SHOULDER TERMINAL SENSORY ARTICULAR NERVES: ECO-GUIDED CRYONEUROLYSIS
B. Violo1, M.L. Violo2 | 1"Nuovo Regina Margherita" Hospital, Rome; 2MD, Rome
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
BACKGROUND
A high percentage of patients suffer from chronic shoulder pain. New anatomical knowledge has encouraged the possibility of permanently blocking the sensory nerves of the shoulder joint capsule while leaving the motility completely intact. This technique can be implemented by cryoneurolysis in cases of arthrosis, arthritis and rotator cuff syndrome.
METHODS
A series of 14 cases (rotator cuff impingement syndrome, arthrosis, frozen shoulder) underwent the ultrasound-guided cryoneurolysis procedure and the response on pain was evaluated. The anatomical points where the sensory branches of the complex innervation of the shoulder are located were treated: zone A (suprascapular nerve: lateral subacromial branch and posterior glenohumeral branch), zone B (axillary nerve), zone C (supracoracoid branch of the lateral pectoral nerve), zone D (suprascapular nerve: medial subacromial branch and superior subscapular nerve). The positioning of the tip of the cryoneurolesion system is represented by the red points in the figure. Multiple strip lesions are made on each zone. The convex probe is used to visualize the posterior anatomical regions and the linear probe to intercept the supracoracoid branch.
RESULTS
Pain was assessed using the NRS scale: before the procedure, after 7 days, 14 days, 1 month, 3 months and 6 months. Expressing a qualitative judgment, a clear improvement in pain symptoms was found in the majority of enrolled patients. Chronic pain not responding to pharmacological therapy and physiotherapy, advanced age with the impossibility of performing surgery were the conditions for making the indication found most frequently.
CONCLUSIONS The cryoneurolysis ablation protocol, which is based on recent knowledge of shoulder neuroanatomy, produces a complete interruption of sensory innervation and significantly relieves chronic shoulder pain. These are few cases, large-scale studies must be performed to define its scientific validation.
Altmetrics
Downloads
Citations
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.