A Systematic Review of Radiofrequency Procedures for Chronic Shoulder Pain
Hemkumar Pushparaj MD1, Yasmine Hoydonckx MD FIPP1, Pranab Kumar MD FIPP CIPS1 , Philip Peng MD FRCPC1, Anuj Bhatia MD, FRCPC1,2
1Department of Anesthesia and Pain Management, University of Toronto; University Health Network-Toronto Western Hospital
2 Institute of Health PolicyManagement and Evaluation, University of Toronto, Toronto, Ontario, Canada
Shoulder pain has an incidence of 20% to 50% and it is the main cause of non-traumatic upper limb pain. The shoulder receives innervation from the Axillary (AN), Lateral Pectoral (LPN) and Suprascapular (SSN) nerves . Radiofrequency (RF) ablative treatments for articular supply to major joints (e.g., hip and knee) can provide long-term analgesic relief but no evidence synthesis has been performed for RF treatments of articular innervation for shoulder pain.
Materials and methods
MEDLINE and other major medical literature databases were searched for relevant articles. Both types of RF (pulsed neuromodulation and ablative treatments) were included in the search. Data from these paper were extracted and synthesized for procedural aspects including imaging, RF technique and outcomes including analgesia, duration of relief, functional outcomes and complications.
Five publications on RF procedures for chronic shoulder pain (including three randomized controlled trials) that reported on 85 patients were identified(Table 1). All of these studies involved pulsed RF neuromodulation (pRF) of the suprascapular nerve except one that reported RF ablation of this nerve. pRF performed under fluoroscopic guidance (Figure 1D) was the preferred RF technique but ablative RF was reported as providing long-term analgesia in 6 patients in one case series in patients who failed to achieve analgesia following pRF. Significant pain relief from three to 12 months following the procedures was reported. None of the studies reported RF treatments of articular branches of the axillary and lateral pectoral nerves even though these nerves provide significant innervation to the shoulder joint (Figure 1 A,B,C). No adverse outcomes were reported in any of the papers. RF procedures on the SSN appeared to provide better analgesia and functional outcomes when compared to physical therapy or injections but a publication bias cannot be ruled out.
All studies focused on RF procedures of SSN with none addressing the LPN or AN. No study has attempted to ablate the articular innervation of the shoulder joint close to its capsule. High quality anatomical dissections, studies evaluating different imaging techniques for guidance, and RCTs are required on RF procedures on these nerves as well as to compare outcomes against non-interventional techniques.
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