Assistant Professor Shirley Ryan AbilityLab Chicago, Illinois, United States
Case Diagnosis: 75 year-old female with C7 AIS C Brown Sequard spinal cord injury (SCI) from 1980 who presents for bilateral, left >right, shoulder pain. Pain ongoing and worsening over past 5 years which has decreased independence in activities of daily living (grooming, bathing, dressing, and transferring). She failed conservative medical management of NSAIDs, baclofen, pregabalin, and duloxetine. Orthopedic surgery recommended physical therapy; however, progress was limited due to pain. X-rays showed bilateral osteoarthritis and MRI showed left rotator cuff tear. Patient’s physical exam consistent with bilateral adhesive capsulitis with limited shoulder active/passive range of motion most significant in forward flexion and abduction. Discussed available options with patient; orthopedic surgery not recommending surgical intervention, intra-articular steroid injection decided against in setting of osteoporosis, and peripheral nerve stimulation (PNS).
Case Description: Under fluoroscopy, left suprascapular and axillary nerve blocks performed with complete relief and subsequently two temporary percutaneous PNS leads were placed for 60 days. The same procedures were repeated on the right following left PNS removal. Left PNS provided 70-80% relief, right PNS provided 50-60% relief, and both improved patient’s capabilities in physical therapy to improve activities of daily living.
Discussions: Chronic pain can cause maladaptive cortical plasticity leading to decreased physical activity and subsequent disuse resulting in more pain. PNS is proposed to recondition the primary somatosensory cortex via constant afferent input for selective target neuroplasticity. The goal of successful PNS is to provide pain relief lasting well beyond the PNS placement period. This patient continues to have substantial shoulder pain relief; 75% on left at 11 months and 60% on right at 9 months post-PNS removal.
Conclusions: PNS is a minimally invasive, temporary implant to treat chronic shoulder pain that can provide long-lasting pain relief. This is an important treatment option for SCI patients that have increased/altered strength and flexibility demands of the shoulders.
