Disclosures: William F. Brady, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 64-year-old male with refractory, post-operative shoulder pain.

Case Description: A 64-year-old male with history of shoulder surgery x5 is referred to the PM&R clinic for refractory left shoulder pain. He rates pain 6/10 at rest and 10/10 with minimal movement. Pain is described as sharp and burning in character and is managed with Percocet 7.5/325mg taken up to 6 times per day. He has attempted physical therapy as well as corticosteroid injections without improvement and requires moderate to maximum assistance with activities utilizing the left arm. No further surgical intervention is recommended by his orthopedist. On exam the left arm appears well-perfused without cyanosis. There is atrophy of the infraspinatus, and he exhibits diffuse tenderness to palpation along the posterior and anterior aspects of the shoulder. Range of motion (ROM) is globally diminished. Motor strength is greatly diminished secondary to pain. Patient agreed to undergo peripheral nerve stimulator (PNS) placement utilizing a SPRINT® lead system. A single lead was placed overlying the left suprascapular nerve near the suprascapular notch utilizing ultrasound guidance.

Setting: Physical Medicine and Rehabilitation (PM&R) Outpatient Clinic, Outpatient Procedure SuiteAssessment/

Results: At 4-week follow-up the patient reported 100% pain relief without complication and was independent with use of the left upper extremity. On exam, he was able to actively flex and abduct the shoulder to approximately 150°. At 8-week follow-up, results were reconfirmed, and the lead was safely removed. These findings remained unchanged at 12-week follow-up, and he was able to decrease his narcotic needs by 33%.

Discussion: The patient was able to obtain significant and sustained pain relief with minimally invasive neuromodulation, and he demonstrated improved function with decreased narcotic usage.

Conclusion: In the treatment of chronic postoperative pain of the shoulder, PNS is a viable treatment option that warrants further consideration and application, particularly in targeting the suprascapular nerve.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/peripheral-nerve-stimulation-in-the-treatment-of-refractory-postoperative-shoulder-pain-a-case-report/