Peripheral Nerve Stimulation of the Axillary Nerve Improves Chronic Shoulder Pain and Dysfunction After Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty is an effective procedure to improve shoulder pain, range of motion, and function for a variety of conditions, including glenohumeral osteoarthritis and rotator cuff arthropathy. However, up to 22% of patients have persistent shoulder pain 12-24 mos after reverse total shoulder arthroplasty, even in the absence of surgical complications. Currently, there are no widely accepted nonpharmacological treatments for persistent postoperative pain after reverse total shoulder arthroplasty. This case report details the successful management of a 64-yr-old woman with chronic postoperative shoulder pain after reverse total shoulder arthroplasty. She was treated with single-lead percutaneous peripheral nerve stimulation to the right axillary nerve for 8 wks with 12 Hz motor-level stimulation. She demonstrated improvement in shoulder flexion active range of motion, shoulder flexion strength, and shoulder abduction strength. Her Shoulder Pain and Disability Index total score improved from 26.93% to 8.46% 1 yr after treatment. She reported an overall Global Rating of Change of +7 one year after treatment. This case's success demonstrates that short term peripheral nerve stimulation may provide long-term improvement of persistent postoperative pain and dysfunction in patients with painful reverse total shoulder arthroplasty.