Comparing neuromodulation modalities involving the suprascapular nerve in chronic refractory shoulder pain: retrospective case series and literature review

Case report: Movement analysis in oncological rehabilitation: proposal of a kinematic and surface electromyographic protocol in breast oncology

Introduction

Breast cancer disease often affects the ipsilateral shoulder joint, with pain and joint limitation. Proper pain management, which can be obtained using, for example, pulsed radiofrequency of the suprascapular nerve, can help the physiotherapist mitigate patient pain. The modern technologies of kinematic analysis and surface electromyography of movement analysis can give further support in building a personalized rehabilitation program, based on the quantitative study of movement, in this case of the upper limb.

Methods

A brief case report was conceived to develop and test the evolution of a shoulder joint analysis protocol based on an inertial accelerometer and non-invasive surface electromyography.

Results

An analysis algorithm was defined to adapt to the needs of patients operated on at the breast based on a kinematic component (ROM - range of movement - and Jerk index) and an electromyographic one (study of muscle behavior in groups of four). The coactivations were also evaluated, both as an average value and in graphical form, to offer the physiotherapist a complete overview of the movement of the upper limb.

Discussion

The promising protocol results underline its strengths, including the simplicity of use, combined with the reduced time required for processing the reports and the portability of the PC-sensors complex, making these analyses potentially valuable for patient care.

Peripheral Nerve Stimulation in Painful Conditions of the Upper Extremity-An Overview

Our objective is to present a brief history of the evolution of peripheral nerve stimulation, the current understanding of peripheral nerve stimulation mechanisms in chronic pain, peripheral nerve stimulation applications in upper extremity chronic pain conditions, and complications of peripheral nerve stimulation. The evolution of peripheral nerve stimulation from the early ages to the current status has been facilitated by discoveries in neurobehavioral mechanisms of pain, advances in technology and percutaneous lead development, and the availability of high-quality portable ultrasound units. Peripheral nerve stimulation application in managing upper extremity pain of amputated limbs, post-stroke shoulder pain, complex regional pain syndrome (CRPS), and median, ulnar, and radial neuropathies are discussed. Finally, we describe complications of peripheral nerve stimulation. The availability of ultrasound-guided peripheral nerve stimulation techniques and superior peripheral nerve stimulation technology have opened up new and minimally invasive treatment options for chronic intractable neuropathic pain of the upper extremity. Additionally, the ability to place peripheral nerve stimulation leads percutaneously without open peripheral nerve surgery expands the pool of implanting physicians, while simultaneously decreasing the risks and complications that are associated with open surgery.

Outcomes after minimally invasive and surgical management of suprascapular nerve entrapment: A systematic review

BACKGROUND

The prevalence of suprascapular neuropathy is higher than previously estimated. Recent literature highlights a myriad of treatment options for patients ranging from conservative treatment and minimally invasive options to surgical management. However, there are no comprehensive review articles comparing these treatment modalities.

OBJECTIVE

The purpose of this review article is to summarize the current state of knowledge on suprascapular nerve entrapment and to compare minimally invasive treatments to surgical treatments.

METHODS

The literature search was performed in Mendeley. Search fields were varied redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. A full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached.

RESULTS

Recent studies have further elucidated the pathoanatomy and described several risk factors for entrapment ranging. Four studies met our inclusion criteria regarding peripheral nerve stimulation with good pain and clinical outcomes. Two studies met our inclusion criteria regarding pulsed radiofrequency and showed promising pain and clinical outcomes. One study met our inclusion criteria regarding transcutaneous electrical nerve stimulation and showed good results that were equivalent to pulsed radiofrequency. Surgical treatment has shifted to become nearly all arthroscopic and surgical outcomes remain higher than minimally invasive treatments.

CONCLUSIONS

Many recently elucidated anatomical factors predispose to entrapment. A history of overhead sports or known rotator cuff disease can heighten a clinician's suspicion. Entrapment at the suprascapular notch is more common overall, yet young athletes may be predisposed to isolated spinoglenoid notch entrapment. Pulsed radiofrequency, peripheral nerve stimulation, and transcutaneous electrical nerve stimulation may be effective in treating patients with suprascapular nerve entrapment. Arthroscopic treatment remains the gold-standard in patients with refractory entrapment symptoms.

Cancer Pain Management-New Therapies

PURPOSE OF REVIEW

Despite the rapid advance in anti-cancer treatment in recent years, the treatment to cancer-related pain remains largely unchanged. One systemic review has shown that approximately 32% of patient with cancer-related pain were undertreated. While in patients responding to strong opioids, long-term use of opioids will lead to many undesired side effects such as constipation, tolerance, and addiction. The goals of this review are to re visit the current algorism of cancer pain management and bring attention to the emerging interventional pain management techniques.

RECENT FINDINGS

Peripheral nerve stimulation (PNS) has been successfully used to treat certain types of chronic non-cancer pain with long-term analgesic effect. PNS has also brought some promising results in treating localized cancer-related pain in a pilot study. More studies are needed to advance the novel and safe treatment of cancer-related pain. Incorporating interventional techniques such as PNS properly can optimize the current treatment strategy and improve outcomes.