Anesthesiology | Interventional Pain Medicine
Assistant Professor — University of Toronto
Interventional Pain Physician — Afiya Spine & Pain Institute
Staff Anesthesiologist — Scarborough Health Network
Shoulder pulsed radiofrequency neuromodulation is a procedure used to reduce pain signals from selected nerves around the shoulder.
Pulsed radiofrequency uses brief pulses of radiofrequency energy near a nerve. Unlike traditional radiofrequency ablation, it is not intended to burn or destroy the nerve. The goal is to calm or modulate the pain signal.
This is not a cure for the underlying shoulder problem. It does not repair a rotator cuff tear, reverse arthritis, or remove scar tissue from a frozen shoulder. It is intended to reduce pain enough that you can move the shoulder more comfortably and participate more actively in physiotherapy.
The usual targets are the suprascapular nerve and the axillary nerve.
The suprascapular nerve supplies a large portion of sensation from the shoulder joint and also supplies the supraspinatus and infraspinatus muscles. The axillary nerve contributes to sensation around the shoulder and supplies the deltoid and teres minor muscles.
Because these nerves also have motor functions, pulsed radiofrequency is used as a neuromodulation technique rather than a destructive nerve lesion. The goal is pain reduction, not loss of shoulder strength.
The shoulder joint also receives nerve supply from other branches, including the lateral pectoral nerve. This is one reason results vary from person to person and why the procedure may not treat every source of shoulder pain.
A shoulder joint injection is often performed at the same visit. The exact injection depends on your pain pattern and examination.
The glenohumeral joint is the main ball-and-socket joint of the shoulder. A glenohumeral joint injection usually contains corticosteroid medication, often with local anesthetic. Steroid medication is intended to reduce inflammation and pain inside the joint. This can help create a window where physiotherapy, stretching, and strengthening are more tolerable.
An acromioclavicular joint injection may be performed instead of a glenohumeral joint injection, or in addition to it, depending on your pain pattern. The acromioclavicular joint is the small joint at the top of the shoulder where the collarbone meets the shoulder blade.
For some patients with adhesive capsulitis, also called frozen shoulder, hydrodilation of the glenohumeral joint may also be performed. This involves injecting fluid into the joint to stretch the tight shoulder capsule, usually along with local anesthetic and steroid medication.
The goal of adding joint injection is not to cure the shoulder problem. It is to reduce pain enough that you can participate more actively in rehabilitation.
This procedure may be considered for chronic shoulder pain that remains significant despite medication, physiotherapy, activity modification, previous injections, or time.
Common situations include glenohumeral arthritis, adhesive capsulitis or frozen shoulder, rotator cuff disease, persistent pain after injury, or persistent pain after surgery when further surgery is not planned or not appropriate.
Shoulder pain may be felt in the front, side, or back of the shoulder, and may travel toward the upper arm. Pain may be worse with reaching overhead, reaching behind the back, lifting, dressing, sleeping on the shoulder, or physiotherapy exercises.
The main goal is meaningful pain relief so you can participate more actively in physiotherapy. Better pain control may make it easier to work on range of motion, stretching, strengthening, posture, and gradual return to function.
Tell us if you have shoulder replacement surgery booked within the next 6 months. We generally do not want to inject steroid into the shoulder joint if this could delay your surgery.
Tell us if you already have a shoulder replacement, have had recent shoulder surgery, have an active infection, are taking antibiotics, or have had a recent major change in your health.
If you already have a shoulder replacement and have persistent pain, your surgeon should assess the shoulder replacement before nerve procedures are considered. Problems such as infection, loosening, fracture, instability, or other surgical complications need to be ruled out first.
You usually do not need to fast for this procedure unless you are specifically told otherwise.
The procedure is usually quick, but the full visit includes check-in, assessment, preparation, and recovery.
Most patients should expect the full appointment to take approximately 60 to 90 minutes, although this can vary depending on clinic flow that day.
We use fluoroscopy rather than ultrasound for this procedure in our clinic.
Most patients describe:
Local anesthetic is used to reduce discomfort. The procedure is usually brief.
You may move the shoulder gently and do normal light activity after the procedure. Avoid unusually strenuous activity for the rest of the day.
Do not drive until any numbness, weakness, heaviness, lightheadedness, or altered sensation has fully resolved.
Do not judge the procedure only by the first few hours afterward. The steroid effect can take days, and the pulsed radiofrequency effect may take longer.
Once pain begins to improve, the most important next step is to use that window to participate in physiotherapy, stretching, range-of-motion work, and strengthening as directed.
Some patients notice improvement within days, especially from the joint injection. For others, the benefit from pulsed radiofrequency may take 2 to 6 weeks to become clearer.
It is common to have temporary soreness or a pain flare before the benefit becomes clear.
The amount and duration of relief varies from person to person. Some patients have substantial relief, some have partial relief, and some do not improve.
When it works, relief often lasts several months. A reasonable expectation is around 6 months of benefit, although some patients have shorter relief and some have longer relief.
The procedure is not curative. The goal is to reduce pain enough to allow more effective physiotherapy and shoulder rehabilitation.
The next step depends on how much relief you have after the procedure and how well you are able to participate in rehabilitation.
If your shoulder pain improves significantly, we may continue to monitor your response and focus on physiotherapy, range-of-motion work, stretching, strengthening, and gradual return to activity.
If your pain returns after a period of meaningful relief, repeat treatment may be considered depending on your response, goals, and overall treatment plan.
If your pain does not improve, or only partially improves, we would usually reassess. This may mean reviewing imaging, reconsidering the pain source, considering whether the acromioclavicular joint is contributing, or discussing whether orthopedic or surgical review is needed.
Some patients have more than one source of shoulder pain. Shoulder pulsed radiofrequency neuromodulation may help nerve-mediated shoulder pain, but it may not explain or treat all of your symptoms.
Keep the needle sites dry for 24 hours. Remove bandages after 24 hours.
If you develop a pain flare, this usually improves with time. Ice packs and over-the-counter pain relievers may help if you are allowed to use them. Avoid unusually strenuous activity for the rest of the day.
Shoulder pulsed radiofrequency neuromodulation is generally a low-risk procedure when performed with image guidance and sterile technique, but it is performed near nerves, blood vessels, and the chest wall.
The most common issues are temporary soreness, bruising, lightheadedness, temporary increase in pain, or temporary irritated-nerve discomfort.
Uncommon risks include bleeding, infection, allergic reaction, medication entering a blood vessel, temporary numbness or weakness, skin irritation, or worsening pain.
Pneumothorax, or air around the lung, is a rare but important risk because parts of the shoulder region are near the chest wall and lung. Fluoroscopy and careful needle positioning are used to reduce this risk.
Steroid injection into the shoulder before shoulder replacement surgery may delay surgery because of infection-risk concerns. Tell us if you have shoulder replacement surgery booked within the next 6 months.
Seek medical attention if you develop fever, worsening redness or swelling at the needle site, drainage from the needle site, severe worsening pain, new arm weakness that does not settle, chest pain, shortness of breath, or difficulty breathing.
The procedure itself, including the clinic visit and use of X-ray guidance, is covered by OHIP.
OHIP does not cover the cost of medications used or prescribed, such as local anesthetic, steroid medication, contrast dye, or other medications. These costs may be covered by private insurance.
The medication cost is usually in the range of $25 to $100, depending on the extensiveness of the procedure, but this may vary.
Unless you are told otherwise, you may usually take your regular medications. Blood thinners require separate review.
Tell us before the procedure if you take blood thinners or antiplatelet medications. Do not stop them on your own. We will give you specific instructions based on the medication and your medical history.
Tell us before the procedure if you have ever had an allergy or serious reaction to contrast dye, local anesthetic, steroid medication, or antiseptic skin-cleaning solution.
Tell us if you have diabetes, an active infection, are taking antibiotics, are pregnant or may be pregnant, have shoulder replacement surgery booked within the next 6 months, or have had a recent major change in your health.
Afiya Spine & Pain Institute
301 - 15 Wellesley St W, Toronto, ON M4Y 1G1
Phone: 416-413-7999 | E-Fax: 416-641-4520
For questions or concerns after your procedure, contact the clinic.