Kabbara J, Alsalak C, Kabbara A
Cureus 17(8): e89729. doi:10.7759/cureus.89729
This case report describes an 87-year-old woman with severe bilateral shoulder osteoarthritis and major movement restriction, particularly on the right side. X-rays showed severe degenerative changes with multiple loose bodies in the left shoulder (Figure 1) and advanced glenohumeral osteoarthritis with humeral head flattening and joint space narrowing on the right (Figure 2). Conservative therapies failed, but a diagnostic suprascapular nerve block provided complete pain relief and improved motion.
Given this success, fluoroscopy-guided conventional radiofrequency ablation (RFA) of the right suprascapular nerve was performed. Under imaging guidance, a 20-gauge RF needle was placed into the suprascapular notch (Figure 3). Sensory stimulation reproduced her pain, and motor testing showed no motor response, allowing for safe ablation. An 80°C thermal lesion was applied for 90 seconds.
The patient reported immediate and sustained pain relief (0–1/10) with marked mobility improvement, lasting over two years—well beyond the typical 6–12 months seen with pulsed RFA. The authors note that high-temperature RFA is usually avoided to protect motor fibers, but in this patient with minimal pre-procedure shoulder function and absent motor response, the approach was both safe and effective.
The case underscores the importance of patient selection, precise anatomical targeting, and intraoperative stimulation in optimizing outcomes. It also challenges the assumption that only lower RFA temperatures are safe for suprascapular interventions.
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