Man suffering from chronic shoulder pain

Chronic shoulder pain can significantly impact daily life, limiting mobility and diminishing overall quality of life. When conservative treatments like physical therapy and medications fail to provide adequate relief, individuals often seek alternative long-term pain management solutions. Suprascapular nerve block and radiofrequency ablation (RFA) have emerged as minimally invasive procedures that offer hope for those suffering from persistent shoulder pain.

This article explores the intricacies of suprascapular nerve blocks and RFA, their mechanisms, benefits, risks, and who is a good candidate for the treatment. By understanding these procedures, patients can make informed decisions regarding their treatment options and potentially find lasting relief from debilitating shoulder pain.

Whether you are a patient seeking information or a healthcare professional looking to expand your knowledge, this article provides a valuable resource for understanding the role of suprascapular nerve block and RFA in managing chronic shoulder pain.

In This Article:

Key Takeaways:

  • Chronic Shoulder Pain Relief: Suprascapular nerve blocks and radiofrequency ablation (RFA) offer minimally invasive approaches to managing chronic shoulder pain arising from conditions such as rotator cuff tears, frozen shoulder, and arthritis.
  • Targeted Pain Relief: These procedures specifically target the suprascapular nerve, which provides sensation to the shoulder joint and surrounding muscles, effectively interrupting pain signals and reducing inflammation.
  • Diagnostic and Therapeutic: Suprascapular nerve blocks can be used diagnostically to confirm the source of pain, while RFA offers a longer-term solution by disrupting nerve transmission.
  • Combined Approach: Combining a nerve block with RFA can enhance pain relief and improve the accuracy of the RFA procedure.
  • Minimally Invasive with Potential Risks: Both procedures are minimally invasive but carry potential risks, including temporary soreness, nerve injury, and infection, which should be discussed with a qualified pain doctor.
  • Careful Candidate Selection: Ideal candidates are those with chronic shoulder pain who are unresponsive to conservative treatments, in good overall health, and committed to rehabilitation.

Suprascapular Nerve Block

The suprascapular nerve block is a minimally invasive procedure for diagnosing and treating shoulder pain. It involves injecting a local anesthetic, and sometimes a corticosteroid, around the suprascapular nerve to temporarily interrupt pain signals and reduce inflammation. This technique can provide significant relief for individuals suffering from various shoulder conditions.

What is the Suprascapular Nerve?

The suprascapular nerve originates from a network of nerves that controls movement and sensation in the shoulder and arm (brachial plexus). This nerve travels through the suprascapular notch, a bony passageway in the shoulder blade. It provides sensory innervation to the shoulder joint and surrounding muscles, including the muscles that are essential for shoulder movement and stability (supraspinatus and infraspinatus).

Dysfunction or injury to the suprascapular nerve can lead to pain, weakness, and a limited range of motion in the shoulder. Conditions such as rotator cuff tears, frozen shoulder (adhesive capsulitis), and arthritis can impinge or irritate the nerve, resulting in chronic shoulder pain.

How is a Suprascapular Nerve Block Performed?

A suprascapular nerve block is typically performed by a physician specializing in pain management or interventional radiology. The procedure is usually performed using ultrasound or fluoroscopy to ensure accurate needle placement and minimize the risk of complications.

Depending on the physician’s preference and technique, the patient is usually positioned sitting or prone to begin the procedure. Next, imaging guidance with ultrasound or fluoroscopy is used to visualize the suprascapular nerve and surrounding structures, allowing the physician to guide the needle precisely to the target location. The skin around the injection site is then cleansed and numbed with a local anesthetic.

Using image guidance, a small needle is inserted through the skin and advanced toward the suprascapular nerve. When properly positioned, a mixture of local anesthetic and sometimes a corticosteroid is injected around the nerve. Following the procedure, the patient is typically monitored for a short period to assess for any immediate complications.

Benefits and Risks of Suprascapular Nerve Blocks

Suprascapular nerve blocks provide multifaceted benefits for individuals with shoulder pain. In addition to providing significant pain relief, the procedure allows patients to participate in physical therapy and rehabilitation more comfortably and helps alleviate discomfort. Additional benefits include:

  • Diagnostic Tool: The procedure can help determine if the suprascapular nerve is the source of shoulder pain, aiding in diagnosis and treatment planning.
  • Reduced Inflammation: A corticosteroid injection can help reduce inflammation around the nerve, further contributing to pain relief.
  • Improved Function: A suprascapular nerve block can improve shoulder mobility and function by reducing pain and inflammation.

Serious complications from suprascapular nerve blocks are rare, especially when performed by an experienced pain doctor using image guidance. Nevertheless, potential risks to be aware of include:

  • Bleeding or Infection: As with any invasive procedure, there is a small risk of bleeding or infection at the injection site.
  • Nerve Injury: Although rare, there is a potential risk of injury to the suprascapular nerve or surrounding nerves.
  • Pneumothorax: When performing the anterior approach, there is a risk of pneumothorax (collapsed lung) if the needle is inadvertently advanced too far. However, this risk is minimized with the use of ultrasound guidance.
  • Temporary Weakness: Some patients may experience temporary weakness in the muscles supplied by the suprascapular nerve. This usually resolves within a few hours as the anesthetic wears off.

It’s important to discuss the potential benefits and risks with your pain doctor to determine if a suprascapular nerve block is the right treatment option for you.

Radiofrequency Ablation

Radiofrequency ablation (RFA) is a minimally invasive procedure that utilizes heat energy to disrupt nerve signals, providing longer-term pain relief than a temporary nerve block. In the context of shoulder pain, RFA targets the suprascapular nerve to reduce pain signals originating from the shoulder joint and surrounding muscles. This technique can offer lasting relief for individuals with chronic shoulder conditions who haven’t responded adequately to conservative treatments.

What is Radiofrequency Ablation (RFA)?

RFA involves inserting a specialized needle electrode near the targeted nerve. Radiofrequency waves are then passed through the electrode, generating heat that creates a lesion or disruption in the nerve tissue. This lesion prevents the nerve from transmitting pain signals to the brain, effectively reducing pain.

There are two main types of RFA used for pain management:

  • Conventional RFA: This technique uses continuous radiofrequency waves to create a thermal lesion in the nerve.
  • Pulsed RFA: This technique uses short bursts of radiofrequency waves, minimizing heat generation and potentially reducing the risk of complications.

While both methods aim to disrupt nerve signals, pulsed RFA is often preferred for nerves located near critical structures. It provides more precise control over the lesion size and reduces the risk of unintended tissue damage.

How is RFA Performed for Shoulder Pain?

A pain management specialist or interventional radiologist typically performs RFA for shoulder pain. The procedure is usually carried out under local anesthesia and guided by imaging techniques like ultrasound or fluoroscopy.

Depending on the targeted nerve and the pain doctor’s preference, the patient is positioned comfortably, usually lying prone or sitting. A local anesthetic is administered to numb the skin and deeper tissues at the insertion site. Next, ultrasound or fluoroscopy is used to visualize the suprascapular nerve and guide the needle placement accurately. A specialized RFA needle electrode is then inserted through the skin and advanced toward the suprascapular nerve under image guidance.

Mild electrical stimulation is applied once the needle is positioned correctly to confirm proper placement and ensure it is not near motor nerves, preventing unintended muscle weakness. After confirming proper placement, radiofrequency waves are delivered through the electrode to create a heat lesion around the nerve, disrupting pain signals. After the procedure, the patient is typically monitored for a short period to assess for any immediate side effects.

Benefits and Risks of RFA for Shoulder Pain

As a minimally invasive procedure, RFA provides numerous benefits for chronic shoulder pain patients. Some of the key advantages are:

  • Long-Term Pain Relief: RFA can provide significant and long-lasting pain relief, often lasting several months to a year or more.
  • Reduced Medication Reliance: By reducing pain, RFA may help patients decrease their reliance on pain medications, minimizing potential side effects and improving quality of life.
  • Improved Function: With reduced pain, patients may experience improved shoulder mobility and function, allowing them to participate more fully in daily activities and rehabilitation.
  • Minimally Invasive: RFA is a minimally invasive procedure with a relatively short recovery time compared to surgical interventions.

Serious complications from RFA are rare, especially when performed by an experienced pain doctor using image guidance. Nevertheless, it’s important to be informed about the potential risks, which can include:

  • Temporary Pain: Some patients may experience temporary soreness or increased pain at the injection site after the procedure.
  • Nerve Injury: Although rare with proper technique and imaging guidance, there is a small risk of injury to the suprascapular nerve or surrounding nerves.
  • Infection or Bleeding: There is a minimal risk of infection or bleeding at the injection site.
  • Skin Burns: In rare cases, skin burns can occur if the procedure is not performed correctly.

It’s important to thoroughly discuss with your pain doctor the potential benefits and risks of RFA and determine if it’s an appropriate treatment option for your specific condition.

Combining Suprascapular Nerve Block and RFA

While both suprascapular nerve blocks and radiofrequency ablation can effectively treat shoulder pain, combining these procedures can offer a synergistic approach to pain management. This strategy leverages the diagnostic capabilities of nerve blocks and the long-term pain relief potential of RFA, leading to a more comprehensive and effective treatment plan for many individuals.

Why Combine the Two Procedures?

There are several reasons why a pain doctor might recommend combining a suprascapular nerve block with RFA:

  • Diagnostic Confirmation: A nerve block can serve as a diagnostic tool to confirm that the suprascapular nerve is the primary source of pain. If the patient experiences significant pain relief after the nerve block, it suggests that RFA targeting this nerve is likely beneficial. This “diagnostic block” helps ensure that the RFA procedure is accurately targeted and increases the likelihood of a successful outcome.
  • Enhanced Pain Relief: The subsequent RFA procedure can be performed more comfortably and effectively by initially reducing inflammation and pain with a nerve block. The combined approach may also lead to a longer duration of pain relief than either procedure alone.
  • Reduced Risk for RFA: A successful diagnostic block can increase confidence in the precise location for the RFA procedure, minimizing the risk of complications and ensuring that the radiofrequency lesion is created at the optimal site.

What to Expect During and After the Procedures

When undergoing a combined suprascapular nerve block and RFA procedure, patients can generally expect the following:

  • Procedure Day: Both procedures are usually performed in an outpatient setting. The patient is positioned comfortably, and the skin is cleansed and numbed with a local anesthetic. Imaging guidance (ultrasound or fluoroscopy) is used throughout the procedures.
  • During the Procedures: The nerve block will be performed first, followed by the RFA. The patient may feel some pressure or discomfort during needle insertion, but it should be minimal due to the local anesthetic.
  • Post-Procedure Care: After the procedures, the patient will be monitored for a short period before being discharged. The medical team will provide detailed post-procedure instructions, which may include activity restrictions, pain management strategies, and follow-up appointments.
  • Recovery Time: Recovery time varies depending on the individual and the extent of the procedures. Most patients can resume normal activities within a few days, but following all post-procedure recommendations for optimal healing and pain management is essential.

By combining the diagnostic precision of a suprascapular nerve block with the long-term pain relief of RFA, patients with chronic shoulder pain have a greater chance of achieving lasting relief and regaining lost function. It’s crucial to discuss your specific needs and expectations with your pain management physician to determine if this combined approach is the most suitable treatment option for you.

Candidacy and Considerations

Suprascapular nerve blocks and radiofrequency ablation are valuable tools for managing chronic shoulder pain, but they are not suitable for everyone. Careful consideration of individual factors, including the underlying cause of pain, overall health, and treatment goals, is essential in determining the appropriateness of these procedures.

Who is a Good Candidate for These Procedures?

Individuals experiencing chronic shoulder pain that has not responded adequately to conservative treatments like physical therapy, medications, and injections may be good candidates for suprascapular nerve blocks and RFA. Specific conditions that often respond well to these procedures include:

  • Rotator Cuff Tears: Pain arising from rotator cuff tears, especially in cases where surgery is not an immediate option or has been unsuccessful.
  • Frozen Shoulder (Adhesive Capsulitis): These procedures can help alleviate pain and improve the range of motion in individuals with a frozen shoulder.
  • Shoulder Arthritis: RFA can provide long-term pain relief for individuals with shoulder arthritis, particularly when pain primarily originates from the joint itself.
  • Post-surgical Pain: In some cases, these procedures can be used to manage chronic pain following shoulder surgery.

In addition to specific conditions, ideal candidates generally possess the following characteristics:

  • Good Overall Health: Patients should be in reasonably good health to minimize the risk of complications.
  • Realistic Expectations: Patients must understand that these procedures aim to reduce pain and improve function but may not eliminate all symptoms.
  • Commitment to Rehabilitation: Active participation in physical therapy and a home exercise program is crucial for maximizing the benefits of these procedures and achieving long-term pain relief.

While generally safe and effective, suprascapular nerve blocks and RFA may not be appropriate for everyone. Contraindications and situations where these procedures are not recommended include:

  • Active Infection: An active infection in the shoulder region increases the risk of complications.
  • Bleeding Disorders: Patients with bleeding disorders may be at increased risk of bleeding complications.
  • Pregnancy: The safety of these procedures during pregnancy has not been established.
  • Severe Nerve Damage: These procedures may be ineffective if the suprascapular nerve is severely damaged.
  • Uncontrolled Diabetes: Patients with uncontrolled diabetes may have impaired healing and an increased risk of infection.
  • Lack of Diagnostic Clarity: If the source of shoulder pain is unclear, a diagnostic nerve block should be performed before considering RFA to confirm that the suprascapular nerve is involved.

Finding a Qualified Provider

The success of suprascapular nerve blocks and RFA depends on the expertise of the pain management physician performing the procedures. When considering these treatments, it’s crucial to find a qualified provider with:

  • Specialized Training: Look for a doctor with experience performing pain management, interventional radiology, or anesthesiology procedures.
  • Board Certification: Board certification ensures that the physician has met rigorous standards of training and expertise.
  • Access to Advanced Imaging: Using ultrasound or fluoroscopy is essential for accurate needle placement and minimizing the risk of complications.
  • Positive Patient Reviews: Consider patient reviews and testimonials to gauge the physician’s experience and patient satisfaction.

By carefully considering these factors and consulting with a qualified pain management professional, patients can decide whether suprascapular nerve block and RFA are suitable treatment options for their individual needs.

FAQs

What is the difference between a suprascapular nerve block and radiofrequency ablation?

Both suprascapular nerve blocks and radiofrequency ablation (RFA) aim to reduce shoulder pain by targeting the suprascapular nerve, but they differ significantly in their mechanism and duration of effect. A suprascapular nerve block involves injecting a local anesthetic, and sometimes a corticosteroid, around the nerve to temporarily interrupt pain signals and reduce inflammation. This provides relatively immediate but short-term pain relief, lasting from a few hours to several months. Nerve blocks are often used diagnostically to pinpoint the source of pain and predict the effectiveness of more permanent solutions like RFA.

Radiofrequency ablation, on the other hand, utilizes heat energy to create a lesion on the nerve, disrupting its ability to transmit pain signals. This results in longer-term pain relief, typically lasting several months to a year or more. While both procedures are minimally invasive, RFA involves a more deliberate disruption of nerve function, offering a potentially more durable solution for chronic shoulder pain. The choice between these procedures depends on individual needs, the diagnostic certainty of the pain source, and the desired duration of pain relief.

How long does pain relief last after each procedure?

The duration of pain relief varies significantly between suprascapular nerve blocks and radiofrequency ablation (RFA). A suprascapular nerve block provides relatively short-term relief, typically lasting from a few hours to several months, depending on the individual and the specific medications used. The primary goal of a nerve block is often diagnostic, confirming the source of pain and helping determine the potential effectiveness of more permanent solutions like RFA.

In contrast, radiofrequency ablation aims to relieve longer-term pain by disrupting the nerve’s ability to transmit pain signals. The effects of RFA can last anywhere from six months to a year or more, and in some cases, even longer. The variability in pain relief duration for both procedures is influenced by factors such as the underlying cause and severity of shoulder pain, individual response to treatment, and the extent of nerve damage. It’s essential to discuss your specific circumstances and expectations with your pain doctor to gain a clearer understanding of the potential duration of pain relief for your condition.

Is the procedure painful?

Both suprascapular nerve blocks and radiofrequency ablation (RFA) are generally well-tolerated procedures, but some discomfort can be expected. During the procedures, patients typically experience a pressure sensation as the needle is inserted and advanced toward the nerve. The administration of local anesthetic helps numb the area, minimizing any sharp pain. Some patients may feel a brief burning sensation as the anesthetic is injected.

Following the procedures, mild soreness at the injection site is common and usually subsides within a few days. With RFA, there might be a temporary increase in pain for a short period before the nerve lesion takes full effect and pain relief sets in. Your physician will provide detailed post-procedure instructions and may recommend over-the-counter pain medications or other strategies to manage any discomfort effectively.

How long does it take to recover?

Recovery time for both suprascapular nerve block and radiofrequency ablation (RFA) is generally short, with most individuals able to resume normal activities within a few days. Immediately following the procedures, you will be monitored for a brief period to assess for any immediate side effects. You may experience some soreness or numbness at the injection site, which can be managed with over-the-counter pain medications and ice packs.

While a nerve block may provide immediate pain relief, the full effects of RFA can take a few days or even weeks to manifest as the targeted nerves become less responsive to pain signals. Your pain management team will provide specific post-procedure instructions, including guidance on activity restrictions, pain management, and any necessary follow-up appointments. Following these recommendations is essential to optimize healing and ensure the best possible outcome.

What are the alternatives if these procedures are not suitable for me?

If suprascapular nerve block or radiofrequency ablation are not suitable options for your shoulder pain, several alternative treatments should be considered. These can be broadly divided into conservative, minimally invasive, and surgical interventions, each with its benefits and limitations.

Conservative approaches form the foundation of shoulder pain management and include physical therapy, pain medications (NSAIDs, analgesics), corticosteroid injections, and lifestyle modifications (rest, ice, compression, elevation). Minimally invasive alternatives encompass other injection therapies like platelet-rich plasma (PRP) or stem cell injections, which aim to promote natural healing.

Surgical intervention may be considered when conservative and minimally invasive options fail to provide adequate relief. This can range from arthroscopic procedures to address specific joint problems to more extensive surgeries like shoulder replacement for advanced arthritis. It is crucial to consult with your physician to determine the most appropriate alternative treatment based on the underlying cause of your shoulder pain, your overall health, and your treatment goals.

Conclusion

Suprascapular nerve block and radiofrequency ablation offer valuable treatment options for individuals seeking long-term relief from chronic shoulder pain. By disrupting pain signals and reducing inflammation, these minimally invasive procedures can significantly improve quality of life and restore lost function. While not suitable for everyone, those suffering from conditions like rotator cuff tears, frozen shoulder, and arthritis may find substantial relief through these interventions.

If you are struggling with persistent shoulder pain, consult with a qualified pain management specialist to determine if a suprascapular nerve block or RFA is right for you. By carefully considering your needs and expectations and working closely with your pain doctor, you can take proactive steps toward regaining comfort and mobility in your shoulder.

Novus Spine & Pain Center

Novus Spine & Pain Center is in Lakeland, Florida, and treats patients with chronic pain with numerous therapies, including suprascapular nerve blocks and radiofrequency ablation. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle while minimizing the need for opiates.

For your convenience, you may schedule an appointment online, request a call back, or call our office at 863-583-4445.

Additional Resources

How I Do It: Shoulder Articular Nerve Blockade and Radiofrequency Ablation (ASRA Pain Medicine)
Suprascapular Nerve Block (National Institutes of Health)
Pulsed Radiofrequency Lesioning of the Suprascapular Nerve for Chronic Shoulder Pain (Oxford Academic)

author avatar
Dr. Benito Torres, DO CEO/Owner
Dr. Benito Torres is a pain management doctor in Lakeland, Florida. Dr. Torres established the award-winning Novus Spine & Pain Center to provide the highest quality pain management care to patients. Using a comprehensive approach and cutting-edge therapies, we work together to restore your function and regain your active lifestyle while minimizing the need for opiates.
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