Use of Cooled Radiofrequency in Ultrasound‑guided Neuroablation of Sensory Articular Branches of the Shoulder: A Preliminary Study

INTRODUCTION Pulsed and/or thermal radiofrequency (RF) is used to treat chronic shoulder pain, with results that are sometimes inconsistent1. Recent anatomical studies have determined the precise location of the articular branches of the main nerves innervating the joint capsule: suprascapular, lateral pectoral, and axillary nerves. Cooled radiofrequency is a neuroablative treatment modality that has proven effective in various anatomical sites. Targeting these nerves, combined with the larger lesion size, may lead to a longer-lasting pain relief2. The aim of this study is to evaluate the effectiveness of ultrasound-guided cooled radiofrequency for the treatment of chronic shoulder pain. METHODS We conducted a retrospective study. All patients aged between 18 and 90 who provided informed consent, underwent a positive diagnostic block, and subsequently received cooled radiofrequency treatment of the suprascapular, lateral pectoral, and axillary nerves under ultrasound guidance for chronic shoulder pain. The treatments were performed between 04/2024 and 11/ 2024 at Bellaria Hospital in Bologna. Demographic data were collected, and pain and quality of life were assessed using the Numerical Rating Scale (NRS) and the Brief Pain Inventory (BPI) questionnaire, respectively, at baseline (T0) and at 1, 3, and 6 months post-procedure. Quantitative variables were expressed as mean and standard deviation after checking for normal distribution using the Shapiro-Wilk test. A Linear Mixed Model for repeated measures was used to evaluate the trend of the outcomes over time, as well as the change in outcomes. In each model, the timepoints were considered fixed effects, while the patients were treated as random effects. RESULTS Eight patients were included in the study group. The mean age was 76 ± 6.3 years, and 87.5% of the participants were female. Table 1 describes the trends of mean NRS, BPI Pain, and BPI Quality of Life over time. The Linear Mixed Model for repeated measures showed a statistically significant reduction in mean NRS (p = 0.002), BPI Pain (p < 0.001), and BPI Quality of Life (p = 0.003). However, no statistically significant differences were observed when comparing the reductions in outcome values at 1 month, 3 months, and 6 months from baseline. CONCLUSIONS Despite the limitations related to the small sample size, ultrasound-guided cooled radiofrequency ablation of the articular branches of the suprascapular, axillary, and lateral pectoral nerves results in a significant and lasting reduction in pain, as well as a significant improvement in quality of life in patients suffering from chronic shoulder pain. To date, the treatment of these nerves has been validated in the literature using radiographic or mixed imaging techniques2,3. Further data collection standardized by nerve target, type of neuroablation, and follow-up duration beyond 6 months will be necessary to validate the long-term pain relief achieved by this technique.