Peripheral Nerve Stimulation of the Shoulder: A Technical Primer

Abstract

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

Acknowledgments

Jane Moore, MS, ELS, MSRM, LLC, provided writing and editing assistance, and formatted the manuscript for journal style under the direction of S.A. and M.J.D., funded by Nalu Medical. We acknowledge the intellectual contributions of Elise M. Bradley, PhD, Louisiana State University Health Sciences Center.

Disclosure

SA has received consulting fees from Nalu Medical for providing educational services, including serving on the speakers’ bureau. MJD has received research funding from Abbott, Amgen, Bioness, Mainstay, Nalu, Nature Cell, Nevro, Seikagaku, SPR Therapeutics, and Vivex; serves as a consultant for Abbott, Avanos and Relievant; Stock ownership/options in SPR Therapeutics, SynerFuse, and Virdio. All other authors have no conflicts of interest to disclose for this work.

Additional information

Funding

Nalu Medical, Carlsbad, CA.