequency ablation (RFA) of the suprascapular nerve in comparison to the injection of lidocaine and hydro-cortisone mixture under ultrasound guidance.Patients and Methods: 20 patients with chronic shoulder pain were divided in to two equal groups one group was submitted to RFA of the suprascapular nerve using the Cool-Tip RF system and an internally cooled electrode (group A) and the other group had lidocaine and hydrocortisone mixture injection (group B) of the same nerve, both groups were followed-up over a period of 6 months with pre and post interventional assessment of the pain though visual analogue score for pain (VAS).Results: All patients had chronic shoulder pain not re-sponding to medical treatment and physiotherapy, after RFA, 6 patients were pain free, 4 cases had mild pain that responded to conservative treatment, regarding those of the injection group all cases had relief for 3 months, at 6 months, only 3 had no complain while 4 patients had recurrence and 3 had stationary course of pain relief.Conclusion: RFA proved to be a superior technique com-pared to the injection method in management of chronic shoulder pain.

Radiofrequency Ablation for Management of Shoulder Pain.

The treatment options for the management of shoulder pain are broad but evolving process. Modalities for controlling shoulder pain have commonly focused on pharmacotherapy, physical therapy, rehabilitation, and invasive procedures (surgical procedures, surgical, intra-articular steroid injections, many times, being sub-optimal). The use of radiofrequency ablation (RFA) for managing shoulder pain is on the rise. Our review investigated the evidence for the use of RFA in the management of shoulder pain. In our investigation, a review of the literature was conducted using Medline, PubMed, and Cochrane Database of Systematic Reviews from 1966 to 2018. Our study included RCTs, open non-randomized control studies, prospective studies, retrospective studies, case series, and case reports. We limited our search to patients with chronic shoulder pathologies. Our initial search identified 96 articles for initial review. This was narrowed down to 31 articles, which met our inclusion criteria, with only 18 articles remaining after our exclusion criteria was applied. This systematic review suggests that shoulder RFA may provide a safe and significant benefit in the management of chronic shoulder pain. There were a few high-quality RCTs included in our study, which supports the findings of several case reports and case series.

Clinician's experiences and views on the use of suprascapular nerve block injections in the management of shoulder pain

Purpose: Suprascapular nerve block (SSNB) injections are used in the management of chronic shoulder pain, including degenerative glenohumeral joint disease, subacromial pain, frozen shoulder and non-specific shoulder pain, however little is known about its use and application in clinical practice in the United Kingdom. This preliminary study explored the experiences and views of clinicians who use SSNB injections for the non-surgical management of shoulder pain. The main objectives were to gain an in-depth understanding regarding the current use and application of SSNB injections in clinical practice and identify where future research is needed to inform clinical practice in the future.

Ultrasound-Guided Block of the Suprascapular Nerve in Breast Cancer Survivors with Limited Shoulder Motion – Case Series

Background: Suprascapular nerve block is performed in the management of chronic shoulder pain and frozen shoulder. Objective: To investigate the effects of ultrasound-guided suprascapular nerve block in restoration of shoulder motion in breast cancer survivors. Study Design: A cohort study. Setting: A training and research hospital, outpatient setting. Methods: A total of 18 breast cancer survivors with limited shoulder motion, pain, and difficulty in positioning the upper extremity for radiation treatment following surgery were enrolled in this study. Ultrasound-guided suprascapular nerve blocks were performed while the patients were seated in a chair without a backrest. After visualization of the suprascapular nerve under the transverse suprascapular ligament, 20 mg of triamcinolone and 4 mL of 0.5% bupivacaine were injected. Shoulder range of motion, pain, disability, and upper extremity circumference measurements were assessed in all participants before and 10 days after the block. Results: A significant decrease was observed in severity of pain and disability 10 days after the block. The ranges of shoulder abduction, flexion, and external rotation were improved significantly. All patients were able to receive radiation therapy without delay. Limitations: Absence of a control group and absence of randomization reduces the strength of our findings. Small sample size and absence of long-term follow-up are other limitations of this study. Conclusions: This is the first study investigating the effect of ultrasound-guided suprascapular block on shoulder limitation in breast cancer survivors. The results demonstrate that it may be a promising treatment approach for rapid recovery of shoulder motion in women with breast cancer before radiation treatment. Key words: Breast cancer, upper extremity, shoulder pain, range of motion, disability, ultrasound, injection, triamcinolone, local anesthetics

Management of chronic shoulder pain with restricted mobility - a case series.

Management of chronic shoulder pain with restricted mobility - a case series.

Combined Ultrasound and Fluoroscopic Guided Suprascapular and Interscalene Denervation for the Management of Chronic Shoulder Pain in a Patient with a History of Dislocated Total Shoulder Replacement and Huntington's Chorea: A Case Report

Combined Ultrasound and Fluoroscopic Guided Suprascapular and Interscalene Denervation for the Management of Chronic Shoulder Pain in a Patient with a History of Dislocated Total Shoulder Replacement and Huntington's Chorea: A Case Report

Percutaneous radiofrequency lesioning of the suprascapular nerve for the management of chronic shoulder pain: a case series

PurposeThe objective of this study was to retrospectively evaluate the analgesic effects of continuous radiofrequency lesioning of the suprascapular nerve (SSN) for chronic shoulder pain. The authors sought to obtain insight into the time-sensitive analgesic success and complications of this therapy.Patients and methodsThis study was a retrospective case series involving patients with unremitting shoulder pain that had lasted for at least 12 months. Patients were selected if they showed a reduction of at least 50% in pain intensity during the anesthetic phase after SSN block, no additional motor weakness of the shoulder, and pain relief lasting for less than 2 months after separate treatments of the SSN with depot corticosteroids and pulsed radiofrequency. Nine patients were referred to the Arnold Pain Management Center. Of these nine patients, six patients who had significant chronic shoulder pain unresponsive to oral medications and intra-articular injections and who were not considered surgical candidates were selected. These patients were treated with a single radiofrequency lesion of the SSN at 80°C for 60 seconds. The primary outcome was a reduction in pain intensity by 50%, as determined by the numeric rating scale, and duration of this effect. The secondary outcome was improvement in either the passive or the active range of motion (ROM). Patients were also monitored for adverse effects such as weakness or increased pain.ResultsThe pooled mean numeric rating scale score before the procedure was 7.2 ± 1.2; this fell to 3.0 ± 0.9 at 5–7 weeks post procedure. The duration of pain relief ranged from 3 to 18 months, and all patients underwent at least one additional treatment. The change in baseline ROM improved from an average of 60° ± 28° (flexion) and 58° ± 28° (abduction) to 99° ± 46° (flexion) and 107° ± 39° (abduction). No adverse side effects were observed.ConclusionContinuous radiofrequency lesioning of the SSN seems to be an effective treatment for chronic shoulder pain. There can be improved ROM of the shoulder following this treatment. More formal, controlled studies are required to confirm these observations.

만성 어깨통증을 위한 신경차단과 방아쇠점 주사

The shoulder is a complex area which makes it vulnerable to painful pathologic processes. Chronic shoulder pain has become more common recently due to increased use of computers and a ,generally more sedentary life style among most people . Trigger point injection and neural blockade are useful for the management of chronic shoulder pain which has not improved with conservative treatment. Published articles concerning trigger point injection or neural blockade for chronic shoulder pain were reviewed to evaluate promising methods. If we are careful to remain aware of the details and complications in addition to adhering to effective treatments, these should be good armamentarium for doctors enthusiastic about the management of chronic shoulder pain.

Radiofrequency Treatment of Peripheral Nerves

Treatment of chronic refractory pain in which peripheral nerves are involved has proven to be difficult. Neurolysis by surgical, chemical, cryogenic, or thermal means may be considered as an option on seldom occasions, because of the risk of neuritis and deafferentation pain, motor deficit, and potential unintentional damage to nontargeted tissue. To our knowledge, there is only 1 report concerning selective radiofrequency (RF) treatment of the obturator and femoral nerves that was published. The introduction of the non-neurodestructive pulsed radiofrequency technique has provided new possibilities for the treatment of peripheral nerves. Today there is some experience with the management of chronic shoulder pain and additional case reports on other indications.