Targeting the suprascapular nerve in chronic shoulder pain

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1 Targeting the suprascapular nerve in chronic shoulder pain Poster No.: C-0682 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Exhibit D. Grant, L. Watts, R. Giggens; Oxford/UK Musculoskeletal joint, Ultrasound, Ablation procedures, Treatment effects, Arthritides, Outcomes /ecr2015/C-0682 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 8

2 Aims and objectives Shoulder pain is a common problem [1,2] and can be associated with substantial disability. [2] Causes of shoulder pain are diverse but include rotator cuff pathology, disorders of the glenohumeral or acromioclavicular joints, adhesive capsulitis or referred pain. [3] A variety of treatments have been tried including oral medications, physiotherapy, local injections and surgery. [3] The suprascapular nerve relays information from the glenohumeral and acromioclavicular joints and part of the joint capsule and is therefore an attractive target for relief of shoulder pain. The suprascapular nerve (SSN) can be specifically targeted by ultrasound guided injection or radiofrequency ablation (RFA). Whilst there have been promising results, evidence is limited on the effectiveness of these interventions. [3-12] We present the results of a cohort of suprascapular nerve procedures performed in our centre. Methods and materials All ultrasound guided suprascapular nerve injections and radiofrequency suprascapular nerve procedures performed at our centre between July 2013 and September 2014 were retrospectively analysed. For SSN injection, the standard procedure was identification of the suprascapular nerve and injection of steroid and local anaesthetic (amounts determined by the operator) into the surrounding area. Radiofrequency ablation was delivered either in 42 o C pulses at two or more locations along the nerve, or in a continuous 80 o C-90 o C fashion. As is standard practice at our centre, patients were issued with a pain diary to complete over the subsequent two weeks. They are also asked to rate their daily activities, analgesic use and give an overall rating as to whether they found the procedure helpful. Results 109 procedures were performed in the time period. Overall 85 pain diaries returned (response rate 78%). Fig. 1 on page 3 Page 2 of 8

3 Compared to pre-procedure score, patients reported highly significant decreases in pain scores at all time points (P<0.001) in both radiofrequency ablation and suprascapular nerve injection. Table 1 on page 3 Fig. 2 on page 4 Overall, 64% found their procedure helpful (22.6% very helpful, 22.6% helpful, 19% somewhat helpful). Fig. 3 on page 4 51% reported that daily activities were easier and 43% reported a decrease in analgesic use. Fig. 4 on page 5 Fig. 5 on page 5 Comparing all radiofrequency ablations vs. injections, or pulsed radiofrequency alone vs. injection, there was a significantly greater decrease in pain score in the radiofrequency group in the first two days (p<0.05). However, no significant difference was demonstrated between the two groups by 2 weeks post-procedure. Continuous radiofrequency ablation showed promising results, however was too small a sample size for meaningful interpretation. Images for this section: Fig. 1: Breakdown of included procedures Page 3 of 8

4 Table 1: Mean change in Visual Analogue Scale (VAS) pain score at various time points post-procedure compared to pre-procedure score. P-values derived using Wilcoxon signed rank test. Fig. 2: Graph showing mean pain score for suprascapular nerve (SSN) procedures at defined time points. Page 4 of 8

5 Fig. 3: Overall patient rating of procedure Fig. 4: Patient rating of ease of daily activities post-procedure Page 5 of 8

6 Fig. 5: Patient analgesic use post-procedure Page 6 of 8

7 Conclusion In our retrospective case series, both SSN injections and SSN radiofrequency ablations appear efficacious in reducing shoulder pain in our centre. RFA appears to demonstrate a more immediate effect, however no significant difference was identified between injections and RFA by two weeks post-procedure Limitations: non-randomised, retrospective nature of the data lack of a control group short length of follow up selection bias of RFA group in that many had previously undergone SSN injections without positive effect Personal information References [1] Andersson, Clin J Pain. 9(3): 174 Chronic pain in a geographically defined general population: studies of differences in age, gender, social class and pain localization [2] Urwin, Ann Rheum Dis 57: 649 Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation [3] Murphy, Clin Evid (Online) 2010:1107 Shoulder pain [4] Shanahan, Ann Rheum Dis 62: 400. Suprascapular nerve block (using buvipicaine and methylprednisolone acetate) in chronic shoulder pain [5] Dahan, J Rheumatol 27(6): Double blind randomized clinical trial examining the efficacy of buvipicaine suprascapular nerve blocks in frozen shoulder Page 7 of 8

8 [6] Gorthi, Orthopaedics. 33(4) The effectiveness of ultrasonography-guided suprascapular nerve block for perishoulder pain. [7] Eyigor, Clin J Pain 26(5): 386 Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder: a prospective, randomized, single-blinded study [8] Garbhelik, Irish Journal of Medical Science 179(3):369 Effect of pulsed radiofrequency therapy on the suprascapular nerve in shoulder pain of various aetiology [9] Jang, J Korean Neurosurg Soc 54(6): 507 Effect of pulsed radiofrequency neuromodulation on clinical improvements in the patients of chronic intractable shoulder pain [10] Liliang, Pain Med 10(1): 70. Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain: a preliminary report [11] Gofeld, Pain Practice 13(2): 96. Pulsed Radiofrequency of suprascapular nerve for chronic shoulder pain: a randomized double-blind active placebo controlled study [12] Kane, J Shoulder Elbow Surg 17(3): 436. Pulsed radiofrequency applied to the suprascapular nerve in painful cuff tear arthropathy Page 8 of 8

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