281: Pulsed Radio-frequency Application for Shoulder Adhesive Capsulitis. A Revisited Treatment Modality.

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Developing methodology/technology, Non-pharmacological treatments, Treatment/management

Background and Aims: Pulsed radio-frequency (PRF) is non-destructive, safe neuromodulation modality for neuropathic and non-neuropathic pain. Mechanisms of action include: 1-disruption of impulse transmission, 2-neuronal structure modification, 3-neuronal excitation phenomenon, 4-immune-modulatory effect.

Intra-articular PRF targets the peri-capsular sensory nerve endings. This concept depends on bone insulating properties with reduced dilutional effect and deflected RF waves with better therapeutic effect.

Adhesive capsulitis is characterized by shoulder pain with global limitation of movement. Literature review showed neuroanatomical distribution of sensory receptors within the joint complex. Nociceptors are identified in the superior quadrant of the joint including subacromial bursa, anterior glenohumeral capsule, coracoacromial and acromioclavicular ligaments.

Methods: Thirty patients (aged 30–65 years) with primary adhesive capsulitis refractive to four weeks of conservative treatment were recruited from a tertiary hospital. Following informed consent, baseline Visual Analogue Scale (VAS), Range of Motion (ROM), and Shoulder Pain and Disability Index (SPADI) scores were recorded.

Under ultrasound guidance, patients received a posterior-approach glenohumeral injection of 5 ml bupivacaine (0.125%). Subsequently, intra-articular PRF was delivered via a 20-gauge, 10-cm curved needle with a 10-mm active tip for two 120-second cycles. Clinical outcomes, including ROM and resting/movement VAS and SPADI scores, were reassessed at weeks 1, 2, 4, and 8 post-intervention.

Results: During follow-up period, repeated measures analysis showed significant longitudinal improvements across all clinical parameters. Resting pain (VASr) and movement pain (VASm) decreased significantly compared to pre-intervention values starting at discharge (p=.008 and p<.001, respectively) and continuing through week 8 (p<.001 for both). Significant functional improvements in pain component of SPADI (p=.008), disability component of SPADI (p=.022), and ROM (p=.002) emerged by the second week and persisted thereafter. Notably, there were no significant improvements observed in any parameter during the first week post-intervention.

Conclusions: Intra-articular pulsed radiofrequency (PRF) is a highly effective non-operative intervention for primary adhesive capsulitis, offering significant long-term improvements in pain and joint mobility. Intra-articular PRF therapeutic response is progressive, beginning significantly from the second week post-intervention. PRF demonstrates substantial long-term efficacy, particularly in reducing resting pain (VASr) by the eighth week. This clinical benefit is likely driven by the immunomodulatory and neuromodulatory effects of PRF on the C-fiber nerve endings within the joint capsule. Consequently, ultrasound-guided intra-articular PRF provides a durable and potent treatment option for achieving sustained baseline pain reduction and functional recovery in cases resistant to conservative treatment.

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Presenting Author: Ahmed Foula, MD
Submitting Author: Ahmed Foula

Senior Author: Ahmed Foula, MD

IASP 2026 Global Year theme of Neuropathic Pain: No

• Adel Ibrahim Hozein: MD, PhD - Medical Research Institute - Alexandria University
• Manal Ali Ahmed: MSc - Alexandria University