Treatment of Refractory Shoulder Osteoarthritis Pain with
Pulsed Radiofrequency Neuromodulation of the Suprascapular Nerve
Chris Keener, DO; Bhargavi Madhu, DO; Ghazaleh Ebrahimi, MD; De’Jon Parker, DO; Hein Linn Thant, MD
Larkin Community Hospital South Miami
•Shoulder osteoarthritis (OA) is 2nd most common cause of chronic shoulder pain and disability in up to 20% of adults >65 years old1.
•Standard management: physical therapy, lifestyle modification, and NSAIDs; surgery reserved for advanced cases.
•Many patients experience persistent, refractory pain despite conservative care (Activity modification, NSAIDs, PT, Intra-articular corticosteroid).
•Pulsed radiofrequency (PRF) neuromodulation provides analgesia without the neurodestructive risks of continuous radiofrequency ablation (CRF)2.
•Evidence for PRF in shoulder OA is limited, highlighting the need for further clinical evaluation.
Patient: 91-year-old man with 3-year history of severe left shoulder pain (10/10), limiting activity and sleep.
•Sharp achy pain
•Denies injuries or trauma, no prior surgery
•No fevers, chills, weight loss, night sweats, bowel/bladder incontinence, numbness, neck pain
Findings:
•X-Ray showed Advanced glenohumeral degeneration (Fig 1) as well as PPM, non-compatible with MRI
•Failed conservative therapies (NSAIDs, PT, ultrasound-guided shoulder injection with 20mg Kenalog)
•Diagnostic suprascapular nerve block resulted in 80% temporary relief, confirming pain source.
Technique:
Ultrasound-guided (Mindray M7 with a curvilinear transducer C5-2S) PRF of suprascapular nerve at the suprascapular notch.
•16-gauge 10 cm RF electrode, 2 Hz at 40 V (20 ms active, 480 ms silent), temperature maintained < 42 °C.
•Two lesions applied with electrode tip rotation 180º to ensure circumferential coverage.
Outcome after PRF:
•Pain reduced from 10/10 → 4/10 within one week.
•Improved sleep and function — able to vacuum for 2 hours without discomfort.
•Analgesia sustained for 3 months without additional medication.
•No complications observed, strength unchanged after procedure, no motor branches affected.
CRF utilizes temperature between 60-90º C for 60-90s
•Results in selective destruction of pain-carrying unmyelinated A delta and C fibers.
•RFA with temperatures >65°C can result in axonal injuries3.
•
PRF offers a safe, minimally invasive option for refractory shoulder OA pain, particularly in elderly patients who are not candidates for surgery.
•Mechanism: Sub-ablative temperature (<42 °C) allows neuromodulation rather than neural destruction of C fibers4
•Advantages: reduced risk of neuritis or motor deficit compared with CRF.
•Demonstrated significant pain reduction and functional improvement.
Conclusions:
•Supports growing evidence for suprascapular nerve PRF as a viable analgesic intervention.
•Further studies warranted to clarify mechanisms, durability, and broader clinical efficacy.
