# Addition of Pulsed Radiofrequency to Suprascapular Nerve Block with Glenohumeral Steroid Injection in Patients with Chronic Shoulder Pain

## TL;DR

Adding pulsed radiofrequency to a nerve block and steroid injection improves chronic shoulder pain outcomes more than the standard treatment.

## Contribution

This study demonstrates that combining pulsed radiofrequency with standard shoulder pain treatments yields better long-term results.

## Key findings

- Group B showed significantly lower pain scores at six months compared to Group A.
- Group B had better shoulder range of motion in internal rotation, external rotation, and abduction.
- Combined PRF treatment improved functional outcomes as measured by SPADI scores.

## Abstract

Chronic shoulder pain frequently affects individuals in contemporary societies. However, the benefits of conventional therapies are limited and do not result in sustained clinical improvement.

The purpose of this study is to evaluate the potential benefits of integrating pulsed radiofrequency (PRF) neuromodulation into current approaches for managing long-term shoulder pain.

In this prospective, randomized, clinical interventional study, 60 patients suffering from chronic shoulder pain were randomly assigned to two groups. Group A consisted of 30 patients and received a glenohumeral steroid injection of Diprofos® (betamethasone dipropionate 14 mg/2 mL) along with an ultrasound-guided suprascapular nerve (US SSN) block using 10 mL of 0.25% preservative-free bupivacaine. Group B, also comprising 30 patients, underwent the same protocol as group A, with the additional administration of PRF treatment targeting the suprascapular nerve (SSN). Pain and function were assessed using the Shoulder Pain and Disability Index (SPADI), Numerical Rating Scale (NRS), and shoulder active range of motion (AROM) at baseline, 15 days, 1 month, 3 months, and 6 months post-procedure.

Both groups showed significant pain and functional improvement throughout the study course. However, group B exhibited superior outcomes at all follow-up points. The SPADI score decreased from 69.71 ± 16.54 at baseline to 48.16 ± 15.77 at six months in group B, compared to 72.02 ± 14.51 to 64.91 ± 14.34 in group A (P < 0.001). Median NRS scores at six months were also significantly lower (P < 0.0001) in group B [2.00 (IQR: 1.00 - 4.00)] compared to group A [5.00 (IQR: 4.00 - 6.00)]. The AROM measurements at six months favored group B for internal rotation (74.77 ± 6.84 vs. 67.10 ± 9.26, P = 0.001), external rotation (74.40 ± 9.90 vs. 67.23 ± 9.32, P = 0.006), and abduction (163.23 ± 9.96 vs. 155.30 ± 10.13, P = 0.003). Flexion improvement at six months was greater in group B (162.80 ± 21.14) than in group A (154.93 ± 12.76), though not statistically significant (P = 0.086).

This study showed that the addition of PRF therapy to the SSN significantly improved clinical outcomes compared to the suprascapular nerve block (SSNB) combined with intra-articular corticosteroid injection in patients with chronic shoulder impingement syndrome. The combined modality led to significantly better outcomes in terms of pain alleviation, range of motion, and functional capacity.