Shoulder Osteoarthritis Pain Treated with Suprascapular Nerve Block and Pulsed Radiofrequency Ablation
Case Study Series
Pain Medicine — Shoulder Osteoarthritis
Relief from severe shoulder pain with suprascapular nerve block and pulsed radiofrequency
A case study exploring how a stepwise, ultrasound-guided nerve-targeted approach restored sleep, independence and quality of life in an elderly patient unsuitable for surgery.
~18 mo
Sustained pain relief
2
Targeted procedures
US
Ultrasound-guided precision
✓
Surgery avoided
Margaret — Age late 70s
Retired • Advanced glenohumeral osteoarthritis • Multiple comorbidities • Surgery unsuitable
Advanced shoulder OARight (dominant) shoulderSevere night pain~18 months sustained relief post-PRF
The Presentation
A relentless shoulder pain that conventional treatment could not settle
Margaret, a retired woman in her late 70s, presented to PainSpa with severe, persistent pain in her right shoulder that had progressively worsened over many months. Previously independent and active, she had reached a point where the simplest daily tasks — dressing, washing, reaching into a cupboard — had become painful and exhausting.
She described a deep, constant ache that never fully settled, with sharp exacerbations on any movement of the arm. Overhead activity, reaching and rotation were particularly painful. Most distressing of all was the severe night pain, which prevented comfortable lying positions and disrupted sleep almost every night, leaving her chronically fatigued.
Imaging and clinical assessment were consistent with advanced degenerative osteoarthritis of the glenohumeral joint. She had previously engaged with physiotherapy, activity modification and a stepped analgesic regimen, with only modest, short-lived benefit. Given her age, comorbidities and overall surgical risk profile, joint replacement and other surgical options had been considered inappropriate.
She was referred for specialist pain medicine input with Dr Murli Krishna at PainSpa for consideration of targeted, image-guided interventional treatment.
Clinical Background
Shoulder osteoarthritis when surgery is not an option
Severe shoulder osteoarthritis is a common but often profoundly disabling condition in older patients. While shoulder replacement surgery can offer excellent results for suitable candidates, a significant proportion of elderly patients are unsuitable for surgery due to medical comorbidities, frailty or anaesthetic risk.
In these patients, persistent shoulder pain can become chronic and deeply distressing. The impact reaches well beyond the joint itself: loss of sleep, loss of independence, low mood, social withdrawal and reduced mobility are frequent companions of severe shoulder pain in older age.
Targeting the nerve that carries the pain — not just the joint that hurts
Suprascapular nerve
Supplies around 70% of the sensory innervation to the shoulder joint and capsule, making it an ideal therapeutic target for shoulder pain.
Joint injections
Steroid placed inside the joint or bursae can settle inflammation, but in advanced osteoarthritis benefit is often modest and short-lived as the structural damage remains.
Nerve-targeted block
An ultrasound-guided suprascapular nerve block interrupts the pain signal upstream — before it ever reaches the spinal cord and brain.
Pulsed radiofrequency
Delivers controlled pulses of energy below 42°C, modulating pain transmission without destroying the nerve — longer-lasting, repeatable and nerve-preserving.
Symptom Assessment
A picture of severe, life-limiting shoulder pain
Margaret’s symptom profile was consistent with severe degenerative shoulder pain with prominent night and functional components — a pattern in which both rest pain and movement-evoked pain combine to erode sleep, independence and quality of life.
Background pain
Constant, deep ache
Continuous shoulder pain present even at rest • Never fully settled • Worse at the end of the day • Poorly responsive to simple analgesia
Movement-evoked pain
Sharp exacerbation with activity
Overhead reaching painful • Pain on abduction and rotation • Dressing the upper body difficult • Reaching into cupboards distressing
Night pain & sleep loss
Severe nocturnal disturbance
Unable to lie on the affected shoulder • Pain waking from sleep most nights • Chronic fatigue • Low mood related to insomnia
Functional limitation
Loss of independence
Difficulty with dressing and washing • Household tasks limited • Reduced social and outdoor activity • Increased reliance on family for basic care
Failed conservative management and unsuitable for surgery — an indication for interventional treatment
Margaret had engaged fully with physiotherapy, activity modification and a stepped analgesic regimen, with only short-lived benefit. With surgery not appropriate given her medical background, an ultrasound-guided suprascapular nerve approach offered a targeted next step.
The Treatment Journey
A structured, stepwise approach to recovery
Dr Krishna’s approach was grounded in thorough assessment, transparent discussion of options and a carefully sequenced plan — using a diagnostic nerve block first to confirm the pain generator, before committing to a longer-lasting therapeutic intervention.
Step 1 — Initial Consultation
Comprehensive assessment and diagnosis
Dr Krishna reviewed Margaret’s full symptom history, imaging and previous treatments. A clinical formulation of severe glenohumeral osteoarthritis with surgery unsuitable was made. Options were discussed including continued conservative care, image-guided joint injections and a nerve-targeted approach with diagnostic suprascapular nerve block followed potentially by pulsed radiofrequency.
Step 2 — Shared Decision-Making
Honest expectation-setting before proceeding
Margaret was informed that a diagnostic suprascapular nerve block would confirm whether the nerve was a meaningful contributor to her pain, that PRF typically takes a few weeks to reach maximum effect, that benefit commonly lasts many months and that the procedure can be safely repeated if symptoms recur over time.
Step 3 — Diagnostic Suprascapular Nerve Block
Ultrasound-guided block with local anaesthetic and steroid
Under real-time ultrasound guidance, Dr Krishna performed a precise suprascapular nerve block. Margaret experienced significant improvement in her pain in the following days, confirming the suprascapular nerve as a major contributor to her symptoms and making her an excellent candidate for pulsed radiofrequency.
Step 4 — Pulsed Radiofrequency Ablation
Ultrasound-guided PRF of the suprascapular nerve
Building on the positive diagnostic response, Margaret proceeded to ultrasound-guided pulsed radiofrequency treatment of the suprascapular nerve. Controlled pulses of energy were delivered to the nerve under live imaging, modulating pain signalling without destroying nerve fibres — an important consideration in an elderly patient.
The PainSpa Approach
Four pillars of shoulder pain management at PainSpa
Severe shoulder pain in elderly patients deserves more than a single injection. Dr Krishna’s approach combines precision pain medicine, accurate imaging guidance and a focus on restoring function and independence — not just suppressing pain.
1. Precise clinical assessment
A thorough evaluation of the joint, nerve and functional contributors to each patient’s shoulder pain before any intervention is planned.
2. Real-time ultrasound guidance
Every block and PRF needle placement is performed under live ultrasound, allowing precise visualisation of the suprascapular nerve and surrounding structures.
3. Diagnostic-then-therapeutic strategy
A diagnostic nerve block confirms the pain generator before any longer-lasting intervention — ensuring the right patients receive the right treatment.
4. Nerve-preserving, repeatable PRF
Pulsed radiofrequency modulates pain signalling without destroying the nerve and can be safely repeated — offering a long-term, surgery-sparing pathway.
Pulsed radiofrequency of the suprascapular nerve is highly technique-dependent. Even small deviations from the optimal position can compromise the result — experience and live ultrasound guidance are everything.
Dr Murli Krishna — Consultant in Pain Medicine, PainSpa
The Specialist Perspective
Why imaging guidance and technique matter so much
The success of suprascapular nerve interventions is highly dependent on accurate needle placement. The nerve runs through a defined anatomical corridor at the suprascapular notch, in close relation to important neurovascular structures. Real-time ultrasound allows continuous visualisation of the nerve, surrounding vessels and the advancing needle tip — making the procedure both safer and more effective.
Pulsed radiofrequency in particular is technique-dependent. Even small deviations from the optimal target can significantly reduce treatment effect. For this reason, experience in ultrasound-guided nerve interventions and a careful, methodical approach are critical to achieving consistent results in patients with complex, refractory shoulder pain.
In Dr Krishna’s practice, this precision is paired with an emphasis on patient-centred goals: restoring sleep, restoring independence and avoiding unnecessary surgery in patients for whom surgical risk would be unacceptable.
Outcome
What changed for Margaret following PRF
In the weeks following pulsed radiofrequency treatment, Margaret experienced a meaningful and clinically significant improvement in her shoulder pain. For a patient who had spent many months unable to sleep through the night or dress comfortably, the changes were transformative.
Key improvements following PRF
● Significant reduction in pain intensity — the constant background ache largely resolved
● Restoration of sleep — able to lie comfortably and sleep through the night
● Return of daily function — dressing, washing and household tasks once again possible without distress
● Regained independence — reduced reliance on family for basic personal care
● Improved mood, energy and engagement with everyday activities
● Sustained benefit lasting approximately 18 months — with the option to safely repeat PRF when needed
Dr Krishna was particularly encouraged by the resolution of night pain and the return of independence. The duration of relief — approximately 18 months — aligns well with typical outcomes from suprascapular PRF in carefully selected patients, and importantly the treatment can be safely repeated should symptoms recur over time.
Looking Ahead
The next steps in Margaret’s care
With pain relief well established and function restored, the ongoing plan focuses on maintaining gains, preserving independence and providing a clear pathway should symptoms recur in time.
Recommended ongoing management plan
Next stepOpen access for repeat ultrasound-guided pulsed radiofrequency of the suprascapular nerve when symptoms recur.
OngoingMaintenance physiotherapy and gentle shoulder mobility work to protect range of movement and functional capacity.
ActivityEncouragement to remain active within comfort, supporting general mobility, mood and overall wellbeing.
ReserveUltrasound-guided intra-articular shoulder injection considered if a different pain pattern emerges.
WellbeingAttention to sleep, mood and social engagement — recognising the wider impact of chronic pain in older patients.
Follow-upOpen review at PainSpa with prompt access for repeat assessment if symptoms return.
Your Specialist
About Dr Murli Krishna
Dr Murli Krishna
Consultant in Pain Medicine — PainSpa
MBBS • FRCA • FFPMRCA • Fellow of the Faculty of Pain Medicine
Dr Krishna is a highly experienced Consultant in Pain Medicine practising at PainSpa’s clinics in Bristol, including Willow Surgery in Downend and the Chesterfield Nuffield Hospital in Clifton. He has a specialist interest in ultrasound-guided interventional pain medicine, including suprascapular nerve blocks and pulsed radiofrequency for complex shoulder pain.
His approach is grounded in a thorough understanding of the structural, neuropathic and functional contributors to each patient’s pain. He works closely with physiotherapists and other specialists, recognising that the best outcomes are achieved through coordinated, patient-centred care — particularly in elderly patients where preserving function and independence is paramount.
Dr Krishna consults in person and via telephone or videolink. Patients wishing to explore image-guided injections or pulsed radiofrequency for shoulder pain are encouraged to contact PainSpa to arrange an initial assessment.
Please note: This case study is published for educational and informational purposes. All patient-identifying details have been changed to protect confidentiality, while the clinical history and treatment described remain accurate. Individual results vary; the procedure does not guarantee improvement. Pulsed radiofrequency is most effective as part of a comprehensive, individualised plan. This does not constitute medical advice. For queries write to clinic@painspa.co.uk.
Painspa
Willow Surgery, Downend • Chesterfield Nuffield, Clifton • clinic@painspa.co.uk • www.painspa.co.uk
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