A Shoulder That Had Run Out of Surgical Options

Robert, a man in his late seventies, had been living with persistent pain in his left shoulder for over six years. The pain had developed gradually but had become increasingly disabling, making it difficult for him to lift his arm above head height, perform everyday tasks, or sleep comfortably on his left side. Any movement of the left arm — particularly raising it out to the side — provoked significant discomfort.

He had already undergone shoulder decompression surgery, but at the time of the operation the rotator cuff tear was found to be irreparable. Despite the procedure, his pain persisted. He had also received a glenohumeral joint injection, which provided little meaningful benefit. By the time he was referred for specialist pain management, his shoulder pain had become chronic and was significantly limiting his independence and quality of life.

Robert had significant background medical comorbidities — including a cardiac condition requiring anticoagulant therapy and previous joint replacement surgery — which meant that further surgical intervention carried unacceptable risk and was not a realistic option. Managing his shoulder pain effectively without surgery was therefore the priority.

Imaging, Assessment, and the Case for Nerve-Targeted Treatment

Ultrasound imaging confirmed a full-thickness tear of the supraspinatus tendon — a finding consistent with Robert’s clinical presentation. Abduction of the left shoulder was moderately restricted on examination, and internal rotation was mildly limited. There were no neurological red flags, and his symptoms were clearly localised to the left shoulder complex.

Prior to his referral to Pain Spa, Robert had received a diagnostic suprascapular nerve block under ultrasound guidance, which had produced near-complete pain relief lasting approximately three months. This strongly positive response was clinically significant: it confirmed that the suprascapular nerve was the dominant driver of his pain, and provided a clear rationale for pursuing a longer-lasting nerve-targeted intervention.

The challenge was to translate that short-lived diagnostic response into durable, sustained pain relief. This is where pulsed radiofrequency treatment of the suprascapular nerve offered a compelling solution — as the following sections explain.

The Full Picture Before Treatment

A thorough assessment was undertaken to characterise Robert’s pain, identify relevant clinical factors, and confirm his suitability for pulsed radiofrequency treatment.

From Diagnostic Confirmation to Lasting Relief

Robert’s path to treatment followed a structured, evidence-informed pathway — moving from diagnostic confirmation of the pain source through to a precisely delivered interventional procedure and subsequent long-term follow-up.

Four Pillars of Expert Pain Care

Robert’s case exemplifies the PainSpa model of care: a structured, evidence-led pathway in which every clinical decision is made with the individual patient at its centre.

More Than Two Years of Sustained Pain Relief

Robert’s response to pulsed radiofrequency treatment of the suprascapular nerve has been excellent and durable. The key improvements are summarised below.

It is important to note that pulsed radiofrequency treatment of the suprascapular nerve targets the pain signal rather than the underlying structural pathology. Robert’s rotator cuff tear remains, and the procedure does not reverse the degenerative changes in the shoulder joint. However, by substantially reducing the pain transmitted via the suprascapular nerve, the treatment has achieved what further surgery could not: a meaningful and lasting improvement in his quality of life.

This case adds to a growing body of experience at PainSpa with pulsed radiofrequency treatment for chronic shoulder pain. Across a series of patients treated by Dr Krishna using this technique, the results have been consistently encouraging — with many patients achieving substantial and durable relief following a single ultrasound-guided procedure.

Ongoing Management Plan

Robert continues to do well and his management plan reflects his current excellent response to treatment.

Dr Murli Krishna

Dr Krishna is a Consultant in Pain Medicine with extensive experience in the management of chronic shoulder pain using advanced interventional techniques. He has developed particular expertise in ultrasound-guided pulsed radiofrequency treatment of the suprascapular nerve — a technique in which precise needle positioning is critical to achieving an excellent and lasting outcome. His practice is built on the principle that real-time imaging and meticulous technique are the cornerstones of effective pain intervention.

Across a growing series of patients treated with suprascapular nerve pulsed radiofrequency at PainSpa, Dr Krishna has seen consistently strong results, with many patients achieving significant and durable pain relief from a single procedure. This case study is one example of a pattern that has now been observed across multiple patients with chronic shoulder pain in whom surgery is either not possible or has not provided adequate relief.

If you or someone you know is living with persistent shoulder pain that has not responded to conventional treatment, Dr Krishna and the PainSpa team would be pleased to discuss whether pulsed radiofrequency or another interventional approach may be appropriate. To arrange a consultation, please contact the PainSpa clinic directly.