Percutaneous Tenotomy Versus Radiofrequency Ablation for Rotator Cuff Tear - Related Pain.

Rotator cuff tears are among the most common direct and indirect causes of chronic shoulder pain. Patients with irreparable rotator cuff tears face a choice of pain management options. The principal treatments available for chronic shoulder pain associated with irreparable rotator cuff tears include arthroscopic tenotomy of the long head of the biceps tendon, shoulder arthroplasty, pharmacological treatment, and radiofrequency ablation of the suprascapular nerve. Arthroscopic tenotomy of the long head of the biceps tendon is an established treatment for pain associated with massive irreparable rotator cuff tears, as supported by the available literature. Radiofrequency ablation of the suprascapular nerve provides temporary pain control by destroying the sensory nerve fibres supplying the shoulder joint. Tenotomy of the long head of the biceps tendon can be performed safely using a minimally invasive, ultrasound-guided outpatient procedure under local anaesthesia, without the general anaesthesia required for arthroscopy. The aim of the study is to compare the reduction in pain intensity and the duration of analgesia following percutaneous tenotomy of the long head of the biceps tendon versus continuous radiofrequency ablation of the suprascapular nerve. Changes in shoulder mobility limitations following the two procedures will also be compared using the Constant-Murley score, which assesses shoulder function.

Inclusion Criteria: * Age \>65 years. * Massive irreparable posterosuperior rotator cuff tears (Patte grade 3 and Goutallier grade 4 on MRI). Exclusion Criteria: * Absence of consent to participate in the study. * Psychiatric disorders and antidepressant treatment. * Uncontrolled cardiovascular disease. * Alcohol or psychoactive substance dependence. * Active infection. * Known active malignancy. * A cardiac pacemaker (a relative contraindication to radiofrequency ablation).