J Korean Neurosurg Soc.  2024 Sep;67(5):568-577. 10.3340/jkns.2023.0204.

Pulsed Radiofrequency Neuromodulation for Post-Stroke Shoulder Pain in Patients with Hemorrhagic Stroke

• Na D
• Park MS
• Choi HJ
• Yang J
• Cho YJ
• Jeon JP

• KMID: 2558682
• DOI: http://doi.org/10.3340/jkns.2023.0204

Abstract

Objective
: Post-stroke shoulder pain (PSSP) is a common complication that limits the range of motion (ROM) of the shoulder, the patient’s rehabilitation and in turn, affects the patients’ quality of life (QoL). Several treatment modalities such as sling, positioning, strapping, functional electrical stimulation, and nerve block have been suggested in literatures, however none of the treatments had long-term effects for PSSP. In this study, the authors evaluated clinical efficacy of pulsed radiofrequency (PRF) neuromodulation on the suprascapular nerve for PSSP, and suggested it as a potential treatment with long-term effect.
Methods
: This retrospective case series was conducted at a single center, a private practice institution. From 2013 to 2021, 13 patients with PSSP underwent PRF neuromodulation of the suprascapular nerve. The primary outcome measure was the Visual analog scale (VAS) score. The secondary outcome measurements included the shoulder ROM, Disability assessment scale (DAS), modified Ashworth scale, modified Rankin scale (mRS), and EuroQol-5 dimension-3L questionnaire (EQ-5D-3L) scores. These parameters were evaluated before PRF modulation, immediately after PRF modulation, and every 3 months until the final follow-up visit.
Results
: Six men and seven women were enrolled, and all patients were followed-up for a minimum of 12 months. The mean VAS score was 7.07 points before PRF neuromodulation and 2.38 points immediately post-procedure. Shoulder ROM for abduction and flexion, DAS for pain, mRS, and EQ-5D-3L demonstrated marked improvement. No complications were reported.
Conclusion
: PRF neuromodulation of the suprascapular nerve is an effective modality in patients with PSSP, and has long-term effect of pain relief, improvement of QoL.

Keyword

Stroke; Shoulder pain; Chronic pain; Pain management; Neuromodulation; Pulsed radiofrequency

Figure

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  Fig. 1. A : Axial brain computer tomography images show acute subarachnoid hemorrhage in the posterior fossa, mainly perimedullary cistern and cisterna magna (black arrows). B : On the left vertebral 3-dimensional digital subtraction angiography and cerebral angiography, the left posterior inferior cerebellar artery (arrowheads) and anterior inferior cerebellar artery show severe stenosis at the proximal portion. Moreover, a small aneurysm is observed in the left lateral spinal artery (LSA) (arrows). C : Suboccipital craniectomy was performed to access the lateral spinal artery aneurysm (arrows) and clipping was performed. D : On the 14th postoperative day, cerebral angiography shows complete occlusion of treated LSA aneurysm.

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  Fig. 2. A : Axial brain computer tomography image shows acute subarachnoid hemorrhage in the cisterna magna and perimedullary cistern. B : On the left vertebral 3-dimensional digital subtraction angiography and cerebral angiography, an aneurysm is observed in the left lateral spinal artery (LSA) (arrows), forming anastomosis with left posterior inferior cerebellar artery (PICA) (arrowhead). C : After suboccipital craniectomy, the left LSA aneurysm (arrow) is clipped. PICA (arrowhead). D : On the follow-up cerebral angiography, no aneurysm can be detected.

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  Fig. 3. A : Axial computer tomography (CT) angiography images of the brain show acute subarachnoid hemorrhage in the prepontine and perimedullary cisterns. B : On right vertebral artery angiography, no visible aneurysm is observed. The posterior inferior cerebellar artery shows hypoplastic, and the anterior inferior cerebellar artery has dominancy. C : Axial maximum intensity projection image of brain CT angiography shows a small aneurysm in the right lateral spinal artery (arrow).

Reference

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