Effectiveness of ultrasound-guided percutaneous nerve stimulation in rotator cuff related shoulder pain: A randomized clinical trial

J Hand Ther. 2026 Nov 11:S0894-1130(26)00107-9. doi: 10.1016/j.jht.2026.09.003. Online ahead of print.

ABSTRACT

BACKGROUND: Rotator cuff related shoulder pain (RCRSP) is the most common shoulder disorder, with rotator cuff weakness being a risk factor. Ultrasound-guided percutaneous electrical nerve stimulation (US-guided PENS) targeting peripheral nerves may improve muscle strength and reduce pain.

PURPOSE: To determine changes in muscle strength after US‑guided PENS in the suprascapular nerve (SSN) compared with a sham control intervention, followed by a home‑based exercise program, as well as its effectiveness in reducing pain, disability, and improving perceived recovery in subjects with unilateral chronic RCRSP.

STUDY DESIGN: Double-blind (participants and outcome assessor) randomized clinical trial (NCT04454671).

METHODS: Sixty-three adults (65% women) with unilateral chronic RCRSP (mean of 26 ± 40 months) and shoulder muscle weakness were randomized to a single intervention of US-guided PENS (10 contractions, 10 Hz, and 250 µs) in the SSN or control group (no stimulation). After 1 month, all participants performed a home-based exercise program. Shoulder muscle strength (abduction and external rotation of both shoulders), pain intensity, disability, and perceived recovery were assessed at baseline, post-intervention, 1-week, 1-month, and 6-months.

RESULTS: No significant treatment effects were found for symptomatic shoulder muscle strength (External Rotation: p = 0.50, h²_p = 0.01; Abduction: p = 0.63, h²_p = 0.01), pain intensity (VAS: p = 0.24, h²_p = 0.03; Dynamometry VAS: p = 0.62, h²_p = 0.01), or asymptomatic external rotation (p = 0.71, h²_p = 0.01). Significant group x time interactions were observed for SPADI (p = 0.02, h²_p = 0.07), DASH (p = 0.02, h²_p = 0.07), and asymptomatic abduction (p = 0.03, h²_p = 0.05). At 6 months, the experimental group reported superior perceived recovery (p = 0.04, φ² = 0.28). No serious adverse events were reported.

CONCLUSIONS: A single US-guided PENS session targeting the SSN, combined with a home-based exercise program did not significantly improve symptomatic shoulder strength or pain intensity in subjects with RCRSP compared to control group. However, US-guided PENS, when combined with exercise, showed improvements in disability, perceived recovery, and asymptomatic shoulder strength. Further high-quality trials are needed to better understand the efficacy and optimal application of PENS on neural tissue.

PMID:43015184 | DOI:10.1016/j.jht.2026.09.003