Background and Aims Shoulder pain is a disease with a reported prevalence up to 26% and the incidence increases with age. Minimally-invasive treatments provide a short term analgesic benefit in patients not suitable for surgery.
Methods The sensory innervation of shoulder joint is provided by suprascapular nerve(SN), subscapular nerve(ScN), axillary nerve(AN), and lateral pectoral nerve(LPN).
Improving on the knowledge of the innervation of this area by cadaveric and anatomic studies, a recent review proposed four distinct zones for fluroscopic-guided ablation.
A recent systematic review highlights a lack of consensus in pRF protocols, the most commonly used is a pulsed frequency milliseconds with the treatment delivered over 2–10 min.
The ultrasound tecnique is more recent and it has multiple advantages: real-time assessment, higher success rate and shorter treatment time, reduced complications, and absence of radiation.
Results All recent studies on ultrasound-guided pRF reported nerve radiofrequency is a safe and effective technique for treating chronic shoulder pain, providing significant improvement in pain and functional scores during at least 6 months.
However, a meta-analysis of the seven RCTs found no analgesic benefit or functional improvement over conventional management.
The limiting factors would be the following: most of the studies targeted the SN with a few publications on other possible targets, the extreme heterogeneity in scores to asses pain and functional capacity,the absence of a punctual diagnosis and the absence of a prognostic block with local anaesthetics.
Conclusions To properly assess efficacy of RF treatments additional large-scale studies and controlled comparative-effectiveness trials are required.
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