Ultrasound guided pulsed radiofrequency ablation of axillary nerve
for quadrilateral space syndrome. Case report

Akhil Bhalla; Sanjog Mekewar

doi:10.63231/2595-0118.20250030-en

Case Report

Ultrasound guided pulsed radiofrequency ablation of axillary nerve for quadrilateral space syndrome. Case report

Ablação por radiofrequência pulsada guiada por ultrassom do nervo axilar para síndrome do espaço quadrilateral. Relato de caso

Akhil Bhalla; Sanjog Mekewar

http://dx.doi.org/10.63231/2595-0118.20250030-en BrJP, vol.8, e20250030, 2025

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Abstract

BACKGROUND AND OBJECTIVES: Pulsed radiofrequency (PRF) neuromodulation of the axillary nerve offers a promising alternative to surgical decompression for managing Quadrilateral Space Syndrome (QSS), a rare but debilitating cause of chronic shoulder pain. QSS, characterized by axillary nerve and posterior circumflex humeral artery compression, presents with nonspecific symptoms, complicating diagnosis.

CASE REPORT: This case report details a 57-year-old male with refractory QSS who achieved significant and sustained pain relief following ultrasound-guided PRF neuromodulation. Initial diagnostic axillary nerve block confirmed QSS, but pain recurred after temporary relief. PRF neuromodulation provided immediate pain relief, allowing early mobilization and sustained symptom resolution over six months. This minimally invasive technique was performed under ultrasound guidance, avoiding vascular complications and facilitating precise targeting of the axillary nerve.

CONCLUSION: The report underscores PRF’s potential as a safe, effective treatment modality for refractory QSS, offering a viable alternative to invasive surgery while enabling improved patient compliance and outcomes.

Keywords

Interventional ultrasound; Nerve compression syndromes; Pulsed radiofrequency treatment; Radiofrequency ablation; Shoulder pain; Shoulder impingement syndrome; Ultrasonography

Resumo

JUSTIFICATIVA E OBJETIVOS: A neuromodulação por radiofrequência pulsada (PRF) do nervo axilar oferece uma alternativa promissora à descompressão cirúrgica para o tratamento da Síndrome do Espaço Quadrilateral (QSS), uma causa rara, mas debilitante, de dor crônica no ombro. A QSS, caracterizada por compressão do nervo axilar e da artéria circunflexa posterior do úmero, apresenta sintomas inespecíficos, dificultando o diagnóstico.

RELATO DO CASO: Paciente do sexo masculino, 57 anos com QSS refratária que obteve alívio significativo e sustentado da dor após neuromodulação PRF guiada por ultrassom. O bloqueio diagnóstico inicial do nervo axilar confirmou QSS, mas a dor recorreu após alívio temporário. A neuromodulação PRF proporcionou alívio imediato da dor, permitindo a mobilização precoce e a resolução sustentada dos sintomas ao longo de seis meses. Essa técnica minimamente invasiva foi realizada sob orientação ultrassonográfica, evitando complicações vasculares e facilitando o direcionamento preciso do nervo axilar.

CONCLUSÃO: O caso sublinha o potencial do PRF como uma modalidade de tratamento segura e eficaz para QSS refratária, oferecendo uma alternativa viável à cirurgia invasiva, ao mesmo tempo que permite melhor adesão e resultados do paciente.

Palavras-chave

Ablação por radiofrequência; Dor de ombro; Síndromes de compressão nervosa; Tratamento por radiofrequência pulsada; Síndrome do impacto do ombro; Ultrassonografia de intervenção

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Submitted date:
02/11/2024

Accepted date:
04/23/2025