Neuromodulation of the Suprascapular Nerve

Chronic intractable shoulder pain (CISP) is defined as shoulder pain which is present for longer than 6months and does not respond to standard treatments like medication, physical therapy, rehabilitation,selective nerve blocks and local infiltrations, or orthopedic procedures. The etiology of CISP maybe very diverse, varying from many orthopedic conditions to non-orthopedic conditions. The factthat the suprascapular nerve is one of the most important nerves supplying the shoulder regionmakes this nerve an interesting target in treating patients suffering shoulder pain. Invasive treatmentoptions are peripheral nerve blocks, temporary electrical stimulation, and neurostimulation. Toour best knowledge, thus far there are only a few reports describing the technique of permanentneurostimulation of the suprascapular nerve. In this article we present a patient suffering shoulderpain after she underwent surgery for cervical stenosis. After a step by step treatment protocol wasdone, we finally offered her trial stimulation of the suprascapular nerve. A single quad lead wasimplanted via a posterior approach under fluoroscopic and ultrasound guidance. Two weeks aftersuccessful stimulation, we implanted a permanent neuromodulation system.Permanent neurostimulation of the suprascapular nerve and its end branches may be a new interestingtarget in treating patients suffering shoulder pain due to various etiologies. In our patient the followup period is 9 months with an excellent result in pain relief, we observed no complications thus far,especially no dislocation or breakage of the lead. In this report, literature on this subject is reviewed, andour technique is well documented with additional anatomical illustrations.Key words: Suprascapular nerve, shoulder pain, peripheral nerve stimulation, neuromodulation,neurostimulation, chronic pain