Cooled radiofrequency ablation promising alternative to treat chronic shoulder pain and stiffnessp

Andrew Tran et al conducted a pilot study to introduce cooled radiofrequency nerve ablation (C-RFA) as an alternative to managing symptomatically moderate to severe glenohumeral osteoarthritis (OA) in patients who have failed other conservative treatments and who are not surgical candidates or refuse surgery. The authors found that Image-guided axillary, lateral pectoral, and suprascapular nerve C-RFA has minimal complications and is a promising alternative to treat chronic shoulder pain and stiffness from glenohumeral arthritis.

The prospective pilot study conducted at Atlanta, GA, USA includes a total of 12 patients experiencing chronic shoulder pain from moderate to severe glenohumeral OA.

Patients underwent anesthetic blocks of the axillary, lateral pectoral, and suprascapular nerves to determine candidacy for C-RFA treatment. Adequate response after anesthetic block was over 50% immediate pain relief. Once patients were deemed candidates, they underwent C-RFA of the three nerves 2–3 weeks later by the interventional musculoskeletal radiology physicians.

Treatment response was evaluated using the clinically validated American Shoulder and Elbow Surgeons (ASES) score and visual analogue scale (VAS) to assess pain, stiffness, and functional activities of daily living. Follow-up outcome scores were collected up to 6 months after C-RFA procedure.

The results of the study were:

• Twelve patients underwent C-RFA procedure for shoulder OA.

• Five patients showed KL grade 3 and 7 showed KL grade 4.

• VAS scores significantly improved from 8.8±0.6 to 2.2±0.4 6 months after the C-RFA treatment (p <0.0001).

• Patient's ASES score results significantly improved in total ASES from 17.2±6.6 to 65.7±5.9 (p<0.005).

• No major complications arose.

• Upon follow-up after the treatments, there was no motor dysfunction or nerve palsy seen on physical exam.

• No patients received re-treatment or underwent shoulder arthroplasty.

The authors opined that: C-RFA is a promising minimally invasive alternative that could be considered for conservative management, especially for patients who are not surgical candidates or refuse surgery. With this pilot study, C-RFA's effects have shown to last up to 6 months, but more studies, especially with large multi-centre patient groups, are required to assess the efficacy beyond that time frame and to compare it to other conservative treatments.

Further reading:

Pilot study for treatment of symptomatic shoulder arthritis utilizing cooled radiofrequency ablation: a novel technique

Andrew Tran, David A. Reiter, Jan Fritz et al

Skeletal Radiology (2022) 51:1563–1570

https://doi.org/10.1007/s00256-022-03993-y