title: Ultrasound-guided spinal accessory nerve blockade in the diagnosis and management of trapezius muscle-related myofascial pain.
abstract: We report the first description of ultrasound-guided spinal accessory nerve blockade using single-shot and subsequently continuous infusion (via a perineural catheter) local anaesthetic techniques, for the diagnosis and treatment of myofascial pain affecting the trapezius muscle. A 38-year-old man presented with a two-year history of incapacitating left suprascapular pain after a fall onto his outstretched hand. The history and clinical examination was suggestive of myofascial pain affecting the trapezius muscle. This had been unresponsive to pharmacological therapy, physiotherapy or suprascapular nerve blockade. Following identification of the spinal accessory nerve in the posterior triangle of the neck, we performed ultrasound-guided nerve blocks, first using a single injection of local anaesthetic and subsequently using a continuous infusion via a perineural catheter, to block the nerve and temporarily relieve the patient's pain. We have demonstrated that the spinal accessory nerve is identifiable in the posterior triangle of the neck and can be blocked successfully using ultrasound guidance. This technique can aid the diagnosis and treatment of myofascial pain originating from the trapezius muscle.
authors.affiliation: Department of Anaesthesia, Queen's Medical Centre, Nottingham, UK. paultownsley@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Townsley
authors.forename: A
authors.initials: A
authors.lastname: Ravenscroft
authors.forename: N
authors.initials: N
authors.lastname: Bedforth
mesh_terms: D000055:Accessory Nerve / Q000000981:diagnostic imaging*; D000058:Accidental Falls; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D002908:Chronic Disease; D006801:Humans; D008297:Male; D009209:Myofascial Pain Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D009407:Nerve Block / Q000379:methods*; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local