Peripheral Nerve Stimulation of the Shoulder: A Technical Primer

Abstract

Sailesh Arulkumar,1 Elisa E Neuchat,2 Eric Ly,3 Austin Ingwei Ly,4 Kiana Fahimipour,5 Mehul J Desai6,7 1Department of Anesthesiology, SSM Health, St. Anthony’s Hospital, Oklahoma City, OK, USA; 2School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, USA; 3Department of Anesthesiology, Brown University, Rhode Island Hospital, Providence, RI, USA; 4The University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA; 5Department of Anesthesiology; Louisiana State University Health Sciences Center at New Orleans, New Orleans, LA, USA; 6International Spine Pain & Performance Center, Washington, DC, USA; 7George Washington University School of Medicine and Health Sciences, Washington, DC, USACorrespondence: Mehul J Desai, International Spine Pain and Performance Center, 2021 K Street NW Suite 615, Washington, DC, 20006, USA, Tel [phone], Fax [phone], Email [email protected]: Scapulalgia or shoulder pain accounts for 16% of all musculoskeletal complaints in the healthy adult population and becomes more common as we age. When this pain exceeds 3 months in duration, it is deemed to be chronic, and typically treated in an escalating manner. Spanning a continuum of conservative and non-conservative measures, chronic shoulder pain treatments range from rest and physical therapy to surgery. Since each patient presents with a unique spectrum of symptoms a customized treatment plan is often required. Over the lifetime of many of these patients, a variety of treatment options are required. One of these treatment options, peripheral nerve stimulation (PNS), is a minimally invasive procedure in which an electrical impulse is delivered through a percutaneously implanted, small caliber electrode to a peripheral nerve proximal to the lesion which interferes with the pain signals. Over the past several years, significant growth of PNS in the treatment of chronic neuropathic pain has been observed. However, the procedural techniques have not been well described. The foundation of long-term, minimally invasive percutaneous PNS in patients with chronic shoulder pain, and procedural techniques for stimulating the suprascapular and axillary nerves using fluoroscopy or ultrasonography will be described in this report.Keywords: scapulalgia, shoulder pain, chronic pain, suprascapular nerve, axillary nerve, peripheral nerve stimulation

Keywords

• scapulalgia
• shoulder pain
• chronic pain
• suprascapular nerve
• axillary nerve
• peripheral nerve stimulation