Pulsed radiofrequency applied to the suprascapular nerve before rotator cuff tear arthroscopic repair: A prospective randomized clinical trial

Abstract

Background: clinical studies have demonstrated the efficacy of pulsed radiofrequency (PRF) in treating many pain syndromes. PRF energy is delivered via a percutaneous needle under an image guide to reach the suprascapular nerve as it supplies more than 70% of the shoulder sensation. PRF was introduced as a non-destructive minimally invasive procedure in comparison with arthroscopic management of rotator cuff injury. However, there is a controversy regarding both measures in treating shoulder pain in rotator cuff injuries as standard methods.

Objective: to evaluate the ability of PRF to produce shoulder pain relief by applying of PRF to the suprascapular nerve and measure the pain relief by VAS score at various time intervals prior to arthroscopic repair for rotator cuff injuries. The study should be in comparison with control group undergo arthroscopic repair without attacking of the suprascapular nerve by PRF.

Methods: a prospective randomised controlled trial study including 40 patients divided as PRF or (P) group and control group (C) group equally. Each patient in our study whom their history and examination were fulfilled quietly including pain assessment by Visual Assessment Score (VAS). In The (P) group, a needle is inserted through a well-known point in the shoulder leading directly to the suprascapular notch (where the nerve is hooked above it) under image guidance. Radiofrequency waves at 2Hz of 20 milliseconds and 42 C in the pattern of three cycles each one lasting for 120 seconds. VAS score was assessed postoperatively for 7 time intervals starting from immediate postoperative (after arthroscopic repair) up to 3 months.

Result: Pulsed radiofrequency produced dramatic progressive pain relief throughout our study time. In the 1st 48 hours, the VAS score dropped about 30% in (P) group with comparison to 22% in control group. At 3 months interval the VAS score was reduced by 45% from the preoperative period in comparison to 23% of the control group (P=0.000)

Conclusion

PRF is the safest, optimally invasive method to treat shoulder joint pain in rotator cuff injuries especially in unfitted patients for surgeries.