Pain Medicine Section Editor: Spencer S. Liu

Ultrasound-Guided Pulsed Radiofrequency Stimulation of the Suprascapular Nerve for Adhesive Capsulitis: A Prospective, Randomized, Controlled Trial Yung-Tsan Wu, MD,* Cheng-Wen Ho, MD, PhD,† Yi-Ling Chen, MD,* Tsung-Ying Li, MD,* Kuei-Chen Lee, PT, MS,* and Liang-Cheng Chen, MD, MS*

BACKGROUND: The treatment of adhesive capsulitis (AC) is a well-known, complicated, and long process. Recent studies have shown that pulsed radiofrequency (PRF) lesioning of the suprascapular nerve (SSN) using a fluoroscopy- or computed tomography-guided technique can alleviate shoulder pain. However, there are no studies of PRF lesioning of the SSN in patients with AC using ultrasound-guided (UG) techniques, except for 2 case reports. In this study, we compared the effect of physical therapy alone with physical therapy and PRF lesioning of the SSN using a UG technique. METHODS: Sixty patients with AC were included in the study. Patients were randomized into the following 2 groups: the intervention group containing patients who received 12 weeks of physical therapy after 1 treatment of PRF lesioning of the SSN, and the control group containing patients who received 12 weeks of physical therapy alone. All outcome measurements including visual analog scale (VAS), shoulder pain and disability index, and passive range of motion (PROM) were performed at 1, 4, 8, and 12 weeks after treatment. RESULTS: Forty-two patients (21 patients in each group) completed the study. The intervention group had a notably shorter time to onset of significant pain relief (6.1 ± 3.4 vs 28.1 ± 9.2 days; P < 0.001) and noticeable reduction of VAS score at week 1 (40% vs 4.7%) than the control group (P < 0.001). All measured variables in the intervention group and most variables in the control group showed significant improvement from the baseline (P < 0.05). A comparison of the 2 groups indicated significantly greater improvement in the intervention group at all times in VAS and shoulder pain and disability index scores (all P < 0.05), and for most gain of PROM (P < 0.05). There were no serious adverse effects or complications in either group. CONCLUSIONS: This study indicates that the application of PRF lesioning of the SSN using a UG technique combined with physical therapy provided better and faster relief from pain, reduced disability, and improved PROM when compared with physical therapy alone in patients with AC, an effect that persisted for at least 12 weeks.  (Anesth Analg 2014;119:686–92)

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dhesive capsulitis (AC), more commonly referred to as frozen shoulder, affects 2% to 5% of the general United Kingdom population at any given time.1 This condition is characterized by shoulder pain and a gradual onset of significantly diminished active and passive (PROM) range of motion (ROM) of the glenohumeral joint.1 The prognosis of AC varies depending on the study, and 20% to 50% of patients with AC can have continued pain and limited ROM beyond 3 years.2,3 Although there From the *Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital and †Institute of Aerospace Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China. Accepted for publication May 9, 2014.

Funding: The study is supported, in part, by the National Science Council (grant no. 102-2314-B-016-013) and the Tri-Service General Hospital (grant no. TSGH-C100-096), Taipei, Taiwan, Republic of China. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Liang-Cheng Chen, MD, MS, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Rd., Neihu District, Taipei, Taiwan, Republic of China. Address e-mail to [email protected] Copyright © 2014 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000354

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are many treatments including oral analgesics, intraarticular steroid injections, and physical therapy, there is disagreement in the literature on the best treatment at different stages of the disease. The suprascapular nerve (SSN) originates from the upper trunk of the brachial plexus (C5–C6), and it innervates approximately 70% of the superior and posterior regions of the shoulder joint, capsule, and acromioclavicular joint.4 This nerve also supplies motor innervation to the supra- and infraspinatus muscles.5 An SSN block (SSNB) can effectively relieve the pain and increase the ROM of patients with long histories of shoulder pain including AC, rotator cuff injuries, osteoarthritis, and rheumatoid arthritis.4,6–9 Jones and Chattopadhyay performed a randomized trial that compared SSNB with intraarticular injections in patients with AC and concluded that SSNB provided faster acting and more long-lasting pain relief for up to 3 months.10 Previous research indicated that pulsed radiofrequency (PRF) lesioning can alleviate chronic pain by delivering an electrical field and heat bursts (temperature of

Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis: a prospective, randomized, controlled trial.

The treatment of adhesive capsulitis (AC) is a well-known, complicated, and long process. Recent studies have shown that pulsed radiofrequency (PRF) l...
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