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Carola Santi,1 Thomas Haag,2 Christian Cooke,2 Michael E Schatman,3,4 Andrea Tinnirello5 1Anesthesia, Intensive Care and Pain Management Unit, Manerbio Hospital, ASST Del Garda, Brescia, Italy; 2Pain Management Unit-Wrexham Maelor Hospital, Wrexham, UK; 3Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 4Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA; 5Anesthesia and Pain Management Unit, Iseo Hospital, ASST Franciacorta, Brescia, ItalyCorrespondence: Andrea Tinnirello, Ospedale di Iseo-Asst Franciacorta, Via Giardini Garibaldi 1, Iseo, BS, 25049, Italy, Tel +390303422, Email andrea.tinnirello@asst-franciacorta.itPurpose: Radiofrequency ablation has been used to treat chronic shoulder pain with mixed results. Thanks to recent anatomical studies, the precise location of articular branches of the suprascapular, lateropectoral and axillary nerves has been determined. Cooled radiofrequency is a neuroablative modality of treatment which has been demonstrated as efficient in different anatomical locations, and targeting the aforementioned nerves could result in a complete and efficient denervation of the shoulder. The aim of this study is to assess the efficacy of a fluoroscopic guided cooled radiofrequency technique for chronic shoulder pain.Patients and Methods: This is a retrospective observational study performed in two hospital in Wales and Italy (Wrexham NHS trust and Iseo Hospital). Forty-four patients were treated between December 2019 and January 2023. Follow-up was provided at 1-, 6- and 12-months post-procedure. Pain intensity was measured with a 0– 10-point Numerical Rating Scale (NRS), and was assessed at rest and during movement. Disability was assessed with the Oxford Shoulder Score (OSS). All patients were treated with cooled radiofrequency under fluoroscopic guidance targeting the articular branches of the suprascapular, axillary and lateropectoral nerves.Results: In the 44 patients treated, the mean NRS significantly decreased at all follow ups, pain relief of > 50% was obtained in 70.4%, 61% and 51% of the patients at 1.6 and 12 month follow-ups, respectively. Disability improved significantly, with a mean OSS at 12 months follow up of 30 ± 17.5, compared to 15 ± 3 at baseline. Medication intake (non-steroidal anti-inflammatory drugs (NSAIDS) and/or opioids) significantly decreased at all follow ups.Conclusion: Cooled radiofrequency denervation can be an effective procedure to manage chronic shoulder pain, providing sustained pain relief and functional improvement in more than 50% of the patients.Keywords: radiofrequency, neuromodulation, shoulder pain, pain management |
