Implanted Peripheral Nerve Stimulation Improves Persistent Postoperative Pain and Disability Following Reverse Total Shoulder Arthroplasty: A Case Report

Research Objectives: To describe outcomes of a patient treated with peripheral nerve stimulation (PNS) for persistent pain following reverse total shoulder arthroplasty (rTSA).

Design: Observational

Case Report: describing interventions performed clinically for one patient. Patient’s shoulder arthroplasty surgery was on 10/19/21. PNS device implanted from 9/29/22 to 11/28/22, with follow-up until 5/8/23.

Setting: Outpatient ambulatory care clinic at an academic medical center.

Participants: The patient is a 64-year-old non-Hispanic white female. She worked as a Quality Control Manager before retiring at age 52. She initially presented to our institution in 2016 with right shoulder pain of insidious onset, originally diagnosed by an orthopedic surgeon as calcific tendinitis, and underwent arthroscopic subacromial decompression. In late 2021, she developed pain and weakness of insidious onset. MRI arthrogram confirmed supraspinatus and infraspinatus tear, and she underwent rTSA. Despite uncomplicated surgery, physical therapy for 9 months and trigger point injection, she experienced persistent pain and muscle hypertonicity of the trapezius and deltoid.

Interventions: The SPRINT Peripheral Nerve Stimulator was implanted from 9/29/22 to 11/28/22, starting 11 months post-surgery. PNS device parameters included frequency of 12 Hz, duration of 12 hours/day, and an intensity adjusted to tolerance. The patient additionally underwent 4 physical therapy visits during the time of implant.

Main Outcome Measures: Global Rating of Change, Shoulder Pain and Disability Index

Results: The SPADI is a 13-item questionnaire with a higher score indicative of greater pain and disability. A SPADI score of 35 is expected 12 months after rTSA. Our patient began at 35 during the start of PNS treatment and improved to 32 after 2 months of PNS treatment. She continued to improve and maintained at 23 both 3 and 6 months after explant. She reported a Global Rating of Change of +6, a Great Deal Better, 6 months following device explant.

Conclusions: Our report describes a successful outcome of PNS treatment for persistent pain following rTSA, with improved SPADI score and GROC. Larger trials are needed to confirm the efficacy of the device.

Author(s) Disclosures: No known disclosures.