Radiofrequency of suprascapular nerve as an analgesic strategy for chronic pain management. Systematic review and meta-analysis | Revista Española de Anestesiología y Reanimación (English Edition)

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Sebastián Infante, N. Blackburn, J. Felipe Vargas" "autores" => array:3 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Sebastián Infante" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "N." "apellidos" => "Blackburn" "email" => array:1 [ 0 => "nataliablackburnvillota@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Felipe Vargas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departament of Anaesthesiology and Pain Management, Hospital Pablo Tobón Uribe, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anaesthesiologist, Research Fellow at the Clinica de Dolor y Cuidados Paliativos, Universidad el Bosque, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Radiofrecuencia del nervio supraescapular como estrategia analgésica para el dolor crónico de hombro. Revisión sistemática y metaanálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1252 "Ancho" => 2925 "Tamanyo" => 378187 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Forest Plot VAS 3 months." ] ] ] "textoCompleto" => "<elsevierMultimedia ident="tb1005"></elsevierMultimedia>IntroductionChronic shoulder pain has a prevalence of between 18% and 26% in the general population.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The burden of this type of pain and the resulting disability affect not only the patient’s quality of life but also their productivity, depending on the age of presentation.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The shoulder is innervated by the suprascapular, axillary, lateral pectoral and subscapular nerves. The suprascapular nerve is traditionally considered responsible for most of the sensory innervation of the intra- and extra-articular structures of the shoulder. The functionality of this complex joint is dependent on several different anatomical structures, and it can be difficult to treat each one of these in patients with chronic pain.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>The suprascapular nerve has been the target of successful analgesic strategies when acute postoperative shoulder pain is secondary to manipulation of the joint, muscles and tendons. It has also been a target of nerve block techniques, pulsed radiofrequency, and radiofrequency ablation in patients with chronic shoulder pain.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>Evidence suggests that pulsed radiofrequency modifies the capacity of nociceptors to transduce and transmit pain, while radiofrequency ablation produces a heat injury that disrupts the transmission of pain signals from the nerve. Both techniques inhibit nociception, thereby reducing the intensity of perceived pain.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Several systematic reviews have evaluated the effectiveness of these techniques in shoulder pain; however, due to methodological shortcomings, they have been unable to show the benefit of radiofrequency in chronic shoulder pain with any degree of certainty.<a class="elsevierStyleCrossRefs" href="#bib0025">5,7–10</a>We, therefore, formulated the following research question: In patients with chronic shoulder pain, does radiofrequency treatment of the suprascapular nerve compared to other analgesic strategies reduce the intensity of pain? To explore this question, we performed a systematic review to combine and analyse findings on the analgesic effect of radiofrequency treatment of the suprascapular nerve in chronic shoulder pain.MethodologyWe performed a systematic review of randomized clinical trials in patients aged over 18 years with chronic shoulder pain lasting more than 3 months caused by an injury or a degenerative condition, whose treatment included image-guided pulsed radiofrequency or radiofrequency ablation of the suprascapular nerve.Accepted comparators were conventional medical management, rehabilitation or physical therapy, placebo, sham procedures, intra- or peri-articular steroid injection, suprascapular nerve block, and surgical treatment.The accepted primary outcome measure was pain intensity measured on a visual analogue or verbal numerical scale. The secondary outcome measures were functionality measured on the SPADI (Shoulder Pain and Disability Index) scale and RFS-related adverse events.Studies comparing pulsed radiofrequency and radiofrequency ablation and those not written in English or Spanish were excluded. There was no limit to the publication date.The literature search was performed using MeSH terms, Emtree terms, and keywords, as appropriate, in the Medline, Embase and Central databases. We searched the citations of the reports included in the analysis to identify other reports that were not found in the databases.Two reviewers evaluated the titles and abstracts of the reports retrieved to eliminate irrelevant or duplicate articles. Any reports that lacked an abstract or had a title that did not clarify the inclusion or exclusion criteria were excluded in the following phase. The full text of relevant records was obtained; records referring to similar reports were grouped, while records referring to the same report (duplicates) were excluded. Two independent reviewers read the full texts, and those that met the criteria were included in the review. The reasons for excluding reports were specified.Pain intensity was assessed using a visual analogue scale and functionality was assessed using the SPADI scale. If the visual analogue scale ranged from 0 to 10 0, it was divided by 10 to reduce it to 0 to 10 in order to unify the outcomes of studies that include this measurement with those using a 0–10 visual analogue or verbal numerical scale. Results reported as median or range were converted to mean and standard deviation according to the method described by Hozo et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Therefore, all the results of our systematic review are presented as standardized mean difference and confidence intervals.The occurrence of adverse events is described in terms of absolute and relative frequency, and was analysed in terms of relative risk and confidence intervals.Results were analysed according to follow-up time: 1 week, 1 month, 3 months, 6 months and 1 year. Summary statistics were analysed using RevMan 5.0 and a random effects model. An I2 greater than 50% indicated significant heterogeneity.ResultsThe process of screening and selecting records is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> (PRISMA). A total of 3,030 studies were found, of which 469 were duplicates. We excluded 2,329 records that did not address the population or intervention of interest in their title or abstract, or were not prospective studies. Of the resulting 232 studies, 215 were excluded because they did meet the inclusion criteria for type of study, population or intervention. One study was written in Chinese, and it was impossible to obtain the full text (no response was obtained from the authors). Sixteen full-text studies were analysed: 6 were subsequently excluded because they were not clinical trials, and 2 were excluded because they involved a transcutaneous intervention unrelated to the suprascapular nerve. A total of 8 studies were finally included in the analysis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The included studies analysed various shoulder pathologies, mostly extra-articular, that were treated by pulsed radiofrequency and one or more comparators.The risk of bias analysis for the pain intensity outcome measure showed that only 1 study (Yan 2019<a class="elsevierStyleCrossRef" href="#bib0050">10</a>) had a low probability of bias. Although the other studies used an appropriate randomization method, they did not explain the process of allocation concealment, and neither the study subjects nor the researchers were blinded. Considering the subjectivity of patient-rated pain, this can considerably impact the results, so 7 of the 8 included studies were considered to have a high overall risk of bias. The risk of bias assessment of the functionality outcome measure was similar to that of pain intensity, so the results are not presented separately.The results of some studies were presented as median or range, so these measures were converted to mean and standard deviation using the method described by Hozo et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Data were entered into RevMan 5.0, synthesized using a random effects model, and summarized as a standardized mean difference (SMD) using the previously mentioned conversion method.Pain intensity at 1 month: Seven clinical trials evaluated this outcome,<a class="elsevierStyleCrossRefs" href="#bib0060">12–18</a> and point estimation suggests a benefit in favour of radiofrequency (SMD −0.39, 95% CI [−1.11 to 0.33] I2 88%, p < 0.001). Heterogeneity was not explained by the subgroup analysis of ultrasound vs. fluoroscopy-guided radiofrequency (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Pain intensity at 3 months: Seven clinical trials evaluated this outcome10.13–18, suggesting a significant effect in favour of radiofrequency (SMD −1.17, 95% CI [−1.11 to 0.14] I2 97%, p < 0.001). Heterogeneity was not explained by the subgroup analysis of ultrasound vs. fluoroscopy-guided radiofrequency (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Functionality (SPADI) at 1 month: Five clinical trials evaluated this outcome.<a class="elsevierStyleCrossRefs" href="#bib0070">14–18</a> The results suggest an effect in favour of radiofrequency (SMD −0.31, 95% CI [−0.91 to 0.29] I2 80%, p < 0.001). Heterogeneity was not explained by the subgroup analysis of ultrasound vs. fluoroscopy-guided radiofrequency (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>Functionality (SPADI) at 3 months: Six clinical trials evaluated this outcome,<a class="elsevierStyleCrossRefs" href="#bib0050">10,14–18</a> suggesting an effect in favour of radiofrequency (SMD −1.54, 95% CI [−1.11 to 0.19] I2 98%, p < 0.001). Heterogeneity was not explained by the subgroup analysis of ultrasound vs. fluoroscopy-guided radiofrequency (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia>Pain intensity and functionality at 6 and 12 months: This was not analysed because only 1 study evaluated these outcomes and each time point. This study had a high risk of bias, the sample size was small, and some data were lost.Adverse events: None of the clinical trials reported any RFS- or comparator-related adverse events.DiscussionThe suprascapular nerve is traditionally believed to be responsible for most of the sensory innervation of the shoulder, and for this reason acute and chronic pain management procedures have targeted this nerve.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Recent studies, however, have shown conceptual differences that can potentially change the approach and management of these patients.<a class="elsevierStyleCrossRef" href="#bib0100">20</a>In all 8 studies included in our review, the suprascapular nerve was the target of pulsed radiofrequency (ablation was not performed in any of these cases). Different stimulation parameters were used, although neither the voltage (45 V) nor the duration of therapy (120−360 s) differed significantly. Given the proliferation of treatments available for chronic shoulder pain, there was no shortage of comparators, including intra-articular steroid injection,<a class="elsevierStyleCrossRefs" href="#bib0060">12,17</a> suprascapular nerve block,<a class="elsevierStyleCrossRefs" href="#bib0065">13,16</a> transcutaneous stimulation,<a class="elsevierStyleCrossRef" href="#bib0090">18</a> laser photobiomodulation,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> physical therapy,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> and placebo.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>The analysis of pain and functionality at 1 and 3 months suggests an overall effect in favour of pulsed radiofrequency over comparators at both time points, although the magnitude of the benefit depends on the follow-up time: at 1 month the benefit was slight (SMD −0.39, 95% CI [−1.11−0.33] and SMD −0.31, 95% CI [−0.91−0.29] for pain and functionality; respectively) and at 3 months it was significant (SMD −1.17, 95% CI [−2.49−0.14] and SMD −1.54, 95% CI [−3.26−0.19] for pain and functionality; respectively). This analysis, however, is subject to the interpretation of the standardized mean difference and the recommended cut-off point used to define the effect size.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>The clinical significance, precision, and consistency could make it difficult to make a recommendation based on these results. When the data were analysed to define the effect in terms of mean difference, the decrease in pain intensity on a VAS scale of 0 to 10 was 0.59 and 1.25 at 1 and 3 months, respectively. This is below the decrease considered clinically significant for other interventions.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>Likewise, the precision of the effect is low and has no statistical significance for all outcomes at all measurement times. Although the combined studies gave us an optimal sample size (n > 100),<a class="elsevierStyleCrossRef" href="#bib0115">23</a> the confidence intervals used include the null value and have limits on both sides of the effect. This suggests that pulsed radiofrequency reduced pain in some cases, had no effect in some, and was even inferior to the comparator in others. This makes it difficult to recommend pulsed radiofrequency of the scapular nerve.Although we performed a subgroup analysis of ultrasound vs. fluoroscopy-guided radiofrequency, it did not explain the high heterogeneity of the results. However, studies that used ultrasound-guided radiofrequency<a class="elsevierStyleCrossRefs" href="#bib0050">10,13,15</a> showed a greater effect size and precision than those using fluoroscopy guidance (Alanbay SMD −2.01 [−2.91, −1.11], Wu SMD −0.77 [−1.29, −0.24], Yan SMD −4.67 [−5.33, −4.01] ), although the summary estimate is imprecise and has no statistical significance (SMD −2.48 [−5, 0.04]). Heterogeneity is most probably due to other factors not explored in this analysis, such as the type of pathology associated with chronic shoulder pain. Although most patients in our sample presented extra-articular pathology, the effect of radiofrequency of the suprascapular nerve in predominantly joint-related pathologies is unknown. We were unable to clarify this question, because individual patient data were not available and this outcome was not included in our protocol.We considered performing a sensitivity analysis to determine the presence of bias in the studies included; however 7 of 8 studies had a high likelihood of bias. Yan et al. was the only study that in our opinion had a low probability of systematic error, and suggested a benefit of ultrasound-guided radiofrequency of the suprascapular nerve for clinically and statistically significant pain reduction (RF −4.6 [−6.9, −2.7] vs. Controls −1.7 [−3.0, −0.9], p < 0.01).<a class="elsevierStyleCrossRef" href="#bib0050">10</a> However, some studies used blinding methods that could compromise the evaluation of the results. Patients receiving intra-articular steroid injection were aware of the treatment received,<a class="elsevierStyleCrossRefs" href="#bib0060">12,17</a> the tingling sensation that accompanies pulsed radiofrequency treatment also betrayed treatment assignment,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> and it was obviously impossible to blind patients to transcutaneous or laser stimulation therapy and physical therapy.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15,18</a> Another study failed to clearly explain the randomization and allocation concealment method used. This, in addition the losses during follow-up, could have compromise the validity of the study.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> As patient-reported pain is, by definition, a subjective measurement, failure to blind patients to the intervention can bias outcomes.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> The same can be true of functionality measured using the SPADI scale. Although this is a validated questionnaire, patients are asked to rate their functionality subjectively instead of using objective parameters that quantify pain on the basis of performing certain activities of daily living.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>In conclusion, the imprecision, inconsistency and bias found, the small number studies included, and the possibility of publication bias, suggests that the evidence for the outcomes of pain intensity and functionality is, according to the GRADE methodology, of very low quality.Although we were unable to achieve a high certainty of evidence, our results are similar to previous systematic reviews investigating this topic, albeit with some differences. For example, we differ from Pushparaj et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> in their risk of bias assessment of some included studies and their inclusion of a study that involved transcutaneous shoulder stimulation (Taverner et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>); in addition, our search strategy allowed us to include 2 additional studies in our review.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> We also differ from Liu et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> in their risk of bias assessment, particularly with regard to the randomization and allocation concealment used in some studies, and in their inclusion of a study that involved transcutaneous shoulder stimulation and the corresponding studies retrieved from the citation search.The lack of high quality evidence to recommend the use of pulsed radiofrequency of the suprascapular nerve in the treatment of chronic shoulder pain highlights the difficulty faced by clinicians when treating these patients, and it stands to reason that they could benefit from complementary strategies that alleviate pain without adverse effects. All the studies included in our review collected data on intervention-related complications, although none were observed. Although the evidence for the benefit of pulsed radiofrequency may be imprecise and inconsistent, this procedure does not cause neural damage and has not been associated with any complications. Therefore, the decision to use this technique must be based on the characteristics of each patient and the existence of other potentially safe and beneficial alternatives.The lack of a significant benefit of radiofrequency of the suprascapular nerve could be due to anatomical factors. Recent studies have suggested that the suprascapular nerve is the source of 25% of shoulder nociception.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Promoting research into the combination of structures to be targeted, such as radiofrequency of the suprascapular and axillary nerves and articular branches of the lateral pectoralis, could improve pain control.Tran et al. studied 12 patients with chronic shoulder pain in whom axillary, lateral pectoral and suprascapular nerve block improved pain by 50%. The patients then underwent cooled radiofrequency ablation, suggesting that other structures in addition to the suprascapular nerve can be targeted for treatment in chronic shoulder pain.<a class="elsevierStyleCrossRef" href="#bib0140">28</a>In contrast, in a study comparing the effectiveness of pulsed radiofrequency ablation of the suprascapular nerve and axillary nerve vs. nerve block to treat hemiplegic shoulder pain, Yang, et al. found no significant differences between these techniques in terms of pain control or shoulder range of movement.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> The authors of an ongoing study comparing the effectiveness of pulsed radiofrequency of the suprascapular nerve alone vs. pulsed radiofrequency of the suprascapular, axillary, and articular branches of the lateral pectoral nerve on shoulder functionality and quality of life hope to shed light on interventional management of chronic pain (NCT04954391).The findings of future prospective studies to determine which nerves should be targeted and under which clinical conditions will supplement the weak, possibly biased evidence gained from our literature review.ConclusionsThe benefit of radiofrequency treatment of the suprascapular nerve to control chronic shoulder pain is supported by weak evidence; however, there are suggestions that this therapy reduces pain intensity and is unlikely to cause adverse effects at 1 and 3 months of follow-up. Given the anatomical complexity of the shoulder, future, unbiased, prospective studies investigating other neural targets will help clarify the role of pulsed radiofrequency in the treatment of chronic omalgia.FundingThe authors have not received specific funding from agencies in the private public and non-profit sectors.Conflict of interestsNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres2212516" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1855456" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2212515" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1855455" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methodology" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-04-12" "fechaAceptado" => "2024-03-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1855456" "palabras" => array:4 [ 0 => "Shoulder pain" 1 => "Radiofrequency" 2 => "Pulsed radiofrequency" 3 => "Pain disability" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1855455" "palabras" => array:4 [ 0 => "Dolor de hombro" 1 => "Radiofrecuencia" 2 => "Radiofrecuencia pulsada" 3 => "Discapacidad por dolor" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionChronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects. MethodsWe performed a systematic review of clinical trials retrieved from Medline, Embase and the CENTRAL databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I2 test. ResultsWe identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of −0.9 (95% CI [−1.1, 0.33], p = 0.29; I2 88%, p < 0.001) and −1.17 (95% CI [−2.49, 0.14], p = 0.08; I2 97%, p < 0.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of −0.31 (95% CI [−0.91, 0.29], p = 0.31; I2 80%, p < 0.001) and −1.54 (95% CI [−3.26, 0.19], p = 0.08; I2 98%, p < 0.001), respectively. No RFS-related adverse events were described. ConclusionThe evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl dolor crónico de hombro resulta altamente prevalente en la población general. Se han descrito múltiples estrategias analgésicas incluyendo la radiofrecuencia del nervio supraescapular (RFS) sin lograr identificar su efectividad al momento de generar una recomendación. El objetivo de esta revisión sistemática es actualizar y analizar los ensayos clínicos en términos de efectividad para el control del dolor, funcionalidad y efectos adversos de la radiofrecuencia del nervio supraescapular en pacientes con dolor crónico de hombro. MétodosSe realizó una revisión sistemática de la literatura en Medline, Embase y CENTRAL buscando ensayos clínicos que compararan la radiofrecuencia del nervio supraescapular con otras estrategias incluido placebo e incluyeran como resultado principal la intensidad del dolor medida en una escala visual análoga, la funcionalidad por un índice de dolor y discapacidad del hombro (SPADI) y cuantificaran la ocurrencia de eventos adversos. Se analizó el riesgo de sesgo mediante la herramienta RoB2 de Cochrane. Se analizó la evidencia mediante un modelo de efectos aleatorios y se cuantificó la heterogeneidad mediante la prueba del I2. ResultadosSe identificaron 3030 publicaciones de las cuales 8 cumplieron con los criterios de inclusión (n = 408). Siete tenían alto riesgo de sesgo. La intensidad del dolor al mes y a los tres meses fue menor para la RFS, SMD −0.9 (IC 95% [−1.1, 0.33], p = 0.29; I2 88%, p < 0.001) y SMD −1.17 (IC 95% [−2.49, 0.14], p = 0.08; I2 97%, p < 0.001), respectivamente. El compromiso en la funcionalidad al mes y a los tres meses disminuyó en aquellos sometidos a RFS, SMD −0.31 (IC 95% [−0.91, 0.29], p = 0.31; I2 80%, p < 0.001) y SMD −1.54 (IC 95% [−3.26, 0.19], p = 0.08; I2 98%, p < 0.001), respectivamente. No se describió la ocurrencia de eventos adversos relacionados con la RFS. ConclusiónLa RFS sugiere un beneficio para la disminución del dolor y mejoría de la funcionalidad. Sin embargo, la certeza de los resultados es baja." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1666 "Ancho" => 2083 "Tamanyo" => 195492 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "PRISMA Flow chart." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1255 "Ancho" => 2925 "Tamanyo" => 370077 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Forest Plot VAS 1 month." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1252 "Ancho" => 2925 "Tamanyo" => 378187 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Forest Plot VAS 3 months." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1140 "Ancho" => 2925 "Tamanyo" => 337827 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Forest Plot SPADI I month." ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1191 "Ancho" => 2925 "Tamanyo" => 365822 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Forest Plot SPADI 3 months." ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NA: Not applicable, because the respective studies did not include this variable in their results." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comparator \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NRS/VAS Comparator</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NRS/VAS RF \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SPADI comparator \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SPADI RF \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusion \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kim 2021</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemiplegic shoulder</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radio frequency 45 V, 360 s, 42.2 Hz, 30 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intra-articular corticosteroids</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In favour of intra-articular corticosteroids (p < 0.001)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alanbay 2020</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemiplegic shoulder</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radio frequency 45 V, 120 s, 42.2 Hz, 30 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suprascapular nerve block</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In favour of RF (p < 0.01)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yan 2019</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">136</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frozen shoulder</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radiofrequency, 1 weekly cycle for 12 weeks, 422, 2 Hz, 20 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Placebo</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In favour of RF (p < 0.01). Effect evaluated: pain reduction.</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Okmen 2017</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subacromial impingement</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radio frequency 45 V, 240 s, 42 Hz, 200 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Photobiomodulation (laser)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No difference between interventions (p > 0.05)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wu 2014</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adhesive capsulitis</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radio frequency 180 s, 42.2 Hz, 30 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physical therapy</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In favour of RF (p < 0.001)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gofeld 2012</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adhesive capsulitis, tendinosis, osteoarthritis, rotator cuff or capsular injury</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radio frequency 120 s 42 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suprascapular nerve block</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RF could be superior (p < 0.05)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eyigor 2010</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rotator cuff injury, bicipital tendinopathy, acromioclavicular osteoarthritis</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radio frequency 45 V, 240 s, 42 Hz, 200 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intra-articular corticosteroids</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In favour of intra-articular corticosteroids (p < 0.05)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Korkmaz 2010</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rotator cuff injury, bicipital tendinopathy, acromioclavicular osteoarthritis</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulsed radio frequency 45 V, 240 s, 42 Hz, 200 ms.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TENS</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 week \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No difference between interventions (p > 0.05)</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 month \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3609069.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the studies included in the analysis." ] ] 6 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 13428 ] ] 7 => array:5 [ "identificador" => "tb1005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "Key points<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•The suprascapular nerve is traditionally considered responsible for most of the sensory innervation of the acromioclavicular joint. Recent studies, however, have shown differences that can potentially change the approach and management of patients with chronic shoulder pain.</li><li class="elsevierStyleListItem" id="lsti0010">•The benefit of radiofrequency of the suprascapular nerve to control chronic shoulder pain is supported by weak evidence; however, there are suggestions that this therapy reduces pain intensity and is unlikely to cause adverse effects at 1 and 3 months of follow-up.</li><li class="elsevierStyleListItem" id="lsti0015">•The findings of future prospective studies will help determine which nerves should be targeted and under what clinical conditions.</li></ul>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shoulder disorders and occupation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.H. 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Radiofrequency of suprascapular nerve as an analgesic strategy for chronic pain management. Systematic review and meta-analysis

Radiofrecuencia del nervio supraescapular como estrategia analgésica para el dolor crónico de hombro. Revisión sistemática y metaanálisis

J. Sebastián Infantea, N. Blackburnb,

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nataliablackburnvillota@gmail.com

Corresponding author.

, J. Felipe Vargasa

a Departament of Anaesthesiology and Pain Management, Hospital Pablo Tobón Uribe, Bogotá, Colombia

b Anaesthesiologist, Research Fellow at the Clinica de Dolor y Cuidados Paliativos, Universidad el Bosque, Bogotá, Colombia

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb1005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0025" class="elsevierStylePara elsevierViewall">Chronic shoulder pain has a prevalence of between 18&#37; and 26&#37; in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The burden of this type of pain and the resulting disability affect not only the patient&#8217;s quality of life but also their productivity&#44; depending on the age of presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The shoulder is innervated by the suprascapular&#44; axillary&#44; lateral pectoral and subscapular nerves&#46; The suprascapular nerve is traditionally considered responsible for most of the sensory innervation of the intra- and extra-articular structures of the shoulder&#46; The functionality of this complex joint is dependent on several different anatomical structures&#44; and it can be difficult to treat each one of these in patients with chronic pain&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The suprascapular nerve has been the target of successful analgesic strategies when acute postoperative shoulder pain is secondary to manipulation of the joint&#44; muscles and tendons&#46; It has also been a target of nerve block techniques&#44; pulsed radiofrequency&#44; and radiofrequency ablation in patients with chronic shoulder pain&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Evidence suggests that pulsed radiofrequency modifies the capacity of nociceptors to transduce and transmit pain&#44; while radiofrequency ablation produces a heat injury that disrupts the transmission of pain signals from the nerve&#46; Both techniques inhibit nociception&#44; thereby reducing the intensity of perceived pain&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Several systematic reviews have evaluated the effectiveness of these techniques in shoulder pain&#59; however&#44; due to methodological shortcomings&#44; they have been unable to show the benefit of radiofrequency in chronic shoulder pain with any degree of certainty&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#8211;10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We&#44; therefore&#44; formulated the following research question&#58; In patients with chronic shoulder pain&#44; does radiofrequency treatment of the suprascapular nerve compared to other analgesic strategies reduce the intensity of pain&#63; To explore this question&#44; we performed a systematic review to combine and analyse findings on the analgesic effect of radiofrequency treatment of the suprascapular nerve in chronic shoulder pain&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methodology</span><p id="par0055" class="elsevierStylePara elsevierViewall">We performed a systematic review of randomized clinical trials in patients aged over 18 years with chronic shoulder pain lasting more than 3 months caused by an injury or a degenerative condition&#44; whose treatment included image-guided pulsed radiofrequency or radiofrequency ablation of the suprascapular nerve&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Accepted comparators were conventional medical management&#44; rehabilitation or physical therapy&#44; placebo&#44; sham procedures&#44; intra- or peri-articular steroid injection&#44; suprascapular nerve block&#44; and surgical treatment&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The accepted primary outcome measure was pain intensity measured on a visual analogue or verbal numerical scale&#46; The secondary outcome measures were functionality measured on the SPADI &#40;Shoulder Pain and Disability Index&#41; scale and RFS-related adverse events&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Studies comparing pulsed radiofrequency and radiofrequency ablation and those not written in English or Spanish were excluded&#46; There was no limit to the publication date&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The literature search was performed using MeSH terms&#44; Emtree terms&#44; and keywords&#44; as appropriate&#44; in the Medline&#44; Embase and Central databases&#46; We searched the citations of the reports included in the analysis to identify other reports that were not found in the databases&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Two reviewers evaluated the titles and abstracts of the reports retrieved to eliminate irrelevant or duplicate articles&#46; Any reports that lacked an abstract or had a title that did not clarify the inclusion or exclusion criteria were excluded in the following phase&#46; The full text of relevant records was obtained&#59; records referring to similar reports were grouped&#44; while records referring to the same report &#40;duplicates&#41; were excluded&#46; Two independent reviewers read the full texts&#44; and those that met the criteria were included in the review&#46; The reasons for excluding reports were specified&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Pain intensity was assessed using a visual analogue scale and functionality was assessed using the SPADI scale&#46; If the visual analogue scale ranged from 0 to 10 0&#44; it was divided by 10 to reduce it to 0 to 10 in order to unify the outcomes of studies that include this measurement with those using a 0&#8211;10 visual analogue or verbal numerical scale&#46; Results reported as median or range were converted to mean and standard deviation according to the method described by Hozo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Therefore&#44; all the results of our systematic review are presented as standardized mean difference and confidence intervals&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The occurrence of adverse events is described in terms of absolute and relative frequency&#44; and was analysed in terms of relative risk and confidence intervals&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Results were analysed according to follow-up time&#58; 1 week&#44; 1 month&#44; 3 months&#44; 6 months and 1&#8239;year&#46; Summary statistics were analysed using RevMan 5&#46;0 and a random effects model&#46; An I<span class="elsevierStyleSup">2</span> greater than 50&#37; indicated significant heterogeneity&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">The process of screening and selecting records is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> &#40;PRISMA&#41;&#46; A total of 3&#44;030 studies were found&#44; of which 469 were duplicates&#46; We excluded 2&#44;329 records that did not address the population or intervention of interest in their title or abstract&#44; or were not prospective studies&#46; Of the resulting 232 studies&#44; 215 were excluded because they did meet the inclusion criteria for type of study&#44; population or intervention&#46; One study was written in Chinese&#44; and it was impossible to obtain the full text &#40;no response was obtained from the authors&#41;&#46; Sixteen full-text studies were analysed&#58; 6 were subsequently excluded because they were not clinical trials&#44; and 2 were excluded because they involved a transcutaneous intervention unrelated to the suprascapular nerve&#46; A total of 8 studies were finally included in the analysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The included studies analysed various shoulder pathologies&#44; mostly extra-articular&#44; that were treated by pulsed radiofrequency and one or more comparators&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The risk of bias analysis for the pain intensity outcome measure showed that only 1 study &#40;Yan 2019<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#41; had a low probability of bias&#46; Although the other studies used an appropriate randomization method&#44; they did not explain the process of allocation concealment&#44; and neither the study subjects nor the researchers were blinded&#46; Considering the subjectivity of patient-rated pain&#44; this can considerably impact the results&#44; so 7 of the 8 included studies were considered to have a high overall risk of bias&#46; The risk of bias assessment of the functionality outcome measure was similar to that of pain intensity&#44; so the results are not presented separately&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The results of some studies were presented as median or range&#44; so these measures were converted to mean and standard deviation using the method described by Hozo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Data were entered into RevMan 5&#46;0&#44; synthesized using a random effects model&#44; and summarized as a standardized mean difference &#40;SMD&#41; using the previously mentioned conversion method&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pain intensity at 1 month&#58;</span> Seven clinical trials evaluated this outcome&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;18</span></a> and point estimation suggests a benefit in favour of radiofrequency &#40;SMD &#8722;0&#46;39&#44; 95&#37; CI &#91;&#8722;1&#46;11 to 0&#46;33&#93; I<span class="elsevierStyleSup">2</span> 88&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Heterogeneity was not explained by the subgroup analysis of ultrasound vs&#46; fluoroscopy-guided radiofrequency &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pain intensity at 3 months&#58;</span> Seven clinical trials evaluated this outcome<span class="elsevierStyleSup">10&#46;13&#8211;18</span>&#44; suggesting a significant effect in favour of radiofrequency &#40;SMD &#8722;1&#46;17&#44; 95&#37; CI &#91;&#8722;1&#46;11 to 0&#46;14&#93; I<span class="elsevierStyleSup">2</span> 97&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Heterogeneity was not explained by the subgroup analysis of ultrasound vs&#46; fluoroscopy-guided radiofrequency &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Functionality &#40;SPADI&#41; at 1 month&#58;</span> Five clinical trials evaluated this outcome&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;18</span></a> The results suggest an effect in favour of radiofrequency &#40;SMD &#8722;0&#46;31&#44; 95&#37; CI &#91;&#8722;0&#46;91 to 0&#46;29&#93; I<span class="elsevierStyleSup">2</span> 80&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Heterogeneity was not explained by the subgroup analysis of ultrasound vs&#46; fluoroscopy-guided radiofrequency &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Functionality &#40;SPADI&#41; at 3 months&#58;</span> Six clinical trials evaluated this outcome&#44;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;14&#8211;18</span></a> suggesting an effect in favour of radiofrequency &#40;SMD &#8722;1&#46;54&#44; 95&#37; CI &#91;&#8722;1&#46;11 to 0&#46;19&#93; I<span class="elsevierStyleSup">2</span> 98&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#46; Heterogeneity was not explained by the subgroup analysis of ultrasound vs&#46; fluoroscopy-guided radiofrequency &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Pain intensity and functionality at 6 and 12 months&#58;</span> This was not analysed because only 1 study evaluated these outcomes and each time point&#46; This study had a high risk of bias&#44; the sample size was small&#44; and some data were lost&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Adverse events&#58;</span> None of the clinical trials reported any RFS- or comparator-related adverse events&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">The suprascapular nerve is traditionally believed to be responsible for most of the sensory innervation of the shoulder&#44; and for this reason acute and chronic pain management procedures have targeted this nerve&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Recent studies&#44; however&#44; have shown conceptual differences that can potentially change the approach and management of these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In all 8 studies included in our review&#44; the suprascapular nerve was the target of pulsed radiofrequency &#40;ablation was not performed in any of these cases&#41;&#46; Different stimulation parameters were used&#44; although neither the voltage &#40;45&#8239;V&#41; nor the duration of therapy &#40;120&#8722;360&#8239;s&#41; differed significantly&#46; Given the proliferation of treatments available for chronic shoulder pain&#44; there was no shortage of comparators&#44; including intra-articular steroid injection&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;17</span></a> suprascapular nerve block&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;16</span></a> transcutaneous stimulation&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> laser photobiomodulation&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> physical therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and placebo&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The analysis of pain and functionality at 1 and 3 months suggests an overall effect in favour of pulsed radiofrequency over comparators at both time points&#44; although the magnitude of the benefit depends on the follow-up time&#58; at 1 month the benefit was slight &#40;SMD &#8722;0&#46;39&#44; 95&#37; CI &#91;&#8722;1&#46;11&#8722;0&#46;33&#93; and SMD &#8722;0&#46;31&#44; 95&#37; CI &#91;&#8722;0&#46;91&#8722;0&#46;29&#93; for pain and functionality&#59; respectively&#41; and at 3 months it was significant &#40;SMD &#8722;1&#46;17&#44; 95&#37; CI &#91;&#8722;2&#46;49&#8722;0&#46;14&#93; and SMD &#8722;1&#46;54&#44; 95&#37; CI &#91;&#8722;3&#46;26&#8722;0&#46;19&#93; for pain and functionality&#59; respectively&#41;&#46; This analysis&#44; however&#44; is subject to the interpretation of the standardized mean difference and the recommended cut-off point used to define the effect size&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The clinical significance&#44; precision&#44; and consistency could make it difficult to make a recommendation based on these results&#46; When the data were analysed to define the effect in terms of mean difference&#44; the decrease in pain intensity on a VAS scale of 0 to 10 was 0&#46;59 and 1&#46;25 at 1 and 3 months&#44; respectively&#46; This is below the decrease considered clinically significant for other interventions&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Likewise&#44; the precision of the effect is low and has no statistical significance for all outcomes at all measurement times&#46; Although the combined studies gave us an optimal sample size &#40;n &#62; 100&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> the confidence intervals used include the null value and have limits on both sides of the effect&#46; This suggests that pulsed radiofrequency reduced pain in some cases&#44; had no effect in some&#44; and was even inferior to the comparator in others&#46; This makes it difficult to recommend pulsed radiofrequency of the scapular nerve&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Although we performed a subgroup analysis of ultrasound vs&#46; fluoroscopy-guided radiofrequency&#44; it did not explain the high heterogeneity of the results&#46; However&#44; studies that used ultrasound-guided radiofrequency<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;13&#44;15</span></a> showed a greater effect size and precision than those using fluoroscopy guidance &#40;Alanbay SMD &#8722;2&#46;01 &#91;&#8722;2&#46;91&#44; &#8722;1&#46;11&#93;&#44; Wu SMD &#8722;0&#46;77 &#91;&#8722;1&#46;29&#44; &#8722;0&#46;24&#93;&#44; Yan SMD &#8722;4&#46;67 &#91;&#8722;5&#46;33&#44; &#8722;4&#46;01&#93; &#41;&#44; although the summary estimate is imprecise and has no statistical significance &#40;SMD &#8722;2&#46;48 &#91;&#8722;5&#44; 0&#46;04&#93;&#41;&#46; Heterogeneity is most probably due to other factors not explored in this analysis&#44; such as the type of pathology associated with chronic shoulder pain&#46; Although most patients in our sample presented extra-articular pathology&#44; the effect of radiofrequency of the suprascapular nerve in predominantly joint-related pathologies is unknown&#46; We were unable to clarify this question&#44; because individual patient data were not available and this outcome was not included in our protocol&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">We considered performing a sensitivity analysis to determine the presence of bias in the studies included&#59; however 7 of 8 studies had a high likelihood of bias&#46; Yan et al&#46; was the only study that in our opinion had a low probability of systematic error&#44; and suggested a benefit of ultrasound-guided radiofrequency of the suprascapular nerve for clinically and statistically significant pain reduction &#40;RF &#8722;4&#46;6 &#91;&#8722;6&#46;9&#44; &#8722;2&#46;7&#93; vs&#46; Controls &#8722;1&#46;7 &#91;&#8722;3&#46;0&#44; &#8722;0&#46;9&#93;&#44; p&#8239;&#60;&#8239;0&#46;01&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However&#44; some studies used blinding methods that could compromise the evaluation of the results&#46; Patients receiving intra-articular steroid injection were aware of the treatment received&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;17</span></a> the tingling sensation that accompanies pulsed radiofrequency treatment also betrayed treatment assignment&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and it was obviously impossible to blind patients to transcutaneous or laser stimulation therapy and physical therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15&#44;18</span></a> Another study failed to clearly explain the randomization and allocation concealment method used&#46; This&#44; in addition the losses during follow-up&#44; could have compromise the validity of the study&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> As patient-reported pain is&#44; by definition&#44; a subjective measurement&#44; failure to blind patients to the intervention can bias outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The same can be true of functionality measured using the SPADI scale&#46; Although this is a validated questionnaire&#44; patients are asked to rate their functionality subjectively instead of using objective parameters that quantify pain on the basis of performing certain activities of daily living&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">In conclusion&#44; the imprecision&#44; inconsistency and bias found&#44; the small number studies included&#44; and the possibility of publication bias&#44; suggests that the evidence for the outcomes of pain intensity and functionality is&#44; according to the GRADE methodology&#44; of very low quality&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Although we were unable to achieve a high certainty of evidence&#44; our results are similar to previous systematic reviews investigating this topic&#44; albeit with some differences&#46; For example&#44; we differ from Pushparaj et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in their risk of bias assessment of some included studies and their inclusion of a study that involved transcutaneous shoulder stimulation &#40;Taverner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#41;&#59; in addition&#44; our search strategy allowed us to include 2 additional studies in our review&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> We also differ from Liu et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> in their risk of bias assessment&#44; particularly with regard to the randomization and allocation concealment used in some studies&#44; and in their inclusion of a study that involved transcutaneous shoulder stimulation and the corresponding studies retrieved from the citation search&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The lack of high quality evidence to recommend the use of pulsed radiofrequency of the suprascapular nerve in the treatment of chronic shoulder pain highlights the difficulty faced by clinicians when treating these patients&#44; and it stands to reason that they could benefit from complementary strategies that alleviate pain without adverse effects&#46; All the studies included in our review collected data on intervention-related complications&#44; although none were observed&#46; Although the evidence for the benefit of pulsed radiofrequency may be imprecise and inconsistent&#44; this procedure does not cause neural damage and has not been associated with any complications&#46; Therefore&#44; the decision to use this technique must be based on the characteristics of each patient and the existence of other potentially safe and beneficial alternatives&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The lack of a significant benefit of radiofrequency of the suprascapular nerve could be due to anatomical factors&#46; Recent studies have suggested that the suprascapular nerve is the source of 25&#37; of shoulder nociception&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Promoting research into the combination of structures to be targeted&#44; such as radiofrequency of the suprascapular and axillary nerves and articular branches of the lateral pectoralis&#44; could improve pain control&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Tran et al&#46; studied 12 patients with chronic shoulder pain in whom axillary&#44; lateral pectoral and suprascapular nerve block improved pain by 50&#37;&#46; The patients then underwent cooled radiofrequency ablation&#44; suggesting that other structures in addition to the suprascapular nerve can be targeted for treatment in chronic shoulder pain&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">In contrast&#44; in a study comparing the effectiveness of pulsed radiofrequency ablation of the suprascapular nerve and axillary nerve vs&#46; nerve block to treat hemiplegic shoulder pain&#44; Yang&#44; et al&#46; found no significant differences between these techniques in terms of pain control or shoulder range of movement&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> The authors of an ongoing study comparing the effectiveness of pulsed radiofrequency of the suprascapular nerve alone vs&#46; pulsed radiofrequency of the suprascapular&#44; axillary&#44; and articular branches of the lateral pectoral nerve on shoulder functionality and quality of life hope to shed light on interventional management of chronic pain &#40;NCT04954391&#41;&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The findings of future prospective studies to determine which nerves should be targeted and under which clinical conditions will supplement the weak&#44; possibly biased evidence gained from our literature review&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0220" class="elsevierStylePara elsevierViewall">The benefit of radiofrequency treatment of the suprascapular nerve to control chronic shoulder pain is supported by weak evidence&#59; however&#44; there are suggestions that this therapy reduces pain intensity and is unlikely to cause adverse effects at 1 and 3 months of follow-up&#46; Given the anatomical complexity of the shoulder&#44; future&#44; unbiased&#44; prospective studies investigating other neural targets will help clarify the role of pulsed radiofrequency in the treatment of chronic omalgia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors have not received specific funding from agencies in the private public and non-profit sectors&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interests</span><p id="par0225" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Chronic shoulder pain is highly prevalent in the general population&#46; Many different analgesic strategies have been described&#44; including radiofrequency treatment to the suprascapular nerve &#40;RFS&#41;&#59; however&#44; the effectiveness this approach remains unclear&#44; and no strong recommendation can be made&#46; The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain&#44; post-procedural functionality&#44; and adverse effects&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of clinical trials retrieved from Medline&#44; Embase and the CENTRAL databases&#46; We included trials comparing RFS with other strategies&#44; including placebo&#44; that had as their primary outcome measures pain rated on a visual analogue scale&#44; functionality rated on a shoulder pain and disability index &#40;SPADI&#41;&#44; and the incidence of adverse events&#46; Risk of bias was analysed using the Cochrane RoB2 tool&#46; Evidence was analysed using a random effects model and heterogeneity was quantified using the I<span class="elsevierStyleSup">2</span> test&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We identified 3030 trials&#44; of which 8 met the inclusion criteria &#40;n&#8239;&#61;&#8239;408&#41;&#46; Seven had a high risk of bias&#46; Pain intensity at 1 and 3 months was lower in patients receiving RFS&#44; with a standardised mean difference &#40;SMD&#41; of &#8722;0&#46;9 &#40;95&#37; CI &#91;&#8722;1&#46;1&#44; 0&#46;33&#93;&#44; p&#8239;&#61;&#8239;0&#46;29&#59; I<span class="elsevierStyleSup">2</span> 88&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41; and &#8722;1&#46;17 &#40;95&#37; CI &#91;&#8722;2&#46;49&#44; 0&#46;14&#93;&#44; p&#8239;&#61;&#8239;0&#46;08&#59; I<span class="elsevierStyleSup">2</span> 97&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#44; respectively&#46; Functional compromise at 1 and 3 months decreased in patients receiving RFS&#44; with an SMD of &#8722;0&#46;31 &#40;95&#37; CI &#91;&#8722;0&#46;91&#44; 0&#46;29&#93;&#44; p&#8239;&#61;&#8239;0&#46;31&#59; I<span class="elsevierStyleSup">2</span> 80&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41; and &#8722;1&#46;54 &#40;95&#37; CI &#91;&#8722;3&#46;26&#44; 0&#46;19&#93;&#44; p&#8239;&#61;&#8239;0&#46;08&#59; I<span class="elsevierStyleSup">2</span> 98&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#44; respectively&#46; No RFS-related adverse events were described&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The evidence suggests that RFS reduces pain and improves functionality&#46; However&#44; the certainty of the evidence is low&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El dolor cr&#243;nico de hombro resulta altamente prevalente en la poblaci&#243;n general&#46; Se han descrito m&#250;ltiples estrategias analg&#233;sicas incluyendo la radiofrecuencia del nervio supraescapular &#40;RFS&#41; sin lograr identificar su efectividad al momento de generar una recomendaci&#243;n&#46; El objetivo de esta revisi&#243;n sistem&#225;tica es actualizar y analizar los ensayos cl&#237;nicos en t&#233;rminos de efectividad para el control del dolor&#44; funcionalidad y efectos adversos de la radiofrecuencia del nervio supraescapular en pacientes con dolor cr&#243;nico de hombro&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una revisi&#243;n sistem&#225;tica de la literatura en Medline&#44; Embase y CENTRAL buscando ensayos cl&#237;nicos que compararan la radiofrecuencia del nervio supraescapular con otras estrategias incluido placebo e incluyeran como resultado principal la intensidad del dolor medida en una escala visual an&#225;loga&#44; la funcionalidad por un &#237;ndice de dolor y discapacidad del hombro &#40;SPADI&#41; y cuantificaran la ocurrencia de eventos adversos&#46; Se analiz&#243; el riesgo de sesgo mediante la herramienta RoB2 de Cochrane&#46; Se analiz&#243; la evidencia mediante un modelo de efectos aleatorios y se cuantific&#243; la heterogeneidad mediante la prueba del I<span class="elsevierStyleSup">2</span>&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 3030 publicaciones de las cuales 8 cumplieron con los criterios de inclusi&#243;n &#40;n&#8239;&#61;&#8239;408&#41;&#46; Siete ten&#237;an alto riesgo de sesgo&#46; La intensidad del dolor al mes y a los tres meses fue menor para la RFS&#44; SMD &#8722;0&#46;9 &#40;IC 95&#37; &#91;&#8722;1&#46;1&#44; 0&#46;33&#93;&#44; p&#8239;&#61;&#8239;0&#46;29&#59; I<span class="elsevierStyleSup">2</span> 88&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41; y SMD &#8722;1&#46;17 &#40;IC 95&#37; &#91;&#8722;2&#46;49&#44; 0&#46;14&#93;&#44; p&#8239;&#61;&#8239;0&#46;08&#59; I<span class="elsevierStyleSup">2</span> 97&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#44; respectivamente&#46; El compromiso en la funcionalidad al mes y a los tres meses disminuy&#243; en aquellos sometidos a RFS&#44; SMD &#8722;0&#46;31 &#40;IC 95&#37; &#91;&#8722;0&#46;91&#44; 0&#46;29&#93;&#44; p&#8239;&#61;&#8239;0&#46;31&#59; I<span class="elsevierStyleSup">2</span> 80&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41; y SMD &#8722;1&#46;54 &#40;IC 95&#37; &#91;&#8722;3&#46;26&#44; 0&#46;19&#93;&#44; p&#8239;&#61;&#8239;0&#46;08&#59; I<span class="elsevierStyleSup">2</span> 98&#37;&#44; p&#8239;&#60;&#8239;0&#46;001&#41;&#44; respectivamente&#46; No se describi&#243; la ocurrencia de eventos adversos relacionados con la RFS&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La RFS sugiere un beneficio para la disminuci&#243;n del dolor y mejor&#237;a de la funcionalidad&#46; Sin embargo&#44; la certeza de los resultados es baja&#46;</p></span>"
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        ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Forest Plot SPADI I month&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1191
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        "detalles" => array:1 [
          0 => array:3 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Forest Plot SPADI 3 months&#46;</p>"
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      5 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">NA&#58; Not applicable&#44; because the respective studies did not include this variable in their results&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comparator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NRS&#47;VAS Comparator</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NRS&#47;VAS RF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SPADI comparator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SPADI RF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conclusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kim 2021</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemiplegic shoulder</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulsed radio frequency 45&#8239;V&#44; 360&#8239;s&#44; 42&#46;2&#8239;Hz&#44; 30&#8239;ms&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intra-articular corticosteroids</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour of intra-articular corticosteroids &#40;p&#8239;&#60;&#8239;0&#46;001&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alanbay 2020</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemiplegic shoulder</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulsed radio frequency 45&#8239;V&#44; 120&#8239;s&#44; 42&#46;2&#8239;Hz&#44; 30&#8239;ms&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suprascapular nerve block</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour of RF &#40;p&#8239;&#60;&#8239;0&#46;01&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yan 2019</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Frozen shoulder</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulsed radiofrequency&#44; 1 weekly cycle for 12 weeks&#44; 422&#44; 2&#8239;Hz&#44; 20&#8239;ms&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placebo</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 weeks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour of RF &#40;p&#8239;&#60;&#8239;0&#46;01&#41;&#46; Effect evaluated&#58; pain reduction&#46;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Okmen 2017</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subacromial impingement</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulsed radio frequency 45&#8239;V&#44; 240&#8239;s&#44; 42&#8239;Hz&#44; 200&#8239;ms&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Photobiomodulation &#40;laser&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No difference between interventions &#40;p&#8239;&#62;&#8239;0&#46;05&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wu 2014</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adhesive capsulitis</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulsed radio frequency 180&#8239;s&#44; 42&#46;2&#8239;Hz&#44; 30&#8239;ms&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Physical therapy</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour of RF &#40;p&#8239;&#60;&#8239;0&#46;001&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gofeld 2012</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adhesive capsulitis&#44; tendinosis&#44; osteoarthritis&#44; rotator cuff or capsular injury</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulsed radio frequency 120&#8239;s 42&#8239;ms&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Suprascapular nerve block</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RF could be superior &#40;p&#8239;&#60;&#8239;0&#46;05&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eyigor 2010</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rotator cuff injury&#44; bicipital tendinopathy&#44; acromioclavicular osteoarthritis</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulsed radio frequency 45&#8239;V&#44; 240&#8239;s&#44; 42&#8239;Hz&#44; 200&#8239;ms&#46;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intra-articular corticosteroids</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In favour of intra-articular corticosteroids &#40;p&#8239;&#60;&#8239;0&#46;05&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 month&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">Korkmaz 2010</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">40</td><td class="td" title="\n
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                  \t\t\t\t">Rotator cuff injury&#44; bicipital tendinopathy&#44; acromioclavicular osteoarthritis</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 week&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">93&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">81&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t">No difference between interventions &#40;p&#8239;&#62;&#8239;0&#46;05&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 months&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                          "autores" => array:2 [
                            0 => "C&#46;H&#46; Linaker"
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                      "titulo" => "Comparison of the effectiveness of suprascapular nerve block with physical therapy&#44; placebo&#44; and intra-articular injection in management of chronic shoulder pain&#58; a meta-analysis of randomized controlled trials"
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                            4 => "S&#46;P&#46; Cohen"
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                            0 => "D&#46; Park"
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                      "doi" => "10.12701/jyms.2022.00101"
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                          "etal" => false
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2024.07.006

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