Stellate Ganglion Block Case Report | December 3rd, 2018
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Carol Hanselman, RNP

Chronic Adrenal Fatigue, Hashimoto’s Thyroiditis, Low Testosterone

The patient returned to JWP for a right-side SGB five months after initially receiving a left-side stellate ganglion black. The patient had experienced marked improvements from his left-sided stellate block, but he felt the effects were “wearing off.”

The patient had a history of experiencing long-term burnout and impaired memory function. He believed the stress of co-owning and running a business with over 500 employees had led to overall mental, physical and emotional exhaustion. He reported increased occurrences of losing his train of thought as well as a lack of short-term memory retention.

The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; his pre-right-sided stellate was 29, which was not diagnostic for PTSD, and the practitioners felt that chronic burnout was the more likely diagnosis. The patient’s quantitative electroencephalogram (qEEG) showed that his Delta wave was still fully engulfed with worry, similar to when he was last seen five months prior.
After discussion of the procedure with the JWP staff, the patient requested the second, right-sided SGB treatment, aimed at further improving his mental clarity and functionality.

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 capitus 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.

The patient’s follow-up qEEG reported minimal improvement in brain functionality from the second SGB in comparison to the first, which correlated to the patient’s overall symptomatology. However, the PCL-C scores showed improvements after both procedures. The patient stated he experienced sustained benefits since he began his neurological functional healing journey a year prior. He noted improvement in his memory overall despite a weakness in his short-term recall of multiple items at a time, and his energy and mental acuity has grown considerably. He also reported being able to more successfully communicate with his employees.

The patient began hormone balancing, optimizing his nutrition and creating balance in his life. He recently took his wife on what he felt was a long- overdue vacation, and took his family on a skiing trip. He reported starting to appreciate and prioritize family time for the first time in years. He feels the SGBs helped his start the process of improving his overall quality of life.

Figure 1.
Self-Reported PCL-C, Before & After Right-Side SGB

Figure 2. Self-Reported PCL-C, Before & After Left-Side SGB

In conclusion, it was found that the Stellate Ganglion Block injections were an effective solution to the patient’s PTSD symptoms, as demonstrated by the 8% reduction in the patient’s PCL score after the right-sided SGB and the 24% reduction in the patient’s PCL score after the left-sided SGB.

References: 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.

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.

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

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