Shoulder RFA Pilot Study

Study Overview
=================
Brief Summary
-----------------
Through this prospective, single-arm cohort pilot study, we plan to explore the safety and effectiveness of Shoulder Radiofrequency Ablation (SRFA) in patients with non-operative chronic shoulder pain due to shoulder osteoarthritis with or without rotator cuff tears.

Detailed Description
-----------------
This will be one of the first collaborative prospective, single-arm cohort using a standardized selection protocol and comprehensive SRFA protocol to treat chronic, refractory shoulder pain due radiographically confirmed glenohumeral joint OA with or without RTC pain, in patients deemed non-surgical candidates by a board-certified orthopedic shoulder surgeon. Upon completing the proposed research, we expect our contribution to fill the knowledge gap on whether SRFA is a potentially viable treatment option for this patient population. This contribution is expected to be substantial because SRFA may be a safe and effective treatment option for many people suffering shoulder pain and debility who are sub-optimal surgical candidates and have historically either been undertreated to have less than ideal treatments options, including opioid-based pain management in particular.

Official Title
-----------------
The Effectiveness of Shoulder Terminal Sensory Articular Nerve Radiofrequency Ablation for Non-surgical Refractory Shoulder Pain Due to Rotator Cuff Pathology and Osteoarthritis; A Prospective Pilot Study

Conditions
-----------------
Shoulder Pain, Rotator Cuff Injuries

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: ≥50 years old capable of understanding and providing consent in English, and capable of complying with the outcome instruments used ≥3 months of shoulder pain refractory to conventional treatment (i.e., physiotherapy, medication, steroid injections) Persistent shoulder pain ≥ 4/10 in intensity on a 7-day average Shoulder pain refractory to conventional treatment (i.e., physical therapy, oral analgesics, steroid injection) Prior consultation with a board-certified orthopedic shoulder surgeon, deemed a non-surgical candidate for the primary diagnosis of glenohumeral joint pain +/- rotator cuff pain ≥80% pain relief for at least 30 minutes after a single fluoroscopically-guided block of the sensory branches of the SN, AN, and LPN with 0.5 mL of lidocaine at each nerve Scheduled for procedure of interest Exclusion Criteria: Infection Allergy to any medication needed to participate in this study Previous partial/total/reverse shoulder arthroplasty. Participants with a history of RTC repair will not be excluded. Neurologic disorders including radiculopathy, connective tissue/inflammatory joint disease/widespread soft tissue pain disorder Severe, uncontrolled psychiatric disorder requiring hospitalization within 6 months Intraarticular or subacromial injection to the study shoulder within 3 months before C-SRFA Uncontrolled bleeding diathesis Pregnancy Pacemaker, neurostimulator, or other implanted device potentially sensitive to RF energy Active Worker's compensation claim, litigation, or other possible reason for secondary gain. Prior shoulder radiofrequency ablation Daily opioid use

Ages Eligible for Study
-----------------
Minimum Age: 50 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numerical Rating Scale (NRS) at 1, 3, 6 and 12 months after the SRFA | Pain reduction will be measured by calculating the proportion of participants who experienced ≥50% reduction of their shoulder pain on the Numerical Rating Scale (NRS) at 1, 3, 6 and 12 months after the SRFA. | 1, 3, 6 and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Myotomal strength at 1, 3, 6 and 12 months after SRFA | We will calculate the proportion of participants who experience a minimal clinically important difference (MCID) in shoulder abduction, elbow flexion, wrist extension, elbow extension and hand grip measured by dynamometer after SRFA. We will do this by calculating the proportion of participants who experience ≥20% change (MCID) in myotomal strength at 1, 3, 6 and 12 months after SRFA. | 1, 3, 6 and 12 months after SRFA | 
| American Shoulder and Elbow Surgeons Score (ASES) at 1,3, 6 and 12 months after SRFA | We will use the validated American Shoulder and Elbow Surgeons Score (ASES) questionnaire to calculate the proportion of participants who experience an MCID on ASES (defined as a score of ≥ 7) at 1,3, 6 and 12 months after SRFA. | 1, 3, 6 and 12 months after SRFA | 
| Patient Global Impression of Change (PGIC) at 1,3, 6 and 12 months after SRFA | We will use the validated Patient Global Impression of Change (PGIC) questionnaire to calculate the proportion of participants who experience an MCID on PGIC (defined as a score of ≥ 5) at 1,3, 6 and 12 months after SRFA. | 1, 3, 6 and 12 months after SRFA | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
shoulder radiofrequency ablation