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Shoulder Osteoarthritis Pain Treated with Suprascapular Nerve Block and Pulsed Radiofrequency Ablation

Shoulder pain

Severe Shoulder Pain Treated with Suprascapular Nerve Block and Pulsed Radiofrequency Ablation

Introduction

Shoulder pain is a common but often severely debilitating condition, particularly in elderly patients with degenerative osteoarthritis. While some patients may benefit from surgical intervention, a significant proportion are not suitable candidates due to medical comorbidities, frailty, or surgical risk.

In such cases, pain can become chronic and profoundly distressing, affecting even the simplest daily activities such as dressing, washing, reaching, and sleeping. Persistent shoulder pain can significantly impact independence, mood, and overall quality of life.

Case Presentation

This case involves an elderly patient who presented with severe, persistent shoulder pain secondary to advanced degenerative osteoarthritis.

The pain was constant and significantly exacerbated by movement of the shoulder, particularly overhead activities and reaching movements. The patient also experienced severe night pain, resulting in poor sleep and fatigue.

Functionally, the patient was significantly limited, struggling with basic activities of daily living including dressing, personal care, and household tasks. The ongoing pain caused considerable distress and loss of independence.

Given the patient’s medical background and comorbidities, surgical intervention was not considered an appropriate option.

Why Shoulder Pain Can Be So Distressing

Severe shoulder pain can have a profound impact on day-to-day life:

  • Difficulty with basic activities such as dressing and washing
  • Pain with simple arm movements
  • Significant sleep disturbance due to night pain
  • Loss of independence
  • Emotional distress and reduced quality of life

In elderly patients, this loss of function can be particularly impactful, often leading to reduced mobility and increased reliance on others.

Management Options at Pain Spa

At Pain Spa, we offer a comprehensive, stepwise approach to managing shoulder pain, particularly in patients where surgery is not appropriate.

1. Conservative Measures

  • Physiotherapy and rehabilitation
  • Activity modification
  • Analgesic medications

2. Image-Guided Shoulder Injections

Ultrasound-guided injections can be used to deliver targeted treatment to specific structures within the shoulder, including joints and soft tissues.

3. Suprascapular Nerve Block

The suprascapular nerve is a key contributor to shoulder pain, supplying a significant portion of the shoulder joint.

An ultrasound-guided suprascapular nerve block involves precise placement of local anaesthetic (with or without steroid) around the nerve. This serves both:

  • Diagnostic purpose – confirming the nerve as a source of pain
  • Therapeutic purpose – providing pain relief

At Pain Spa, all such procedures are performed under real-time ultrasound guidance to ensure accuracy and safety.

4. Pulsed Radiofrequency (PRF) of the Suprascapular Nerve

For patients who experience a positive response to the diagnostic suprascapular nerve block, pulsed radiofrequency (PRF) treatment offers a longer-lasting and highly effective option for pain relief.

Pulsed radiofrequency is an advanced, minimally invasive technique that works by modulating pain signals within the nerve, rather than destroying the nerve itself. Unlike conventional radiofrequency treatments, PRF delivers short bursts of electrical energy at controlled temperatures, allowing alteration of pain transmission without causing significant structural damage to the nerve.

This makes PRF particularly suitable for managing chronic shoulder pain, especially in patients where preservation of nerve function is important.

The procedure is performed under real-time ultrasound guidance, allowing precise localisation of the suprascapular nerve and accurate placement of the radiofrequency needle. Once correctly positioned, controlled pulses of energy are delivered to the nerve, leading to a reduction in pain signalling.

The effectiveness of PRF is highly dependent on accurate needle positioning and technical expertise. Even small deviations from the optimal location can significantly reduce the effectiveness of the treatment. For this reason, experience in ultrasound-guided nerve interventions is critical.

At Pain Spa, Dr Krishna has extensive experience in performing pulsed radiofrequency treatments for shoulder pain. His expertise in ultrasound-guided techniques allows:

  • Precise targeting of the suprascapular nerve
  • Optimal delivery of pulsed radiofrequency energy
  • Improved likelihood of sustained pain relief

In this case, the patient experienced excellent pain relief lasting approximately 18 months, with significant improvement in function, sleep, and overall quality of life.

Importantly, PRF is a repeatable treatment, meaning that if symptoms recur over time, the procedure can be safely repeated to maintain pain control.

Importance of Expertise and Imaging Guidance

The effectiveness of suprascapular nerve treatments relies on accurate needle placement and appropriate use of imaging guidance. These procedures are performed under real-time ultrasound to ensure precise localisation of the nerve and safe delivery of treatment.

Pulsed radiofrequency is a technique-dependent procedure, and outcomes are influenced by correct positioning.

At Pain Spa, careful technique and experience help optimise treatment results in patients with complex shoulder pain.

This level of precision and experience is a key factor in achieving excellent results in patients with complex and refractory shoulder pain, particularly in those who are not suitable for surgical management.

Treatment and Outcome

The patient initially underwent an ultrasound-guided suprascapular nerve block.

This resulted in significant improvement in pain, confirming the suprascapular nerve as a major contributor to the symptoms.

Based on this positive response, the patient proceeded to pulsed radiofrequency ablation of the suprascapular nerve.

Following PRF treatment, the patient experienced excellent pain relief, with significant improvement in function and sleep.

Importantly, the benefit from the procedure lasted approximately 18 months, allowing the patient to regain independence and improve overall quality of life.

The treatment can be safely repeated if symptoms recur.

Discussion

This case highlights the importance of interventional pain management techniques in patients with severe shoulder osteoarthritis who are not suitable for surgery.

While conservative measures remain important, targeted interventions such as suprascapular nerve block and pulsed radiofrequency can provide meaningful and sustained relief.

Outcomes are highly dependent on appropriate patient selection, diagnostic accuracy, and technical expertise.

Conclusion

Severe shoulder pain due to osteoarthritis can be extremely distressing and disabling, particularly in elderly patients where surgical options are limited.

This case demonstrates that ultrasound-guided suprascapular nerve block followed by pulsed radiofrequency ablation can provide significant and long-lasting pain relief.

At Pain Spa, advanced imaging techniques combined with specialist expertise allow us to deliver highly effective, targeted treatments for patients with complex shoulder pain.

If you suffer from shoulder pain and would like a specialist assessment, please contact Pain Spa at clinic@painspa.co.uk  or visit www.painspa.co.uk for further information. A structured, mechanism-based plan can significantly improve outcomes.