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

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

HIGHLIGHTS

First documented use of pulsed radiofrequency (PRF) for Quadrilateral Space Syndrome (QSS): This case report introduces PRF neuromodulation of the axillary nerve as a novel, minimally invasive treatment for refractory QSS, offering an alternative to surgical decompression

Pulsed radiofrequency neuromodulation provided long-term pain relief in refractory QSS: PRF was successfully applied to the axillary nerve in a patient with chronic, treatment-resistant QSS, resulting in complete symptom resolution at a 6-month follow-up without the need for surgical decompression

MSK Ultrasound surpassed MRI in detecting clinically relevant features of QSS: While MRI findings were unremarkable, MSK ultrasound allowed real-time visualization of the quadrilateral space and neurovascular structures, enabling both diagnosis and treatment planning - demonstrating its superiority in functional assessment over static imaging