Percutaneous implantation of a brachial plexus electrode for management of pain syndrome caused by a traction injury.

Introduction.  Intractable pain in the affected arm is a common sequel to severe traction lesions of the brachial plexus. Its management presents a challenge. Existing interventional therapies are not effective for the intractable pain from brachial plexus traction lesions, in the long term. Spinal cord stimulation is indicated for the relief of pain following peripheral nerve injury, but has its limitations and, in the UK, is restricted only to specialized centers. Peripheral neuromodulation is widely practiced noninvasively as transcutaneous electrical nerve stimulation and more recently, both as external neuromodulation and, invasively, using a surgical procedure with restricted indications. Methods.  We report here a single case report of the successful management of intractable pain of uncertain pathology following traction injury of the shoulder and brachial plexus with the percutaneous implantation of a permanent stimulating electrode via a stimulating needle to the brachial plexus using the posterior route at the interscalene level. Results.  Stimulation of the brachial plexus in this one patient has resulted in excellent pain control and unexpected beneficial sensory and motor changes in the arm of the patient. Conclusions.  We cautiously conclude that percutaneous implantation of a stimulating electrode to the brachial plexus via a stimulating needle is a relatively simple procedure when compared to surgical implantation and, as shown in our case, very effective.