Shoulder RFTC

[bubaghanush]

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I have a lady in her '70s who had a great response to super scapular nerve and axillary nerve block under ultrasound. Planning on RFTC of both. Anyone encounter issues with weakness? I have done the rftc for SSN without problems - maybe because my patients are typically elderly and not very functional. I have not done the axillary nerve RFTC. Should I do pulsed instead?

 

[mdo1738]

I’ve got a couple folks I do shoulder RFA on. Fluoro guided suprascapular, axillary and lateral pectoral. I do cooled RFA for this. I do motor and sensory testing prior to burn. No weakness.

 

[BobBarker]

Are you using the mdt cooled or did you get the halyard/kc machine?

 

[mdo1738]

Are you using the mdt cooled or did you get the halyard/kc machine?

I use the MDT cooled

 

[paingate21]

Anyone else performing shoulder RF? Been a handful of new techniques being published including strip lesions with bipolar technique.

If you are performing what technique have you been using?

 

[powermd]

Shoulder terminal sensory articular nerve radiofrequency ablation for nonsurgical refractory shoulder pain due to rotator cuff pathology and osteoarthritis: a technical note

AbstractBackground. Given the high prevalence of chronic shoulder pain and encouraging early results of terminal sensory articular branch radiofrequency ab

academic.oup.com

I find this article to be very helpful, but I still struggle with getting acceptable fluoro placement in people with bad GHJ disease and difficulty with arm positioning. One problem I run in to frequently is inability to avoid motor stim with the posterior glenoid needle placements. As far as I can tell, I'm medial to the joint line, and lateral to the SG notch (very hard to appreciate sometimes). Moving the needles more superior can help, so maybe it's an issue with caudocranial tilt.

The article suggests 15-45 degrees of ipsilateral tilt is needed to get an adequate view. That's a very wide range and hard to tell when you have it right.

I've done 4-5 cases so far with about 50% pain relief each.

 

[cowboydoc]

Shoulder terminal sensory articular nerve radiofrequency ablation for nonsurgical refractory shoulder pain due to rotator cuff pathology and osteoarthritis: a technical note

AbstractBackground. Given the high prevalence of chronic shoulder pain and encouraging early results of terminal sensory articular branch radiofrequency ab

academic.oup.com

I find this article to be very helpful, but I still struggle with getting acceptable fluoro placement in people with bad GHJ disease and difficulty with arm positioning. One problem I run in to frequently is inability to avoid motor stim with the posterior glenoid needle placements. As far as I can tell, I'm medial to the joint line, and lateral to the SG notch (very hard to appreciate sometimes). Moving the needles more superior can help, so maybe it's an issue with caudocranial tilt.

The article suggests 15-45 degrees of ipsilateral tilt is needed to get an adequate view. That's a very wide range and hard to tell when you have it right.

I've done 4-5 cases so far with about 50% pain relief each.

I've been doing shoulder RF using the targets in this article since they originally published in 2019. I hit A and B, occasionally C. You are going to get some activation on motor stim with this placement, but it is a lot less than the previous approach in the suprascapular notch. You can adjust to minimize motor activation, but you'll fire some muscle, even if it is just field stim.

I haven't had any clinically significant weakness for any duration with this or the older approach where you bag most of the suprascapular nerve, though one was transiently weaker with ABduction. N~50.

 

[paingate21]

What type of RFA are you using? Thermal monopolar vs bipolar?

 

[painfree23]

Does anyone have pictures of their fluoro to show?

 

[bubaghanush]

I've been doing shoulder RF using the targets in this article since they originally published in 2019. I hit A and B, occasionally C. You are going to get some activation on motor stim with this placement, but it is a lot less than the previous approach in the suprascapular notch. You can adjust to minimize motor activation, but you'll fire some muscle, even if it is just field stim.

I haven't had any clinically significant weakness for any duration with this or the older approach where you bag most of the suprascapular nerve, though one was transiently weaker with ABduction. N~50.

Wow large N for something like this.

Are you using cooled, traditional, or bipolar? If traditional multiple lesions or one? Thanks

 

[cowboydoc]

I use u/s guided cryo (Iovera) or fluoro guided thermal lesions, usually bipolar with 2 needles at each location.

The cryo is analogous to a monopolar lesion, and I do 3-4 in the poster shoulder to target the suprascapular nerve and 2 to target the axillary. I find the axillary is much easier to see with u/s. I’ll see if I can find some decent fluoro images when I’m at the office. I know my last case was trash because she was fixed in an odd position.