Treatment Of Chronic Shoulder Pain Research Articles

A single-center retrospective chart review of percutaneous PNS for treatment of chronic shoulder pain

ObjectiveThe present IRB-approved retrospective chart review describes the use of a 60-day PNS treatment for shoulder pain at a single center in 60 total consecutive patients. BackgroundChronic shoulder pain affects an increasing number of patients per year and is especially prevalent in elderly populations. Percutaneous peripheral nerve stimulation (PNS) treatment targeting the nerves of the shoulder has been shown to reduce pain in prospective clinical studies and in analysis of real-world data. MethodsData were extracted from the electronic medical records of patients who had previously undergone percutaneous PNS treatment for chronic shoulder pain. Demographic data and treatment characteristics were summarized alongside treatment outcomes. ResultsOverall, 84 % (49/58) of patients reported substantial (≥50 %) pain relief at the end-of-treatment. The records for 2 patients did not include patient-reported percent pain relief. The average indwelling period for leads (i.e., treatment period) was 57 days. Findings on treatment effectiveness were consistent when the patient population was stratified by cause of pain, duration living with pain, and presence of pain-modifying comorbidities. Stimulation paradigms were identified and categorized by the nerve target and stimulation frequency (e.g., motor stimulation, sensory stimulation, or bimodal stimulation). ConclusionsThese results indicate percutaneous PNS is an effective treatment for patients with various shoulder pain histories, and while all stimulation paradigms were effective at reducing pain, patients who received bimodal PNS reported the greatest pain relief. Key limitations of the study included heterogeneous shoulder pain etiologies among patients and sparse availability of long-term follow-up data. These data support existing real-world and prospective clinical evidence on the efficacy of 60-day PNS treatment at treating chronic pain and provide valuable insights into its use in clinical practice.

Radiofrequency ablation for shoulder pain: an updated systematic review.

Radiofrequency ablation (RFA) is a treatment modality that has been increasingly used for the management of chronic shoulder pain. Serious conditions that can identified as the cause of chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, osteoarthritis, glenohumeral instability, and acromioclavicular joint disorders. Treatment of chronic shoulder pain typically consists of physical therapy, oral and topical medications, intra-articular corticosteroid injections, and even surgery. The aim of this study was to examine the most recent primary and secondary outcomes of RFA for chronic shoulder pain. A systematic review was conducted using three different databases including PubMed, MEDLINE, and the Cochrane Database. The key concepts of "radiofrequency ablation" and "shoulder pain" were used. The search took place in June 2023, and it included articles from the past 20 years. Of the 396 articles found, 29 were included in the review. Most studies focused on reduction in pain scores, duration of relief, function, and patient satisfaction. In several studies, RFA was compared to conservative options such as physical therapy or corticosteroid injections. Overall, RFA shows positive outcomes in terms of the management of chronic shoulder pain. Therefore, RFA can serve as another treatment option for patients who fail conservative management or are not strong surgical candidates. Understanding the outcomes of RFA for chronic shoulder pain can provide patients and clinicians with evidence for the most appropriate treatment.

The use of corticosteroid injection in the treatment of chronic shoulder pain.

The use of corticosteroid injection in the treatment of chronic shoulder pain.

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

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. 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. 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). 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.

Результаты лечения хронической боли в области плечевого пояса с применением препаратов на основе полинуклеотидов и коллагена

Aim: to evaluate the efficacy and safety of intra- and peri-articular administration of injectable gel implant containing polynucleotides and collagen implants in patients with adhesive capsulitis / impingement syndrome / cervical spondylosis (uncovertebral arthrosis, spondylosis) with clinical reflex and reflex compression signs and orthopedic conditions. Patients and Methods: this prospective multicenter longitudinal 6-month study included 100 men and women (mean age 45 years). The patients were divided into 4 groups (25 patients in each group) based on the diagnosis. Treatment strategy (intra- and peri-articular administration of injectable gel implant containing polynucleotides and collagen implants) was determined by diagnosis and joint inflammation. Before and after treatment, the functional state of the shoulder and pain severity were assessed using questionnaires and laboratory and instrumental tests. Efficacy was assessed by pain relief, improvement in the functional activity of the shoulder joint, and changes in the range of movements in the shoulder joint and cervical spine. Treatment safety was assessed by the adverse effects. Results: after treatment, most patients reported an increase in the range of movements in the cervical spine and shoulder joint, a decrease in pain severity in the cervical spine and shoulder joint, and improvement in the functionality of the shoulder joint. After treatment, a decrease in the CRP levels and ESR was observed. No severe adverse effects were detected. Conclusion: intra- and peri-articular administration of gel implant containing poly-nucleotides and collagen implants for upper shoulder girdle disorders is effective and safe. KEYWORDS: upper shoulder girdle, cervical spine, shoulder joint, chronic pain, polynucleotides, collagen, collagen implant, intraarticular injection, periarticular injection. FOR CITATION: Shcherbakov G.I., Kovtun S.N., Potkina T.N. Outcomes of treatment for chronic shoulder pain using drugs containing polynucleotides and collagen. Russian Medical Inquiry. 2024;8(2):102–109 (in Russ.). DOI: 10.32364/2587-6821-2024-8-2-8.

Comparing digital to conventional physical therapy for chronic shoulder pain: A randomized controlled trial.

Chronic shoulder pain (CSP) is a common condition with various etiologies including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy (PT) constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no prior RCT has compared fully-remote digital physical therapy (DGPT) to in-person rehabilitation for non-operative CSP. The aim of this study is to compare clinical outcomes between DGPT and conventional in-person physical therapy in patients with CSP. Single-center, parallel-group, randomized controlled trial (RCT) involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy including exercises, manual therapy, education, and CBT. Primary outcome was the change (baseline to 8-weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH). Secondary outcome measures included self-reported pain, surgery intent, analgesics intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. Ninety participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function (QuickDASH), with no differences between groups (-1.8, 95%CI -13.5 to 9.8, P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which given the small effect sizes (least pain: 0.15; average pain: 0.16) are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups with no adverse events. This study shows fully-remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage, in-person rehabilitation. ClinicalTrials.gov (NCT04636528).

Council of Experts: chronic shoulder pain as a multidisciplinary problem

Chronic shoulder pain (CSP) is a clinical syndrome associated with inflammatory and degenerative musculoskeletal changes, characterized by pain in the shoulder that persists for at least 3 months, arising or aggravated by functional activity in this area. The frequency of CSP in the modern population reaches 20–33%, it is one of the leading causes of severe suffering, disability and seeking for medical attention. The main causes of CSP are shoulder rotator impingement syndrome (subacromial impingement syndrome), calcific tendinitis, adhesive capsulitis, shoulder and acromioclavicular joint osteoarthritis. Accurate diagnosis of these diseases is necessary for the correct choice of treatment. Differential diagnosis is carried out using tests that evaluate the function of the shoulder joint and the rotator cuff muscles (Neer, Speed, Hawkins tests, etc.), as well as using instrumental methods (ultrasound, magnetic resonance tomography, X-ray). In CSP, it is necessary to exclude septic, oncological, visceral, systemic rheumatic and other diseases, as well as musculoskeletal pathology of the cervical spine, upper chest and back, which can cause pain in the shoulder region.Therapy for diseases that cause CSP should be personalized and complex, aimed at maximum pain control and restoration of function. For this purpose, non-steroidal anti-inflammatory drugs, local injection therapy with glucocorticoids, hyaluronic acid, and platelet-rich plasma are used. In some cases, muscle relaxants, antidepressants, anticonvulsants, local injections of botulinum toxin type A are indicated. Physiotherapy and medical rehabilitation methods play a fundamental role in the treatment of CSP.

ID: 207021 Significant and Sustained Relief of Shoulder Pain Following 60-day PNS Treatment: A Real-World Retrospective Review

Chronic shoulder pain commonly results in disability and reduced quality of life, with frequent causes including post-surgical pain, inoperable musculoskeletal injury or joint degeneration, and stroke. Temporary percutaneous peripheral nerve stimulation (PNS) has demonstrated significant and sustained relief of chronic shoulder pain in previous clinical trials. This study presents the first real-world, retrospective review of patient outcomes through up to 6 months following the start of a 60-day PNS treatment for chronic shoulder pain.

ID: 207193 Placement of a Suprascapular Peripheral Nerve Stimulator for Treatment of Chronic Shoulder Pain

Peripheral nerve stimulation (PNS) is an evolving modality for treating different chronic pain conditions. The intervention was predicated on the gate theory of pain, which posits nociceptive and non-nociceptive inputs modulate the other's intensity in the dorsal horn of the spine. Competing theories now include overstimulation of c-fibers, exhaustion of neurotransmitters, fixed depolarization of afferent axons, and electrically induced changes to long term potentiation.1 No unified mechanism has been established, though the efficacy of PNS is evident.

Ultrasound-guided continuous radiofrequency ablation of the suprascapular nerve for chronic shoulder pain secondary to osteoarthritis: a retrospective cohort study.

The objective of this study is to retrospectively evaluate the use of ultrasound-guided continuous radiofrequency (CRF) lesioning of the suprascapular nerve for treating chronic shoulder pain, due to osteoarthritis. We describe a modified distal and selective ablation technique in the spinoglenoid notch, with motor and sensory stimulation, which protects the motor branch of the nerve from ablation. A retrospective analysis was performed of patients, who underwent ultrasound-guided CRF lesioning of the suprascapular nerve from October 2013 to January 2020. During the procedure, the CRF electrode is placed in the spinoglenoid notch, at the distal suprascapular nerve capsular branch. Motor and sensory stimulations are used to confirm the position. CRF lesioning is applied up to three times, at 3 different points, for 1 min each time, at 80° C. In total, 127 first CRF suprascapular nerve lesioning procedures were performed on 101 patients with chronic shoulder pain secondary to osteoarthritis. One hundred nineteen diagnostic ultrasound-guided suprascapular nerve corticosteroid injections were performed prior to ablation. Mean pre-injection Visual Analogue Scale pain score (VAS) was 8.3, with post-injection VAS score of 4.4 at 24 h and 4.5 at 2 weeks. Mean pre-CRF lesioning VAS pain score was 7.7 with post-CRF lesioning VAS score of 4.4 at 24 h and 4.5 at 2 weeks. Ultrasound-guided CRF lesioning of the suprascapular nerve in the spinoglenoid notch is a safe treatment for chronic osteoarthritic shoulder pain, with repeat treatments infrequently required. It is associated with significant improvement in VAS pain scores. • Ultrasound-guided continuous radiofrequency lesioning of the suprascapular nerve in the spinoglenoid notch is a safe treatment for chronic shoulder pain in degenerative disease, with repeat treatments infrequently required. • The procedure is performed under ultrasound guidance, without the use of ionising radiation.

Safety and Efficacy of Embolization with Microspheres in Chronic Refractory Inflammatory Shoulder Pain: A Pilot Monocentric Study on 15 Patients.

Purpose: Musculoskeletal (MSK) embolization is emerging in tendinopathy treatment. The objective of this study was to assess the efficacy and safety of MSK embolization with microspheres in the treatment of chronic shoulder pain. Patients and methods: This retrospective monocentric study included patients with chronic shoulder pain resistant to 6 months or more of conventional therapies who were treated with MSK embolization between 2017 and 2021. Embolization was performed using calibrated 100–250 µm microspheres. Clinical success was defined as pain reduction, i.e., a decrease in the visual analogue scale (VAS) pain score of ≥50% at 3 months after MSK embolization as compared to baseline. Adverse events were collected. Results: Fifteen patients (11 women, 4 men) were included, with a median age of 50.3 years (IQR: 46.7–54.5). The median duration of symptoms was 26.6 months (20.6–39.8). The median VAS pain scores were 7.0 (7.0–8.0) at baseline, 6.0 (3.5–7.0) at 1 month, 5.0 (4.5–6.5) and 5.0 (3.0–7.4) at 3 months and 6 months (p = 0.002). Three patients (20%) reported clinical success at 3 months. Three patients experienced minor complications after embolization (paresthesia, n = 2; transient osteo-medullary edema, n = 1) and two patients had moderate complications (transient skin ischemia). Conclusion: MSK embolization with microspheres for treatment of refractory chronic shoulder pain showed moderate results in terms of clinical success and safety.

Subthreshold Peripheral Nerve Stimulation with a High Frequency Electro-Magnetic Couple Powered Implanted Receiver for the Treatment of Chronic Shoulder Pain

BACKGROUND: Shoulder pain has an estimated population prevalence of up to 26%. The most common source of shoulder pain is the rotator cuff, which is a group of muscles and tendons that surround the shoulder joint, accounting for over two-thirds of cases. CASE REPORT: A 65-year-old man presented with sharp, localized pain on abduction of the left shoulder due to a left rotator cuff tear. A diagnostic nerve block provided 100% short-term pain relief. Subsequently a peripheral nerve stimulator trial was offered to the patient, which was successful. The permanent peripheral nerve stimulator was implanted at the supraspinous fossa with the middle electrodes at the suprascapular notch. A receiver was inserted into the inner lumen of electrode array and the neurostimulator was coiled and fixated to the fascia. The following stimulation settings were used: frequency at 1.5 kHz, pulse width at 30 µs, and amplitude of 3.5 mA. CONCLUSION: At one year after implant, the patient had close to 100% pain relief and reported excellent mobility of the shoulder. Wirelessly powered peripheral nerve simulation was a successful option for this patient suffering from debilitating left shoulder pain due to a left rotator cuff tear. KEY WORDS: Chronic shoulder pain, glenohumeral osteoarthritis, peripheral nerve stimulator, suprascapular neuralgia

Putting Our Shoulder to the Wheel: Current Understanding and Gaps in Nerve Ablation for Chronic Shoulder Pain.

Shoulder pain is prevalent, burdensome, and functionally limiting, with diverse pathology and associated treatments. This narrative review provides a summary of relevant neuroanatomy, proposed ablation targets, safety and efficacy concerns for ablation targets, and current research gaps. Radiofrequency ablation (RFA) of peripheral sensory nerves is a well-established treatment for chronic joint and spine pain, but it is relatively nascent for shoulder pain. Cadaveric studies demonstrate the shoulder joint is innervated by articular branches of the suprascapular nerve, axillary nerve, lateral pectoral nerve, and upper and lower subscapular nerves. Shoulder articular branch RFA appears to be a safe and effective treatment for chronic shoulder pain, but there are currently no widely accepted protocols for ablation targets. There are also no randomized controlled trials (RCT) assessing safety and efficacy of proposed targets or the prognostic value of articular blocks. Future research studies should prioritize categorical data, use appropriate functional measures as primary endpoints, and would ideally include a large-scale RCT.

Wireless Peripheral Nerve Stimulation for the Treatment of Chronic Shoulder Pain

Background: Shoulder pain is a common condition, often refractory to treatment. Peripheral nerve stimulation (PNS) of the suprascapular nerve (SSN) can be efficacious in providing relief of shoulder pain while improving pain-related quality of life (QOL). The objective of this case report is to demonstrate the effectiveness of a minimally invasive wireless PNS in the treatment of chronic shoulder pain. Case Report: This 94-year old man presented with severe shoulder pain. He suffered from poliomyelitis as a child affecting his left leg, forcing him to use crutches to be ambulatory. He developed progressive right shoulder pain and was subsequently diagnosed with right glenohumeral osteoarthritis. The patient was treated semiannually for 4 years with corticosteroids injections and pain medication with minimal relief (7 out of 10 on the Visual Analog Scale [VAS]). A suprascapular block with lidocaine 2% resulted in significant pain reduction (1 out of 10 on the VAS). As a result, the patient opted for wireless PNS of the SSN via a minimally invasive procedure. Two weeks post implant, the patient reported no postoperative pain, and his chronic pain was rated 0 out of 10 even during movement. Reports of reduced pain were sustained throughout the 6 months of observation with subsequent improvements in QOL and functionality. Conclusion: Wireless neurostimulation of the SSN can be a very effective therapy option for the treatment of refractory, chronic shoulder pain as a result of glenohumeral osteoarthritis. Key words: Endoscopic spine surgery, lumbar radiculopathy, minimally invasive spine, SI joint fusion

Comparison of the effectiveness of subacromial administration of platelet-rich plasma and hyaluronic acid in chronic shoulder pain caused by damage to the tendons of the rotator cuff muscles according to a 6-month open clinical study

Local injections of platelet-rich plasma (PRP) and hyaluronic acid (HLA) are considered an effective method for treating chronic shoulder pain (CSP) associated with damage to the tendons of the rotator cuff muscles (RCM).The aim of the study is to compare the effectiveness and safety of local therapy of PRP and HLA in patients with CSP caused by damage to the tendons of the RCM muscles.Materials and methods. The study included 100 patients (54% women and 46% men, average age 51.5±15.1 years) with CSP (persisting for ≥3 months) associated with damage and tendinitis of the supraspinatus, subacute, scapular or small round muscle, confirmed by magnetic resonance imaging or ultrasound (ultrasound). The patients were randomized into two groups of 50 people who were treated with PRP (three injections at 7-day intervals) or HLA (two injections at 7-day intervals). The injections were performed under ultrasound control in the subacromial SAC. The results of the study were evaluated by the dynamics of pain intensity (on a visual analog scale, up to 100 mm) and functional disorders (ASES and CSS indices) after 1, 3 and 6 months.Results. Against the background of the use of PRP and HLA, there was a significant improvement in the condition of patients, while both drugs showed approximately the same effectiveness. The severity of VAS pain decreased from 56.8±15, respectively, after 6 months.5 and 57.6±17.8 mm to 31.8±27.8 and 30.2±26.3 mm, ASES-c 55.8±15.9 and 53.6±14.7 to 74.6±22.4 and 77.3± 22.4, CSS-c 59.2±14.4 and 47.8±16.9 to 69.9±17.3 and 65.6±19.2. the Dynamics of all these indicators in comparison with the baseline level was statistically significant (p<0.001). Number of patients with moderate / mild pain (<40 mm VAS) after 6 months. after the introduction of PRP and HLA was 48% and 60%, requiring regular NSAID intake 30% and 28%, respectively. In all parameters, the difference in the effectiveness of PRP and HLC was not statistically significant (p>0.05). The effectiveness of PRP and HLA (in terms of pain dynamics, ASES, and CSS) was significantly higher in individuals younger than 45 years, compared to older patients. The tolerability of therapy was good – after the introduction of PRP, 40% of patients had a short-term (3–4 days) increase in pain, which did not require the use of additional analgesics or interruption of treatment. No serious adverse reactions were observed when using PRP and HLA.Conclusion. OTP and GLA are effective and safe in the treatment of CSP associated with damage to the tendons of the RCM muscles. The dynamics of pain intensity and functional status after the use of these drugs did not differ. Treatment of PRP and HLA is more effective in people younger than 45 years.

A Comparison of the Effectiveness of Ultrasound-Guided Versus Landmark-Guided Suprascapular Nerve Block in Chronic Shoulder Pain: A Prospective Randomized Study

Background Suprascapular nerve block (SSNB) is an effective therapeutic approach for shoulder pain and has been increasingly used by professionals in clinical practice. In the landmark-guided nerve block technique, it could be difficult to determine the exact localization of the suprascapular nerve. Objectives To evaluate and compare the clinical and functional outcomes of ultrasound (US)-guided versus landmark-guided SSNB for the treatment of chronic shoulder pain. Study design Randomized, prospective analysis. Setting Outpatient physical therapy and rehabilitation clinic. Methods Seventy-two patients with chronic shoulder pain were enrolled into this study. The patients were randomly allocated to 2 groups. Thirty-six patients received US-guided SSNB and 36 underwent landmark-guided SSNB. Initial examinations before injection and for the first week and first and third months postinjection were recorded. Visual Analog Scale (VAS) pain intensity levels, shoulder functions based on the Shoulder Pain and Disability Index (SPADI), and quality of life levels based on the Health Assessment Questionnaire (HAQ) were evaluated at each control. Results Statistically significant recovery was observed in terms of VAS pain levels, SPADI, and HAQ from the first week after injection in both groups, but no significant difference was observed between the groups. Limitations The absence of a control group. Conclusions Our results indicate that US-guided SSNB does not potentially offer a significantly greater clinical improvement over landmark-guided SSNB in patients with chronic shoulder pain. Further research is required to establish whether this hypothesis is consistently supported in practice.

Stuck-moving needle acupuncture myofascial trigger point to treat idiopathic frozen shoulder: study protocol for a randomized controlled trial

BackgroundThere are evidence for the efficacy of acupuncture treatment for chronic shoulder pain, however, it remains unclear the best acupuncture modes for effective treatment. We compared the effect of the myofascial trigger point (MTrp) stuck-moving needle acupuncture with that of common acupuncture treatments. Further, we evaluated the efficacy and safety of stuck-moving needle acupuncture for the MTrp in improving pain and range of motions in patients with idiopathic frozen shoulder. The aim of present study is to select an effective therapy for patients with idiopathic frozen shoulder.MethodsRandomized controlled trial will be conducted in the three clinical centers of Qingyang Traditional Chinese Medicine Hospital, Qingyang Xifeng district People’s Hospital, and Qingyang Second People’s Hospital in China from February 2020 to January 2021. One hundred and eight frozen shoulder patients will be recruited and randomized into one of three groups in a 1:1:1 ratio of the stuck-moving needle acupuncture group, common acupuncture control group, and physical exercise control group. This trial will include a 1-week baseline period, a 3-week treatment period, and a 12-week follow-up period. During the 3 weeks of the treatment period, patients will receive nine sessions of acupuncture. The primary outcome will be related to change in the Visual Analogue Scale (VAS) and measurement of range of joint motion (ROM) from the baseline period to the 12-week follow-up period. Secondary outcome measures will include measurement of pressure pain threshold (PPT), pressure pain tolerance (PTT), Oxford Shoulder Score (OSS), 36-item short form survey, and patient satisfaction evaluation. Adverse events also will be recorded for safety assessment.DiscussionThe results of this trial will allow us to compare the difference in efficacy between stuck-moving needle acupuncture MTrP with that of common acupuncture treatments. The findings from this trial will be published in the peer-reviewed journals.Trial registrationAcupuncture-Moxibustion Clinical Trial Registry (ChiMCTR1900002862) and Chinese Clinical Trial Registry (ChiCTR1900028452). Registered on 22 December 2019. http://www.chictr.org.cn/showproj.aspx?proj=47354

Pilot Study to Evaluate Autologous, Micro-Fragmented Adipose Tissue as a Treatment For Chronic Shoulder Pain in Wheelchair Users with SCI: A 12-month follow up

Wheelchair users with spinal cord injury (SCI) have a high risk of shoulder pain and injury.1 Surgery is generally the next option after conservative treatments fail, yet is not always effective and restricts independence.2 Biologic treatments are one potential alternative; however, research is needed to determine their efficacy.3 This is a 12-month continuation of a 6-month pilot trial previously reported.4 The objectives of this pilot study were to evaluate 1) safety and 2) potential treatment effect of an autologous, micro-fragmented adipose tissue (MFAT) injection for shoulder pain.

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

Background/AimPulsed radiofrequency (PRF) of the suprascapular nerve has been shown to be effective in the treatment of chronic shoulder pain. Ultrasound (US) guidance has gained popularity in regional blocks recently. This study aims to investigate the efficacy of suprascapular nerve pulsed radiofrequency under the guidance of ultrasonography.Materials and methodsThis retrospective study included patients treated with PRF of the suprascapular nerve with a diagnosis of partial rotator cuff tears. The patients were assessed with a numeric rating scale (NRS), the Shoulder Pain and Disability Index (SPADI), and a Likert patient satisfaction score before the treatment and 3 weeks and 6 months following the treatment.ResultsA total of 31 patients was included in the study. The patients’ mean age was 66.8 ± 13.3 years. The mean scores of the NRS, SPADI, and Likert scale before the procedure (7.32 ± 1.1, 69.0 ± 8.5, 1.6 ± 0.6) and at 3 weeks (2.9 ± 2.1, 32.1 ± 17.20, 4 ± 1.2) and 6 months (3.2 ± 2.6, 33.9 ± 20.8, 3.8 ± 1.2) after the procedure were evaluated. We observed significant improvement in NRS, SPADI, and Likert scores at 3 weeks and 6 months following the treatment (P < 0.001).ConclusionThe study demonstrated that US-guided suprascapular nerve PRF achieves good pain relief and functional improvement in patients with partial rotator cuff tears for at least 6 months.

Efficiency of local injections of platelet-rich plasma in shoulder impingement syndrome

Chronic shoulder pain caused by shoulder impingement syndrome (SIS) is a common pathology that leads to worse quality of life and disability. The local administration of platelet-rich plasma (PRP) is a promising treatment for SIS.Objective: to evaluate the efficiency of subacromial injection of PRP in chronic shoulder pain caused by SIS.Patients and methods. The investigation enrolled 30 patients (13 women and 17 men; mean age, 45.8±14.1 years) with chronic shoulder pain lasting ≥3 months after rotator tendons injury confirmed by ultrasound and/or magnetic resonance imaging and inefficiency of previously medical therapy. All the patients received three subacromial injections of 5 ml of PRP at a 7-day interval. The investigators assessed the course of pain during movement (100-mm visual analogue scale (VAS)) and functional ability according to the ASES and CSC questionnaires at baseline and 1, 3 and 6 months after treatment.Results and discussion. During the treatment, there was a considerable improvement in all indicators. At baseline and 1 and 3 months, the mean pain severity measured on VAS was 49.3±10.3, 32.4±21.3, and 20.6±21.3 mm, respectively; in this case, the positive effect persisted at 6-month follow-up: 10 [0; 30] mm (p&lt;0.001). The mean ASES values were 59.5±11.5, 75.9±17.4, 82.6±17.6, and 86.7±17.1 (p&lt;0.001) and the mean CSC scores were 72.3±14.1, 81.0±16.2, 88.5±16.1, and 92.8±16.2 (p&lt;0.001), respectively. There were no serious adverse reactions.Conclusion. Subacromial injection of PRP is an effective and safe treatment for chronic shoulder pain associated with SIS.