P017: PERIPHERAL NERVE STIMULATOR FOR THE TREATMENT OF RADIATION INDUCED ADHESIVE CAPSULITIS OF THE SHOULDER
Oleg Desyatnikov, DO1; Brandon Valls, OMS2; Leon Anijar, MD3; 1Department of Anesthesiology, Kendall Regional Medical Center; 2Lake Erie College of Osteopathic Medicine- Bradenton; 3Spine and Wellness Centers of America, Miami Beach
Introduction: Radiation induced adhesive capsulitis is a known complication of radiation therapy and has few effective treatments reported in literature. The shoulder joint is a complex mechanical structure with a wide range of motion, but derives sensory innervation primarily from the suprascapular and axillary nerves. Thus, the peripheral nerve stimulator treatment modality is often employed in the treatment of other shoulder joint pain syndromes commonly affecting the population. We present a case of neuromodulation of the suprascapular nerve as a treatment for radiation induced adhesive capsulitis in a patient who has otherwise failed conservative care and is taking high dose opioids for pain control.
Case Report: A 74-year-old male, with extensive history of left axillary squamous cell carcinoma status post lymph node dissection and radiation therapy ten years prior complicated by infection and lymphedema, presents to an outpatient interventional pain clinic with symptoms of significant left brachial plexopathy and left shoulder adhesive capsulitis. The patient has been evaluated by numerous surgeons and surgical oncologists who feel the patient is not a good surgical candidate given the significant radiation injury due to radiation therapy. The patient experiences significant left shoulder and arm pain that limit his activities of daily living, such as dressing himself and feeding himself. The patient has tried a number of joint injections and nerve ablations without significant relief. The patient is also on a pain regimen he wishes to wean due to significant side effects. After discussing the plan with the patient, a peripheral nerve stimulator trial of the left suprascapular nerve was placed. In the trial period the patient reported significant reduction in shoulder pain as well as improvement in his activities of daily living. The patient decreased his opioid consumption. The patient was subsequently scheduled for permanent stimulator placement.
Discussion: Our case provides an example of the successful treatment of chronic left shoulder pain due to adhesive capsulitis. Although similar cases have been published, we present an otherwise healthy and opioid naïve patient prior to his diagnosis and treatment of left axillary squamous cell carcinoma that left him with a chronic pain syndrome that was both poorly controlled and inoperable. The patient was a candidate for peripheral nerve stimulator trial and benefited during the trial period with significant reduction in overall pain as well as significant improvement in his activities of daily living. The patient is now scheduled for placement of the micro implantable pulse generator for continued relief.
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