Pulsed radiofrequency applied to the suprascapular nerve before rotator cuff tear arthroscopic repair: A prospective randomized clinical trial
DOI:
https://doi.org/10.37375/sjms.v1i2.326الكلمات المفتاحية:
suprascapular nerve، pulsed radiofrequency، shoulder joint، rotator cuff injuryالملخص
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.
المراجع
Ahadian FM. Pulsed radiofrequency neurotomy: advances in pain medicine. Current Pain and Headache Reports. Curr Pain Headache Rep 2004; 8: 34-40.
Aicher B, Peil H, Peil B, Diener HC. Pain measurement: Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS) in clinical trials with OTC analgesics in headache. Cephalalgia 2012; 32: 185-97.
Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep 2008; 12: 37-41.
Cahana A. Pulsed radiofrequency: a neurobiologic and clinical reality. Anesthesiology 2005; 103: 1311.
Cahana A, Van Zundert J, Macrea L, van Kleef M, Sluijter M. Pulsed radiofrequency: current clinical and biological literature available. Pain Med 2006; 7(5): 411-23.
Cosman ER. Electric and thermal field effects in tissue around radiofrequency electrodes. Pain Med 2005; 6: 405-24.
Geurts JW1, van Wijk RM, Wynne HJ, Hammink E, Buskens E, Lousberg R,et al. Radiofrequency lesioning of dorsal root ganglia for chronic lumbosacral radicular pain: a randomised, double-blind, controlled trial. Lancet 2003; 361: 21-6.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63(Suppl 11): S240-52.
Heavner JE, Boswell MV, Racz GB. A comparison of pulsed radiofrequency and continuous radiofrequency on thermocoagulation of egg white in vitro. Pain Physician 2006; 9: 135-7.
Holzer N, Cunningham G, Duthon V, Graf V, Ziltener JL, Hoffmeyer P. Rehabilitation after rotator cuff repair: developments and recommendations. Revue Médicale Suisse, 2013; 9: 2376-9.
Kane TPC, Rogers P, Hazelgrove J, Wimsey S, Harper GD. Pulsed radiofrequency applied to the suprascapular nerve in painful cuff tear arthropathy. J Shoulder Elbow Surg 2008; 17: 436-40.
Nam YS1, Jeong JJ, Han SH, Park SE, Lee SM, Kwon MJ, Ji JH, Kim KS. An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. J Shoulder Elbow Surg 2011; 20: 1061-8.
Chua NH, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications- a review. Acta Neurochir (Wien) 2011; 153: 763-71.
Ross D, Maerz T, Lynch J, Norris S, Baker K, Anderson K. Rehabilitation following arthroscopic rotator cuff repair: a review of current literature. J Am Acad Orthop Surg 2014; 22: 1-9.
Shabat S, Pevsner Y, Folman Y, Gepstein R. Pulsed radiofrequency in the treatment of patients with chronic neuropathic spinal pain. Minim Invasive Neurosurg. 2006; 49: 147-9.
Shah AA, Butler RB, Sung S, Wells JH, Higgins LD, Warner JJP. Clinical outcomes of suprascapular nerve decompression. J Shoulder Elbow Surg 2011; 20: 975-82.
Shah RV, Racz GB. Pulsed mode radiofrequency lesioning of the suprascapular nerve for the treatment of chronic shoulder pain. Pain Physician 2003; 6: 503-6.
Simopoulos TT, Kraemer J, Nagda JV, Aner M, Bajwa ZH. Response to pulsed and continuous radiofrequency lesioning of the dorsal root ganglion and segmental nerves in patients with chronic lumbar radicular pain. Pain Physician 2010; 11: 137-44.
Sluijter ME, Cosman E, Rittman W. The effect of pulsed radiofrequency fields applied to the dorsal root ganglion. Pain Clin 1998; 11: 109-17.
Standring S. Gray‟s Anatomy: The Anatomical Basis of Clinical Practice. 40th ed. London: Churchill Livingstone, 2008. 1576.
Trojian TH. Suprascapular Neuropathy. Medscape. 2014. Available at: http://emedicine.medscape.com/article/92672-overview.
Uematsu S, Udvarhelyi GB, Benson DW, Siebens AA. Percutaneous radiofrequency rhizotomy. Surg Neurol 1974; 2: 319-25.
