We would like to thank Dr. Russo and colleagues (Russo et al., 2021) for their interest in our publication (Pushparaj et al., 2021) and for their insightful comments. Dr. Russo and his colleagues are correct in stating our meta-analysis of seven RCTs did not show analgesic benefit of pulsed radiofrequency (pRF) neuromodulation for chronic shoulder pain over conservative medical management (CMM). As noted by Dr. Russo and colleagues, heterogeneity in ‘conventional medical management’ in the included studies was considerable. Though a meta-analysis that does not include the data from Eyigor study (Eyigor et al., 2010) may yield different results, we recommend focusing on the qualitative analysis of the results as summarized in the letter by Dr. Russo et al.

Our objective in performing the systematic review and meta-analysis was to evaluate the role of radiofrequency procedures (ablative and neuromodulatory) performed for chronic shoulder pain that arises from the glenohumeral joint (GHJ) and the acromioclavicular joint. The complex structure and innervation of the shoulder joint, as compared to the knee and the hip joint, make it a challenging target for denervation. As stated in our publication, and as echoed by Dr. Russo and colleagues, adequately powered RCTs of a high quality that include procedures on the shoulder joint based on appropriate anatomical knowledge and address long-term functional outcomes are required.

我们要感谢 Russo 博士及其同事（Russo 等人，  2021 年）对我们的出版物（Pushparaj 等人，2021年）的兴趣 以及他们富有洞察力的评论。Russo 博士及其同事正确地指出，我们对七项 RCT 的荟萃分析并未显示脉冲射频 (pRF) 神经调节对慢性肩痛的镇痛效果优于保守医学治疗 (CMM)。正如 Russo 博士及其同事所指出的，纳入研究中“传统医疗管理”的异质性相当大。尽管不包括 Eyigor 研究（Eyigor 等人，2010 年）数据的荟萃分析 可能会产生不同的结果，但我们建议重点关注 Russo 博士等人在信中总结的结果的定性分析。

我们进行系统评价和荟萃分析的目的是评估射频手术（消融和神经调节）对由盂肱关节 (GHJ) 和肩锁关节引起的慢性肩痛的作用。与膝关节和髋关节相比，肩关节的复杂结构和神经支配使其成为去神经支配的一个具有挑战性的目标。正如我们的出版物中所述，并且正如 Russo 博士及其同事所回应的那样，需要足够有力的高质量 RCT，包括基于适当解剖学知识的肩关节手术并解决长期功能结果。