Case Studies

Before & After Case Reports of Our Patient Treatments

We are a medical-first, holistic clinical practice with a wide range of healthcare degrees. We continually advance our education and push the limits of our knowledge to serve our patients with the most advanced preventive and non-invasive medical care available. Evidence-based practice is the foundation of our work, and we strive to be objective in reviewing each and every treatment after patients go home, so we can assess their results, learn from them and improve for the future. We listen to each patient, encouraging them to share their experiences, and have compiled several of those case reports here.

Since our founding in 2016, we have been recording our clinical results, continuously tracking patient responses and refining our protocols to deliver optimal quality care. Our goal is to stop the progression of conditions like arthritis and work toward shrinking, reducing, or even reversing them. For instance, research indicates that a molecule in our bodies called alpha-2-macroglobulin (A2M) plays a role in halting the progression of arthritis. By learning from this research and harnessing the body’s healing capabilities, we aim to support our patients on the most efficient path to healing, allowing the body to rebuild cartilage and surrounding tissues naturally.

Stellate Ganglion Block

2020

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

13 April 2020 

Carol Hanselman Bender, RNP 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem 

Post-Traumatic Stress Disorder (PTSD) 

Intro 

Patient is a 32-year-old female, who experienced a traumatic health scare ten years ago and had since struggled with anxiety and insomnia. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; her pre-block score was 51. 

After discussion of the procedure with the JWP staff, the patient requested the stellate ganglion block treatment, hoping to improve her sleep and reduce her anxiety. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C6 and C4 nerve roots. 

Treatment 

Under ultrasound guidance, 7 mL 0.5% Ropivacaine was injected over the C6 nerve root and then 6 mL 0.5% Ropivacaine was injected over the C4 nerve root on the right side of the neck by NP Bender. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

Two months after the treatment, the patient reported that although she slept worse for the first five nights following the SGB, her sleep has since improved and is notably better on a consistent basis. She also stated her mental clarity and overall energy has increased. 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Level of PainPre-StellatePost-Stellate
PCL score5140
% Reduction in PTSD Symptoms22%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block was a clinically meaningful solution to the patient’s PTSD symptoms, as demonstrated by the 11 point reduction in the patient’s PCL score5

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

9 April 2020 

Carol Hanselman Bender, RNP 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Posttraumatic Stress Disorder (PTSD) 

Intro 

Patient is a 30-year-old male veteran who had dealt with childhood anger issues that were exacerbated by his military service, in which he sustained a Traumatic Brain Injury (TBI). In recent years he had started self medicating with various drugs to try to help with his anxiety and depression. The PTSD Checklist, known as the PCL, was given to the patient2; his pre-treatment score was 71. 

After discussion of the procedure with the JWP staff, the patient requested the Stellate Ganglion Block treatment, hoping to increase his motivation to care for his physical wellbeing. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C6 and C4 nerve roots. 

Treatment 

Under ultrasound guidance, 7 mL 0.5% Ropivacaine was injected over the C6 nerve root and then 6 mL 0.5% Ropivacaine was injected over the C4 nerve root on the right side of the neck NP Bender. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

The night after the procedure, the patient reported getting a restful nine and a half hours of sleep, when typically his hyper-vigilance and nightmares prevented him from sleeping through the night. 

Two months after the treatment, the patient stated that he feels like, “an 80-ton truck has been lifted off of my body.” A classmate who hadn’t seen him since the prior semester – before he received the SGB – noted that the patient “looked amazing.” He also stopped self-medicating with prescription drugs and alcohol. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of PainPre-StellatePost-Stellate
PCL score712
% Reduction in PTSD Symptoms97%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was a clinically meaningful solution to the patient’s PTSD symptoms, as demonstrated by the 69 point reduction in the patient’s PCL-5 score5

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

2019

Joy Wellness Partners

Stellate Ganglion Block1 (SGB)

Case Report

28 June 2019

Carol Bender, RNP

Taina Danahy, BrainCore Neurofeedback Provider

Peggy McGill, FRNP

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem

Depression & sleep problems

Intro

Patient is a 25-year-old who presented to JWP for a right-side SGB. He stated that he came out as gay when he was 12 and suffered bullying and ridicule ever since. He reported severe sleep problems and anxiety, as well as depression and overall mental fogginess. 

The patient’s quantitative electroencephalogram (qEEG), given by Danahy, the BrainTrain specialist at JWP, showed that his Delta wave was fully engulfed with worry and anxiousness. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient; his pre-SGB score was 38.

After discussion of the procedure with the JWP staff, the patient requested the right-sided SGB treatment, hoping to improve his overall mental clarity and functionality.

Diagnosis

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery, using a high-resolution ultrasound. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots.

Treatment

Under ultrasound guidance, 9 mL 0.5% Ropivacaine was injected by FRNP McGill through the anterior scalene, over the C5 nerve root and under the internal jugular vein on the right side of the neck. The target was confirmed, the needle was visualized throughout the entire approach as well as the bolus in the desired fascial plane. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted.

Follow-up

Post-treatment, the patient reported a five point reduction in his PCL checklist score. While he still struggles with his symptoms, colleagues have reported a notable improvement in his demeanor at work.

Results

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Level of PainPre-StellatePost-Stellate
PCL Score3833
% Reduction in PTSD Symptoms13%

Conclusion

In conclusion, it was found that the Stellate Ganglion Block injection was a moderately effective solution to the patient’s PTSD symptoms, as demonstrated by the 13% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

3 January 2019 

Carol Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Chronic Anxiety & Post-Traumatic Stress Disorder (PTSD) 

Intro 

The patient reported having PTSD symptoms as a result of experiencing multiple life-threatening events, including being attacked by a rocket propelled grenade and two improvised explosive devices, during his time spent serving as an infantryman in the United States Army. He stated he consumed alcohol every night to help him fall asleep, and felt constantly stressed and worried while awake. He said he was motivated to seek help and find treatment for his PTSD because of his 3-year-old daughter. The patient’s quantitative electroencephalogram (qEEG), given by Danahy, the BrainTrain specialist at JWP, showed that his brain was 75% consumed in a stress and anxiety state. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-stellate score was 40. 

After discussion of the procedure with the JWP staff, the patient requested the stellate ganglion block treatment, aimed at relieving his chronic anxiety and stress. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 9 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

Immediately following the treatment, the patient reported feeling incredible relief. 

At his follow-up, the patient stated feeling incredibly happy since the treatment. He noted that his reflexes had dramatically improved, an enhanced ability to perform his profession and, most importantly, an increased ability to cultivate his relationship with his daughter. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

PCL Score 

40 

23

% Reduction in PTSD Symptoms 

42%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 42% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

2018

Joy Wellness Partners

Stellate Ganglion Block (SGB)

Case Report

29 October 2018

Carol Bender, RNP

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem

Post-Traumatic Stress Disorder (PTSD)

Intro

The patient reported experiencing PTSD in childhood, with the effects continuing into adulthood. He stated that there had been significant improvements in his symptoms over the past few years, but wanted to better his stress management.

 The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient; his pre-treatment score was 42.

After discussion of the procedure with the JWP staff, the patient requested the stellate ganglion block treatment to restore his sleep and improve his brain functionality.

Diagnosis

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery, using a high-resolution ultrasound. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots.

Treatment

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the left side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted.

Follow-up

The patient reported feeling substantial relief after the treatment, most notably in his demeanor. His wife stated that he was no longer biting his nails, his responses to mishaps throughout the day were far less dramatic and he returned to a calm state more quickly.

Results

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Level of PainPre-StellatePost-Stellate
PCL Score4213
% Reduction in PTSD Symptoms69%

Conclusion

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 69% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

1 December 2018 

Carol Hanselman Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Post-Traumatic Stress Disorder (PTSD) 

Intro 

The patient reported a history of PTSD symptoms and a traumatic brain injury (TBI) during his time spent as a special warfare operations specialist in the United States military. He stated that being married and raising twins has added to his overall stress. 

The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-treatment score was 35. 

After discussion of the procedure with the JWP staff, the patient requested the Stellate Ganglion Block treatment hoping to restore his sleep, improve overall mood and enhance his familial relationships. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

After the treatment, the patient reported a significant improvement in his quality of sleep; he no longer experiences difficulty falling or staying asleep. He also no longer needs to wear headphones at night to block out sound. He stated he is dreaming every night and wakes up feeling completely rested. The patient noted having an increased amount of patience as well as a heightened ability to control his reactions to situations that trigger his aggression and irritability. At a recent gathering, his family noticed (without mention that he’d undergone the SGB treatment) that he seemed much kinder and happier. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

PCL Score 

35 

24

% Reduction in PTSD Symptoms 

31%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 31% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners (JWP) 

Stellate Ganglion Block1 (SGB) 

Case Report 

25 November 2018 

Carol Hanselman Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Autoimmune diabetes (type 1), Hypothyroidism, Anxiety and Chronic Fatigue Syndrome 

Intro 

The patient reported exhaustion after years of mothering (from a very young age) and feeling responsible for the happiness of her loved ones. The patient’s quantitative electroencephalogram (qEEG) showed she had chronic worry, stress and anxiety. Danahy, the BrainTrain specialist at JWP, recommended an SGB to see if her brain waves could be reset and repaired after a lifetime of self-imposed angst. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; her pre-stellate score was 34. After discussion of the procedure with the JWP staff, the patient requested the SGB treatment, hoping to to restore her sleep, calm her anxiety and improve her brain functionality. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

Two weeks after the treatment, the patient reported having clearer mental focus and less anxiety. She stated that she was able to dream for the first time in years, which is evidence of REM sleep, when the brain repairs itself and regains valuable neuroplasticity. Overall, the patient has a heightened ability to enjoy the present moment. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

   

PCL Score 

34 

22

% Reduction in PTSD Symptoms 

35%

Conclusion 

In conclusion, it was found that the ultrasound-guided Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 35% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

15 December 2018 

Carol Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Post-Traumatic Stress Disorder (PTSD) 

Intro 

The patient reported having PTSD from her profession as a military nurse at Walter Reed Medical Center and her stressful time in nursing school. She stated that she experienced insomnia, anxiety at work and the inability  to relax at work. 

The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; her pre-stellate score was 25. After discussion of the procedure with the JWP staff, the patient requested the SGB treatment to restore her sleep and improve her work-life balance. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

The patient reported feeling significant relief from the Stellate Ganglion Block. She reported that her sleep had improved considerably. Her partner stated that she was no longer sleepwalking at night to “hang IV medications for her patients,” and she was effectively handling the stress of her nursing job. The stressors in her life were no longer overwhelming her and preparations for her upcoming wedding had become easier to manage. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

PCL Score 

25 

21

% Reduction in PTSD Symptoms 

16%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 16% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

15 November 2018 

Carol Hanselman Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Post-Traumatic Stress Disorder (PTSD) & Chronic Adrenal Fatigue 

Intro 

The patient had a history of long-term burnout, impaired memory function and PTSD. He believed the stress of running a large business firm with over 500 employees had led to overall mental, physical and emotional exhaustion. The patient also reported suffering abuse from his father during his adolescence. 

The patient’s first quantitative electroencephalogram (qEEG) was given by Danahy, the BrainCore Neurofeedback provider at JWP; it showed that his Beta waves were 95% consumed in PTSD. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-stellate score was 55. 

After discussion of the procedure with the JWP staff, the patient requested the right-side SGB treatment to increase his energy, mental clarity and overall brain functionality. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

The patient had a follow-up qEEG the same day as the treatment to assess the immediate effects of the SGB. His brain had already started the reorganizing process by almost 70%, with an overall restructuring change of 34%. A few weeks after the treatment, the patient reported feeling more focused and alert to tasks that needed to be completed, along with a heightened sense of calm. He still struggled with his sleep and his intimate relations with others, but the fogginess in his brain had lifted and his mental performance had highly improved. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

PCL Score 

55 

40

% Reduction in PTSD Symptoms 

33%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 33% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

15 November 2018 

Carol Hanselman Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Post-Traumatic Stress Disorder (PTSD) & Chronic Adrenal Fatigue 

Intro 

The patient had a history of experiencing long-term burnout, impaired memory function and PTSD. He believed the stress of running a large business firm with over 500 employees had led to overall mental, physical and emotional exhaustion. The patient also reported suffering abuse from his father during his adolescence. 

The patient’s first quantitative electroencephalogram (qEEG) was given by Danahy, the BrainCore Neurofeedback provider at JWP, and it showed that his Beta waves were 95% consumed in PTSD. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-stellate score was 55. 

After discussion of the procedure with the JWP staff, the patient requested the right-side SGB treatment to increase his energy, mental clarity and overall brain functionality. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

The patient had a follow-up qEEG the same day as the treatment to assess the immediate effects of the SGB. His brain had already started the reorganizing process by almost 70%, with an overall restructuring change of 34%. A few weeks after the treatment, the patient reported feeling less stressed and more focused and alert to tasks that needed to be completed, along with a heightened sense of calm. He still struggled with his sleep and his intimate relations with others, but the fogginess in his brain had lifted and his mental performance had greatly improved. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

PCL Score 

55 

40

% Reduction in PTSD Symptoms 

33%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 33% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

15 December 2018 

Carol Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Post-Traumatic Stress Disorder (PTSD) 

Intro 

A year prior, the patient was hit by a moving vehicle while he was pushing his daughter in a grocery cart across a pedestrian crosswalk; the driver of the vehicle was reportedly on her cellphone at the time. The patient suffered multiple injuries from the force of the impact. However, he stated that the most debilitating factor of the stressful situation was the fact that both he and his daughter’s lives were in immediate danger. He reported that since the accident, his daughter had lost trust in him, and he’d been experiencing guilt, depression and hyper vigilance. 

The patient’s quantitative electroencephalogram (qEEG), given by Danahy, the BrainTrain specialist at JWP, showed that his brain was consistently operating in a state of chronic worry, stress and anxiety. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-treatment score was 79, clearly indicating severe PTSD. 

After discussion of the procedure with the JWP staff, the patient requested the Stellate Ganglion Block treatment hoping to increase his energy, mental clarity and overall brain functionality. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the left side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

Six weeks after the treatment, the patient reported a massive relief from stress and anxiety. He noticed a significant improvement in his strength, cardiovascular endurance and reaction time during physical activities. His wife stated that he was considerably calmer and more level-headed. The patient was very pleased with his current mental and physical state. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

PCL Score 

79 

42

% Reduction in PTSD Symptoms 

47%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 47% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

2017

2016

Joy Wellness Partners

Stellate Ganglion Block (SGB)

Case Report

29 September 2016

Carol Hanselman Bender, RNP

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem

Post-Traumatic Stress Disorder, Fibromyalgia, Chronic Pain

Intro

The patient presented to JWP following years of depression, anxiety and suicidal ideology as a result of Fibromyalgia and chronic pain. She reported receiving minimal relief from various pain treatments over the years, possibly in part due to sympathetic-mediated pain.

The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient; her pre-procedure score was 39.

After discussing the procedure with the JWP staff, the patient requested the Stellate Ganglion Block treatment, hoping to relieve her pain and improve her overall mental health.

Diagnosis

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery, using a high-resolution ultrasound. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots.

Treatment

Under ultrasound guidance, 7 mL 0.5% Ropivacaine was injected by Dr. Maloney around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications;none were noted.

Follow-up

One month after the treatment, the patient reported complete relief from the burning pain she had previously been experiencing in her heel and knee, as well as the pain in her shoulder. However, she did still struggle with walking when she went shopping, due to pain in her sacrum and lower back. She stated she felt calmer and had less mental chatter, and wanted to be cautiously optimistic as she waited to see the last effects of the treatment.

Results

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Level of PainPre-StellatePost-Stellate
PCL Score3920
% Reduction in PTSD Symptoms48%

Conclusion

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 48% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners

Stellate Ganglion Block (SGB)

Case Report

22 June 2016

Carol Hanselman Bender, RNP

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem

Post-Traumatic Stress Disorder (PTSD)

Intro

Patient is a 31-year-old male who medically retired due to PTSD and depression after nine years spent in the Marine Corps. He reported having a hard time dealing with the side effects (sweats, chills and dizziness) of the psychiatric medications he had been prescribed. He suffered from neck and back pain, frequent migraines and situational anxiety.The patient was getting married soon and wedding planning had caused additional stress in his personal life.

The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient; his pre-procedure score was 58.

After discussion of the procedure with the JWP staff, the patient requested the stellate ganglion block treatment.

Diagnosis

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery, using a high-resolution ultrasound. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots.

Treatment

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Carol Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted.

Follow-up

Post-treatment, the patient reported that he feels less stressed, has become more active again, and is motivated to optimize his wellness. He now works in a pit crew of a major racing organization.

Results

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Level of PainPre-StellatePost-Stellate
PCL Score5843
% Reduction in PTSD Symptoms26%

Conclusion

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 26% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners

Stellate Ganglion Block# (SGB)

Case Report

2 August 2016

Carol Hanselman Bender, RNP

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem

Post-Traumatic Stress Disorder (PTSD)

Intro

Patient is a 30-year-old male, who has been suffering from PTSD due to traumatic and stressful situations he endured during his military service. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient#; his pre-procedure score was 68.

After discussion of the procedure with the JWP staff, the patient requested the Stellate Ganglion Block treatment, to increase his energy and mental clarity, and improve his overall brain functionality.

Diagnosis

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery#, using a high-resolution ultrasound#. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots.

Treatment

Under ultrasound guidance, 7 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted.

Follow-up

Patient’s post-treatment score showed a clinically significant improvement in his PTSD symptoms.

Results

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Level of Pain

Pre-Stellate

Post-Stellate

PCL score

68

46

% Reduction in PTSD Symptoms

32%

Conclusion

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 32% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners

Stellate Ganglion Block# (SGB)

Case Report

2 August 2016

Carol Hanselman Bender, RNP

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist

Problem

Post-Traumatic Stress Disorder (PTSD)

Intro

Patient is a 30-year-old male, who has been suffering from PTSD due to traumatic and stressful situations he endured during his military service. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient#; his pre-SGB score was 68.

After discussion of the procedure with the JWP staff, the patient requested the Stellate Ganglion Block treatment to increase his energy and mental clarity, and improve his overall brain functionality.

Diagnosis

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery#, using a high-resolution ultrasound#. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots.

Treatment

Under ultrasound guidance, 7 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted.

Follow-up

Patient’s post-treatment score showed a clinically significant improvement in his PTSD symptoms.
Results

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Level of Pain

Pre-Stellate

Post-Stellate

PCL score

68

46

% Reduction in PTSD Symptoms

32%

Conclusion

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 32% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

Joy Wellness Partners 

Stellate Ganglion Block1 (SGB) 

Case Report 

15 December 2018 

Carol Bender, RNP 

Taina Danahy, BrainCore Neurofeedback Provider 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Post-Traumatic Stress Disorder (PTSD) 

Intro 

A year prior, the patient was hit by a moving vehicle while he was pushing his daughter in a grocery cart across a pedestrian crosswalk; the driver of the vehicle was reportedly on her cellphone at the time. The patient suffered multiple injuries from the force of the impact. However, he stated that the most debilitating factor of the stressful situation was the fact that both he and his daughter’s lives were in immediate danger. He reported that since the accident, his daughter had lost trust in him, and he’d been experiencing guilt, depression and hyper vigilance. 

The patient’s quantitative electroencephalogram (qEEG), given by Danahy, the BrainTrain specialist at JWP, showed that his brain was consistently operating in a state of chronic worry, stress and anxiety. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-treatment score was 79, clearly indicating severe PTSD. 

After discussion of the procedure with the JWP staff, the patient requested the Stellate Ganglion Block treatment hoping to increase his energy, mental clarity and overall brain functionality. 

Diagnosis 

The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery3, using a high-resolution ultrasound4. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Treatment 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the left side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

Six weeks after the treatment, the patient reported a massive relief from stress and anxiety. He noticed a significant improvement in his strength, cardiovascular endurance and reaction time during physical activities. His wife stated that he was considerably calmer and more level-headed. The patient was very pleased with his current mental and physical state. 

Results 

Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain 

Pre-Stellate 

Post-Stellate

PCL Score 

79 

42

% Reduction in PTSD Symptoms 

47%

Conclusion 

In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 47% reduction in the patient’s PCL score.

1 Rae-Olmstead K, Bartoszek M, Mulvaney SW, McLean B, Turabi A, et al. Effect of the Stellate Ganglion Block Treatment on Posttraumatic Stress Disorder Symptoms; A Randomized Clinical Trial. JAMA Psych. 2019.
2 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
3 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
4 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
5 “Evidence for the PCL-5 for DSM-IV suggests that a 5-10 point change represents reliable change (i.e., change not due to chance) and a 10-20 point change represents clinically significant change. Therefore, it was recommended to use 5 points as a minimum threshold for determining whether an individual has responded to treatment and 10 points as a minimum threshold for determining whether the improvement is clinically meaningful using the PCL-5 for DSM-IV.” https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd checklist.asp

1Mulvaney, Sean W., MD; Lynch, James H., MD; Kotwal, Russ S., MD, MPH. (2015). Clinical Guidelines for Stellate Ganglion Block to Treat Anxiety Associated with Posttraumatic Stress Disorder. Journal of Special Operations Medicine, Volume 15 (2), 76-82.

2The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.

3The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.

4The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.

Platelet-Rich Plasma (PRP)

Joy Wellness Partners 

Platelet-Rich Plasma (PRP) 

RegenLab®1 

Case Report 

22 June 2018 

Carol Hanselman Bender, RNP 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Bilateral knee pain & back pain 

Intro 

Patient is a 44-year-old female who presented with persistent pain in both knees and in the right side of her lower back. 

Diagnosis 

The patient was examined by Dr. Tierney using a high-resolution ultrasound2. The exam revealed tenderness to palpation of the right T11 subcostal nerve and left medial patellar retinaculum. It showed mild laxity in the left knee medial collateral ligament, and effusion in the left lateral joint line through the left lateral meniscus and iliotibial band. There was also mild loss of echotexture of the left anterior medial coronary ligament with a lateral meniscal cyst coming through the iliotibial band. 

Treatment 

Under ultrasound guidance, a solution of 1 mL 1% Lidocaine and 9 mL Normal Sterile Saline followed by 6 mL 0.5% Ropivacaine was used to hydrodissect the T11 subcostal nerve. Next a solution of 14 mL Normal lumbar sympathetic block and reset the pain pathways. Finally a solution of 14 mL Normal Sterile Saline and 25 mL PRP was injected into the lateral meniscus, medial coronary ligaments and left knee joint. 

Follow-up 

Two months after the treatment, the patient reported she was pain free, back to her yoga routine and had begun running again. She stated she was grateful the treatment allowed her to return so quickly to her physical activities, especially since she thought it would be impossible without surgery. 

Results 

Figure 1. Self-Reported Pain on a 1-10 Scale, Before & After PRP 

Level of Pain Pre-PRP Post-PRP
 08/12/17 10/12/17
Average Pain 0
% Reduction in Pain 100%

Conclusion 

In conclusion, it was found that ultrasound-guided regenerative injection of PRP was an effective solution to the patient’s lower back and knee pain, as demonstrated by the 100% reduction in the patient’s self-reported pain level.

 

1https://www.regenlabusa.com/leukocyte-poor-prp/
2The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.
Sterile Saline and 6 mL Ropivacaine was injected in the lumbar plexus to perform a lumbar sympathetic block and reset the pain pathways. Finally a solution of 14 mL Normal Sterile Saline and 25 mL PRP was injected into the lateral meniscus, medial coronary ligaments and left knee joint.

Growth Factor Therapy

Joy Wellness Partners 

Growth Factor Therapy & Stellate Ganglion Block1 (SGB) 

Case Report 

19 March 2016 

Carol Hanselman Bender, RNP 

Shawn Tierney, DC, RSMK Musculoskeletal Sonologist 

Problem 

Back pain & depression 

Intro 

Patient is a 52-year-old male who reported years of excruciating back pain despite five surgeries, including a spinal fusion 25 years prior. The chronic pain had reduced his quality of life and caused him severe depression to the point where he had put himself on suicide watch. 

Diagnosis 

The patient was examined by Dr. Tierney using a high-resolution ultrasound2. The exam revealed lumbar radiculopathy and paraspinal muscle atrophy due to spinal fusion and laminectomy. 

Additionally, the Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient3; his pre-SGB  score was 39. After discussion of the procedure with the JWP staff, the patient requested both regenerative microvesicle injection therapy and the Stellate Ganglion Block. The purpose of the Stellate Ganglion Block was to enhance the effect of the regenerative neurologic treatment. 

Treatment 

Under ultrasound guidance, a needle was guided intrathecally, through the dura to the subarachnoid space at the level of the L3 vertebrae. The location was confirmed through aspiration of 0.25 mL of CSF. Next, 1 mL of XoGlo KM3000 microvesicles were injected over two minutes into the epidural space in the spinal canal, and then flushed w 2 mL Normal Sterile Saline. The needle was removed and a sterile bandage was applied with pressure for two minutes. 

Immediately following the procedure, the Stellate Ganglion Block was performed. The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery4, using a high-resolution ultrasound5. The exam also confirmed the location of the fascial plane between the longus capitis and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots. 

Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted. 

Follow-up 

Within 24 hours of the treatments, the patient reported a major reduction in his pain. He felt so motivated by the pain relief that he went on a hike the next day. 

One month after the treatment, the patient stated that he went on a road trip in Cuba on bumpy roads and walked a lot,remaining pain-free throughout his travels and upon returning home. 

One year after the treatment, the patient reported enjoying being pain-free while playing with and caring for his granddaughter. 

Results 

Figure 1. Self-Reported PCL-C, Before & After XoGlo KM3000 microvesicles 

Level of Pain Pre-XoGlo KM3000 Post-XoGlo KM3000
 03/19/16 04/30/16
Average Pain 10 0
% Reduction in Pain 100%

Figure 2. Self-Reported PCL-C, Before & After Stellate Ganglion Block 

Level of Pain Pre-Stellate Post-Stellate
PCL Score 36 22
% Reduction in PTSD Symptoms 39%

Conclusion 

In conclusion, it was found that the microvesicles therapy was an effective solution to the patient’s back pain as demonstrated by the 100% reduction in the patient’s self-reported pain level. The Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 39% reduction in the patient’s PCL score.

1 Mulvaney, Sean W., MD; Lynch, James H., MD; Kotwal, Russ S., MD, MPH. (2015). Clinical Guidelines for Stellate Ganglion Block to Treat Anxiety Associated with Posttraumatic Stress Disorder. Journal of Special Operations Medicine, Volume 15 (2), 76-82.
2 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer and a 2 to 5.3 MHz 4C curvilinear transducer.
3 The PCL aids in the diagnosis of PTSD. According to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5), a score at or above 33 suggests the need for interventional PTSD treatment.
4 The path is posterior to the C6 anterior tubercle, over the stellate ganglion and radicular arteries, and about the C6 anterior tubercle.
5 The ultrasound was a GE R6 B-mode using 8 to 13 MHz high frequency GE 12L linear transducer.

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