What Is Joint Denervation?

Joint denervation involves disabling the small sensory nerves that transmit pain signals from the joint. This can be achieved using heat (radiofrequency ablation) or cold (cryoablation).
The primary goal is pain reduction.
Importantly, this procedure does not affect the structural condition of the joint (e.g., osteoarthritis remains unchanged). However, many patients experience improved range of motion, as the reduced pain allows the surrounding muscles to function more effectively without being inhibited by sharp, sudden pain.

When Is Shoulder Denervation Indicated?

Joint denervation is recommended for patients with advanced osteoarthritis of the shoulder, hip, or knee, particularly when:

  • They are not suitable candidates for joint replacement due to other medical conditions, or
  • They refuse surgery, or
  • They already have a joint prosthesis but continue to suffer from significant residual pain.

When Is the Procedure Contraindicated?

  • Local infection at the planned injection site
  • If a prior diagnostic nerve block fails to produce at least 50% pain relief for several hours

How Is the Procedure Performed?

  • The procedure is image-guided (ultrasound) and performed in an outpatient setting.
  • It takes approximately 45 minutes, followed by a 30-minute observation period.
  • Most patients can go home the same day, accompanied by a responsible adult.

Sedation:

  • Denervation is usually performed under conscious sedation, so the patient remains relaxed and comfortable without being fully unconscious.
  • The skin is numbed, then a needle is guided to the targeted nerve branches.
  • The nerve is treated using radiofrequency (heat) or cryoablation (cold) to disable pain signal transmission.

What to Expect After the Procedure

  • Mild pain increase may occur for a few days post-procedure.
  • Full pain-relieving effects typically develop within up to 7 days.
  • Routine pain medications are usually not necessary after the procedure.
  • Patients can return to normal daily activities as soon as the next day.

How Can the Patient Support Their Recovery?

Participation in physical therapy is highly recommended, as it supports mobility, joint function, and muscle strength—especially in cases of degenerative joint disease involving the shoulder, hip, or knee.

Pre-Procedure Instructions

Patients taking blood thinners such as:

  • Coumadin
  • Warfarin
  • Plavix
  • Heparin
  • Fragmin
  • or similar anticoagulants

…are at increased risk of bleeding.

Important: Never stop taking these medications on your own. Always consult your doctor well in advance of the procedure.

Further preparation guidelines can be found here: https://fajdalomklinika.hu/en/for-patients/

Possible Risks and Complications

Although the procedure is generally low-risk and well-tolerated, the following complications may occur:

  • Pain at the injection site
  • Local inflammation
  • Infection (e.g. abscess)
  • Bleeding
  • Hematoma (localized bruising/bleeding under the skin)
  • Nerve damage
  • Allergic reaction

In case of complications, patients can contact the clinic within 24 hours after the procedure.
For emergencies, please report to the nearest emergency department.