Shoulder Denervation for Post Mastectomy Irradiation Shoulder Pain

Shoulder Denervation as Management of Post Mastectomy Irradiation Shoulder Pain: Randomized Control Trial

Breast cancer is the second most common cancer world-wide following lung cancer. It afflicts about 1.7 million patients annually, of which 60% mandate surgery of the breast and/or the axilla, and nearly 20-50% of them may develop post mastectomy pain syndrome .

After breast cancer surgery, between 6% and 86% of people may develop tight bands of fibrous tissue under their skin, known as axillary web syndrome. These bands can cause pain in the shoulder area by trying to raise or extend the arm. Shoulder pain is a common side effect of breast cancer surgery and treatment.

Various medical and interventional procedures have been tried for treating postmastectomy shoulder pain, with varying efficacy . Among the interventional procedures that may have a role for treatment.

Innervation of the glenohumeral joint (GHJ) can be divided into anterior and posterior innervation from articular branches of the suprascapular nerve (SN):C5 &6 (posterior-lateral), axillary nerve (AN):C5 &6 (anterior-lateral, inferior, and posteriorlateral), and lateral pectoral nerve (LPN): C5 &6 (anterior superior)

The investigators hypothesize that thermal RF (radiofrequency) of shoulder individual nerves is efficacious for the management of post-mastectomy shoulder pain.

Inclusion Criteria:

1. Age (18-65) Years.
2. ASA physical status (II- III).
3. Patients with post mastectomy irradiation shoulder pain.
4. Body mass index (BMI): (20-40) kg/m2.

Exclusion Criteria:

1. Patient refusal.
2. Known sensitivity or contraindication to drugs used in the study.
3. Pregnancy.
4. Recent myocardial infarction.
5. Hemodynamically unstable.
6. Local and systemic sepsis.
7. Psychiatric illness.