CASE 6

Title
Stellate Ganglion Block Case Report | August 26th, 2016
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Carol Hanselman, RNP

Diagnosis
Chronic Adrenal Fatigue, Hashimoto’s Thyroiditis, Low Testosterone

Introduction
Patient is a 69-year-old female who presented anxiety and fibromyalgiarelated pain. She reported taking Norco four times a day and believed she was addicted to it. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient2; her pre-stellate score was 57. After discussion of the procedure with the JWP staff, the patient requested the stellate ganglion block treatment, aimed at providing her the ability to stop taking Norco.

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 capitus 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 and none were noted.

Follow-up
After the treatment, the patient reported no adverse effects and stated she felt less anxious.

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

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 67% reduction in the patient’s PCL score.

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