One dumbed down rhizotomy – 42 degrees centigrade pulse treatment to the suprascapular nerve going to the shoulder can give long term 50% relief of various forms of chronic shoulder pain. The ease of this effect (only one treatment) makes one wonder just how much chronic shoulder pain is a nerve based disorder. Finding in some knee pains and tennis elbows also suggest nerve basis for continued problems.
Pain Pract. 2012 May 4. doi: 10.1111/j.1533-2500.2012.00560.x. [Epub ahead of print]
Pulsed Radiofrequency of Suprascapular Nerve for Chronic Shoulder Pain: A Randomized Double-Blind Active Placebo-Controlled Study.
Gofeld M, Restrepo-Garces CE, Theodore BR, Faclier G.
- 10 cases in lidocaine control group, and 12 in radiofrequency group – average age 70 and 68 respectively
- shoulder pain > 3 months duration,
- adhesive capsulitis, tendinosis, arthritis, rotator cuff or capsular tears
- In either case, the probe was inserted after local, but only the treatment group (turned on by nurse while surgeon out of OR to keep it doulbe blind) got a treatment.
- 120 second, 42 C pulse RF
Comment – Most sink tap water can get to 50 degree centigrade so temperature is not great. This must be just enough to shut off delicate unmyelinated C pain nerve fibers and reset the nerve ganglion pain setting. I have been injecting suprascapular nerves with 1.5 mls of 5% lidocaine which has semineurolytic properties and have noticed, in some cases, remarkable improvement – in one case lasting several months. I suspect neurogenic pain plays a significant role in chronic orthopaedic pains. Some of this will be due to unsuspected neuroirritation.
In the knee, I am impressed by how much pain is medial and associated with pains in the infrapatellar area. Settling the knee with injections can leave the pains medical and below in the area of the saphenous nerve.
Finding the infrapatellar nerve tenderness motivates me to do a saphenous nerve block with benefit.. This again confirms my suspicion that much chronic orthopedic pain is neurogenic.
Tennis elbow is another neuoirritation suspect. An article on Denervation for tennis elbow:
TENNIS ELBOW: TREATMENT OF RESISTANT CASES BY DENERVATION
Journal of Hand Surgery (British and European Volume, 1996) 21B: 4.” 523-533 abstract here
Suggested neuroirritation. Radial nerve irritation could be associated with radial styloid process pain and 1st intermetatarsal space pains.
They suggested selective block to determine which nerve is involved but do not describe well how shots are done: (takes some doiong to orient – 5 is epicondyle and 6 radial head)
Through denervation, they were able to relieve 90% of cases.