Ultrasound-Guided High-Voltage Long-Duration Pulsed Radiofrequency of the Suprascapular Nerve for Persistent Hemiplegic Shoulder Pain

Hemiplegic shoulder pain (HSP) is a common complication after stroke that can interfere with upper-limb rehabilitation. Persistent cases may respond inadequately to conventional conservative treatments or suprascapular nerve blocks. This article describes a standardized ultrasound-guided high-voltage long-duration pulsed radiofrequency (HL-PRF) protocol targeting the suprascapular nerve. Ultrasound is used to identify the suprascapular notch, surrounding anatomical structures, and adjacent vessels. A radiofrequency cannula is advanced to the target under real-time guidance, and its position is confirmed by sensory and motor stimulation. HL-PRF is then delivered at 99 V for 6 min while the temperature is maintained at or below 42 °C. The clinical outcomes presented here are illustrative observations from two patients with persistent HSP and do not represent findings from a controlled clinical study. In both cases, lower resting and movement-evoked pain scores and increased shoulder passive range of motion were observed at the 1-month follow-up. Pain scores at the 3-month telephone follow-up remained below baseline values. No procedure-related adverse events were observed or documented in either case during the available follow-up period. These cases are included to illustrate the clinical application and potential outcomes of the protocol rather than to establish efficacy. This protocol provides a detailed procedural framework for ultrasound-guided HL-PRF of the suprascapular nerve in patients with persistent HSP.