RADIOFREQUENCY RHIZOLYSIS TO THE SUPRASCAPULAR NERVE FOR CHRONIC SHOULDER PAIN

Abstract

The study investigated if suprascapular nerve(SSN) rhizolysis could give effective and longlasting pain relief to patients with chronic shoulder pain(massive cuff tears and /or osteoarthritis) some with significant comorbidity, who did not wish for or were unable to withstand surgery. Sixty two patients(12 male, 50 female, mean age 74years) with longstanding moderate to severe shoulder joint pain(massive rotator cuff tears, osteoarthritis, rheumatoid arthritis), who had failed conventional non-operative management and who were unsuitable for further shoulder surgery, were assessed for radiofrequency(RF) rhizolysis to the SSN. Most patients reported significant anaesthetic co-morbidity. All patients had received full orthopaedic or rheumatological assessment with investigations including Xray, ultrasound and MRI scan. Ninety-five percent of patients had undergone a SSN block which had afforded > 50% pain reduction for three to six months. The suprascapular notch was identified with Xray control. The SSN was located with 100 Hz and 2 Hz stimulation of an insulated 50mm needle. Once localised, 5 mls of 2% lignocaine was injected and a radiofrequency thermocoagulation lesion undertaken at 700C for 90 seconds. Eighty-five percent of patients reported> 50% pain relief still present at six months (as reported by VAS score). No serious adverse side effects were reported (pneumothoraces, haematomas, infection, neurological deficits). RF rhizolysis of the SSN may be a useful treatment for the group of patients with chronic shoulder pain for whom surgery is not an option.