Disclosures: HEIN LINN THANT, MBBS, ECFMG certified: No financial relationships or conflicts of interest

Case Description: A 91-year-old male presented with chronic and progressive worsening of left shoulder pain which severely affected his sleep and ADLs. Physical examination of the left shoulder revealed severely limited ROM in all planes with pain. X-rays reveals extensive degenerative changes of his left glenohumeral joint.He had failed physical therapy, acetaminophen, diclofenac gel, hydrocodone-APA, a left suprascapular nerve block and a left glenohumeral joint injection. He did not want to proceed with surgery.

Setting: Outpatient Musculoskeletal Practice

Patient: 91-year-old male with left shoulder osteoarthritis. Assessment/

Results: One week after PRF, the pain was reduced from a scale of 10/10 to 4/10 with significant improved ADLs. He is not taking any medication for the pain. He can sleep better and for the first time in years, he used his left shoulder vacuuming his house for two hours without pain. The improvement persists as of his 8 week follow up visit.

Discussion: This is the first case report of successful treatment of the recalcitrant pain from shoulder osteoarthritis with PRF to the suprascapular nerve. Conventional radiofrequency ablation (RFA) with temperatures higher than 65°C can result in axonal injuries to the nerve. Conversely, PRF lesioning achieves pain relief by delivering strong electric fields and heat bursts with temperatures less than 42°C. Therefore, using PRF the risk of neural damage and neuritis is minimized.

Conclusion: This case demonstrated that Pulsed RFA can be used effectively for the treatment of recalcitrant shoulder pain secondary to OA. Further studies with large sample of patients are needed to confirm these findings.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treatment-of-recalcitrant-pain-from-shoulder-osteoarthritis-with-pulsedradiofrequency-neuromodulation/