Suprascapular nerve radiofrequency ablation · Dr Joe Coory

Type: Percutaneous, image-guided
Anaesthesia: Local anaesthetic ± light sedation
Day surgery: Yes — walk-in, walk-out
Sling: None
Pain relief onset: Over 2–4 weeks
Duration of relief: 3–12 months, repeatable

When the procedure is indicated.

The shoulder joint is innervated mainly by the suprascapular nerve, which carries 70–100% of the pain signal from the glenohumeral joint, the AC joint, and the subacromial space. Interrupting that signal — without cutting it — can produce meaningful pain relief without changing the underlying joint disease.

It is most useful for:

Advanced shoulder osteoarthritis in patients who are not candidates for shoulder replacement — for example, due to age, frailty or medical comorbidity.
Massive irreparable rotator cuff disease and cuff tear arthropathy in patients who want to defer reverse shoulder replacement, or in whom replacement is not appropriate.
Patients who wish to defer shoulder replacement — for example, those who want to delay the operation by a season or a year while continuing to work.
Post-arthroplasty pain — selected cases of persistent pain after shoulder replacement where the implant and infection workup are clean.

It is not a substitute for shoulder replacement in a patient who is fit for surgery and who would benefit from a definitive joint operation. It treats the pain signal; it does not treat the joint.

How it is performed.

The procedure is a day case. You walk in, walk out, and drive home the same afternoon.

Under local anaesthetic, with light sedation if you prefer, a fine radiofrequency needle is positioned at the suprascapular notch — the bony channel where the suprascapular nerve runs under the transverse scapular ligament. Needle placement is guided by ultrasound or fluoroscopy — this is what makes the procedure safe and accurate. In selected patients a second target is added at the spinoglenoid notch to capture the posterior articular branch that supplies the back of the joint.

Before any energy is applied, the needle position is confirmed twice:

Sensory stimulation — a light electrical pulse reproduces a tingling feeling in the shoulder, confirming the needle is on the sensory branch.
Motor stimulation — a stronger pulse confirms the needle is not too close to the motor branches that drive supraspinatus and infraspinatus, before lesioning begins.

Radiofrequency energy is then delivered. Two techniques are available:

Pulsed radiofrequency (PRF) — the default for most patients. Short, pulsed bursts of energy at 42 °C modulate the nerve without destroying it. No motor weakness; relief lasts 3–9 months on average; safe to repeat.
Conventional (thermal) radiofrequency — sustained energy at approximately 80 °C, applied for 60–90 seconds. Creates a controlled lesion of the sensory fibres; relief tends to last longer (6–12 months), but with a small risk of subtle motor effect — usually clinically silent in shoulders with established cuff disease.

The whole procedure takes 30–45 minutes.

What to expect after the procedure.

Day 0

Mild ache at the needle site. Simple analgesia is usually enough.
Drive home; resume normal activities the same day.

Week 1–2

Soreness settles within 1–3 days.
Pain relief onset is gradual — not instant. Most patients notice improvement around days 7–14.
Continue your usual physiotherapy and home exercise program.

Week 3–4

Maximum pain relief is typically reached.
Patients often reduce or stop simple analgesia at this point.

Month 3–12

Most patients enjoy meaningful pain relief for 3–12 months.
When the pain returns, the procedure can be repeated.

How it sits in the wider shoulder-replacement pathway.

Suprascapular nerve ablation is not in competition with shoulder replacement — it sits alongside it. For a patient with severe glenohumeral arthritis who is medically well and surgically fit, an anatomic or reverse total shoulder replacement remains the definitive operation — with Mako haptic-guided robotic burring available in selected reverse cases. For a patient who is not surgically fit, or who wants more time before committing to a replacement, the suprascapular block-and-ablate pathway is a meaningful intermediate option.

The decision is always individualised. Dr Coory will review your imaging, your function goals, your medical context, and the result of any diagnostic block before recommending one pathway over another.

Recovery guidance

Your physiotherapist receives specific post-operative instructions on the day of surgery. View the recovery roadmap for the full rehabilitation journey, or visit For Physiotherapists for protocol requests.

Frequently asked questions.

Is suprascapular nerve ablation an alternative to shoulder replacement?

It is not a replacement for shoulder replacement. It is a pain-management option, most useful for patients who are not surgical candidates because of age, frailty, or medical comorbidity — and for patients who wish to defer shoulder replacement. The joint disease is unchanged; the operation modifies the pain signal travelling from the joint to the brain.

How long does the pain relief last?

Most patients experience meaningful relief for 3 to 12 months. The suprascapular nerve regenerates over time and the pain typically returns gradually — at which point the procedure can be repeated.

Is it painful?

The needle insertion is uncomfortable but brief. Local anaesthetic is given before the RF energy is applied. Most patients describe the procedure as more tolerable than the dental work they have had.

Will my arm be weak afterwards?

Pulsed RF (the more common technique) does not cause motor weakness. Conventional thermal RFA can cause transient subtle weakness of supraspinatus and infraspinatus; in shoulders with established cuff disease this is usually clinically silent. Motor testing during the procedure helps avoid clinically meaningful weakness.

Do I need a diagnostic block first?

In many patients yes. A diagnostic suprascapular nerve block with local anaesthetic confirms that the nerve is carrying the pain signal. A positive diagnostic block selects patients most likely to benefit from RFA.

Can the procedure be repeated?

Yes. The suprascapular nerve regenerates over months. Many patients return for repeat lesioning every 6 to 12 months. There is no fixed limit on the number of times the procedure can be repeated.

Is it covered by Medicare and private health insurance?

Item numbers exist on the MBS for image-guided radiofrequency neurotomy. Out-of-pocket costs and private health rebate vary with hospital and insurer. The rooms team will provide a written estimate before the procedure is booked.

References.

Liliang PC, et al. Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain. Clin J Pain. 2009;25(6):477–481.
Eyigor C, Eyigor S, Korkmaz OK, et al. Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder. Pain Pract. 2010;10(3):209–217.
Korkmaz OK, Capaci K, Eyigor C, et al. Pulsed radiofrequency versus conventional transcutaneous electrical nerve stimulation in painful shoulder. Clin Rehabil. 2010;24(11):1000–1008.
Wu YT, Ho CW, Chen YL, et al. Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis. Anesth Analg. 2014;119(3):686–692.
Coory JA, Parr AF, Wilkinson MP, Gupta A. Efficacy of suprascapular nerve block compared with subacromial injection: a randomized controlled trial in patients with rotator cuff tears. J Shoulder Elbow Surg. 2019;28(3):430–436. PMID 30651194.

Suprascapular nerve radiofrequency ablation.