Disclosures: Daniel G. Colon-Conde, MD: Nothing to disclose

Case Description: A 48 y/o male patient with chronic Left MCA stroke with right flaccid hemiplegia presented with post stroke right shoulder subluxation and pain unresponsive to medications, shoulder sling, and physical therapy. A right ultrasound guided suprascapular nerve block with lidocaine/methylprednisolone provided 50% relief for 3 weeks. Striving for a longer-lasting relief, after informed consent, an ultrasound-guided suprascapular nerve pulsed radiofrequency ablation was done as follows: With patient sitting, the right suprascapular notch was identified with ultrasound scan, the needle site marked and skin prepped in aseptic manner. A 54-mm radiofrequency probe with a 5-mm active tip was advanced medio-laterally under ultrasound toward the suprascapular notch. After needle confirmation with sensory (50-100 Hz, 1 ms pulse width up to .5 volt) and motor stimulation (2  Hz,  1ms pulse width, up to 1 V) and after lidocaine infiltration, lesioning was done for 3 minutes at 2Hz, 30 ms pulse width and 42°C.

Setting: Veteran’s Affairs hospital.

Patient: 48 y/o male with right chronic hemiplegic shoulder pain.

Assessment/Results: No peri-procedural complications occurred. Pain improvement from 5/10 to 2/10, using Defense and Veterans Pain Rating Scale, was sustained for 6 weeks, and returned to baseline at 3 months post procedure.

Discussion: Chronic hemiplegic shoulder pain secondary to glenohumeral subluxation occurs in 17% of patients post-stroke, and conservative therapeutic management, such as slings, are not effective once subluxation occurs. Pulsed radiofrequency ablation of suprascapular nerve, which provides 50-70% of shoulder capsule innervation, provides a longer term relief by pain signal neuromodulation, with minimal thermal injury to adjacent tissues. Ultrasound guidance increases accuracy of procedure without radiation exposure. There is scarce evidence in literature regarding pulsed radiofrequency ablation for hemiplegic shoulder pain.

Conclusion: Suprascapular nerve pulsed radiofrequency ablation can be an alternative for management of hemiplegic shoulder pain with subluxation in patients with significant but short lasting response to nerve block.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-suprascapular-nerve-pulsed-radiofrequency-ablation-for-chronic-hemiplegic-shoulder-pain-a-case-report/