Andrew Tran1, David A Reiter2, Jan Fritz3, Anna R Cruz4,5, Nickolas B Reimer5, Joseph D Lamplot5, Felix M Gonzalez6. 1. Emory University School of Medicine, Atlanta, GA, USA. 2. Department of Radiology & Imaging Sciences, Orthopedics, and Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, USA. 3. Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA. 4. Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA. 5. Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, GA, USA. 6. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA. fgonzalez401142@gmail.com.
Abstract
OBJECTIVE: To introduce cooled radiofrequency nerve ablation (C-RFA) as an alternative to managing symptomatically moderate to severe glenohumeral osteoarthritis (OA) in patients who have failed other conservative treatments and who are not surgical candidates or refuse surgery. MATERIAL AND METHODS: This prospective pilot study includes a total of 12 patients experiencing chronic shoulder pain from moderate to severe glenohumeral OA. Patients underwent anesthetic blocks of the axillary, lateral pectoral, and suprascapular nerves to determine candidacy for C-RFA treatment. Adequate response after anesthetic block was over 50% immediate pain relief. Once patients were deemed candidates, they underwent C-RFA of the three nerves 2-3 weeks later. Treatment response was evaluated using the clinically validated American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) to assess pain, stiffness, and functional activities of daily living. Follow-up outcome scores were collected up to 6 months after C-RFA procedure. RESULTS: Twelve patients underwent C-RFA procedure for shoulder OA. VAS scores significantly improved from 8.8 ± 0.6 to 2.2 ± 0.4 6 months after the C-RFA treatment (p < 0.001). Patient's ASES score results significantly improved in total ASES from 17.2 ± 6.6 to 65.7 ± 5.9 (p < 0.0005). No major complications arose. No patients received re-treatment or underwent shoulder arthroplasty. CONCLUSION: Image-guided axillary, lateral pectoral, and suprascapular nerve C-RFA has minimal complications and is a promising alternative to treat chronic shoulder pain and stiffness from glenohumeral arthritis.
OBJECTIVE: To introduce cooled radiofrequency nerve ablation (C-RFA) as an alternative to managing symptomatically moderate to severe glenohumeral osteoarthritis (OA) in patients who have failed other conservative treatments and who are not surgical candidates or refuse surgery. MATERIAL AND METHODS: This prospective pilot study includes a total of 12 patients experiencing chronic shoulder pain from moderate to severe glenohumeral OA. Patients underwent anesthetic blocks of the axillary, lateral pectoral, and suprascapular nerves to determine candidacy for C-RFA treatment. Adequate response after anesthetic block was over 50% immediate pain relief. Once patients were deemed candidates, they underwent C-RFA of the three nerves 2-3 weeks later. Treatment response was evaluated using the clinically validated American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) to assess pain, stiffness, and functional activities of daily living. Follow-up outcome scores were collected up to 6 months after C-RFA procedure. RESULTS: Twelve patients underwent C-RFA procedure for shoulder OA. VAS scores significantly improved from 8.8 ± 0.6 to 2.2 ± 0.4 6 months after the C-RFA treatment (p < 0.001). Patient's ASES score results significantly improved in total ASES from 17.2 ± 6.6 to 65.7 ± 5.9 (p < 0.0005). No major complications arose. No patients received re-treatment or underwent shoulder arthroplasty. CONCLUSION: Image-guided axillary, lateral pectoral, and suprascapular nerve C-RFA has minimal complications and is a promising alternative to treat chronic shoulder pain and stiffness from glenohumeral arthritis.
Authors: Adam Schumaier; Joseph Abboud; Brian Grawe; J Gabriel Horneff; Charles Getz; Anthony Romeo; Jay Keener; Richard Friedman; Ed Yian; Stephanie Muh; Gregory Nicholson; Ruth Delaney; Randall Otto; William William; J T Tokish; Gerald Williams; Jack Kazanjian; Joshua Dines; Matthew Ramsey; Andrew Green; Scott Paxton; Surena Namdari; Brody Flanagin; Samer Hasan; Scott Kaar; Anthony Miniaci; Frances Cuomo Journal: Arch Bone Jt Surg Date: 2019-03