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Pain and Spine Medicine

(Kiosk 5) Peripheral Nerve Stimulation (PNS) for Dorsal Scapular Neuropathy: A Case Report

Saturday, November 18, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • Nathan P. Jarrett, MD

    Resident Physician
    Indiana University School of Medicine PM&R Program
    Indianapolis, Indiana

    • Co-Author(s)

  • Wyeth Brock, Other

    Author
    Indiana University School of Medicine
    Indianapolis, Indiana

  • Shashank Dave, DO

    Associate Clinical Professor
    Indiana University School of Medicine PM&R Program
    Indianapolis, Indiana

Case Diagnosis: Refractory periscapular pain due to Dorsal Scapular Nerve (DSN) entrapment

Case Description or Program Description: The patient is a 69-year-old female with chronic, right-sided medial periscapular pain for nearly 10 years. There was no inciting event. Her physical exam was unremarkable, and an extensive workup including an MRI showed only mild degenerative changes of the spine. Her symptoms persisted despite topical and oral medications, massage, chiropractic, physical therapy, acupuncture, dry needling, trigger point injections, epidural steroid injections, botulinum toxin, and cervical radiofrequency neurotomy. After further evaluation, her pain was suspected to be due to DSN entrapment. A subsequent diagnostic ultrasound-guided DSN block with 0.25% bupivacaine imparted 100% pain relief for 6 hours. She then underwent placement of a SPRINT PNS system adjacent to her DSN.

Setting: Academic outpatient clinic

Assessment/Results: The patient experienced >80% pain relief sustained throughout the 60-day duration of treatment and for at least another 30 days at the time of follow up.

Discussion (relevance): The dorsal scapular nerve is the motor supply to the rhomboids and levator scapulae. DSN entrapment is a known but possibly underdiagnosed etiology of periscapular pain; one study of patients with unilateral interscapular pain showed electrodiagnostic changes of the DSN in 52.7% of participants. The SPRINT PNS device is approved for use up to 60 days, providing relief from chronic pain by stimulating targeted afferent nerve fibers to modulate pain signals directly or indirectly via transduction of the physiologic response to efferent fiber stimulation.

Conclusions: Clinicians should increase their awareness of DSN entrapment in the setting of refractory unilateral interscapular pain, as it may be managed with diagnostic nerve block and peripheral nerve stimulation. To our knowledge, this is the first successful case report of peripheral nerve stimulation used to treat dorsal scapular neuropathy.