Revisiting the Role of Stellate Ganglion Blocks for Management of Upper Extremity Complex Regional Pain Syndrome: A Case Study

Abstract Title: Revisiting the Role of Stellate Ganglion Blocks for Management of Upper Extremity Complex Regional Pain Syndrome: A Case Study

Background: The Budapest criteria is the most widely accepted diagnostic criteria for complex regional pain syndrome (CRPS.)1 The criteria include continued pain which is disproportionate to inciting event, along with several specific sensorimotor signs and symptoms. The stellate ganglion is a collection of sympathetic nerves located in the lower anterior cervical spine, near Chassaignac’s tubercle. Stellate ganglion blocks (SGB) can be utilized in the management of a multitude of conditions; ranging from psychiatric to cardiovascular.2, 3 When performed correctly, SGB can play a significant role in the diagnosis and management of upper extremity CRPS. 4

Purpose/Objectives: 64-year-old female presented with complaints of left upper extremity pain, which developed after left elbow surgery. Pain was described as constant, 7/10, burning/stabbing, diffuse and distributed throughout the left arm in a non-dermatomal distribution. There was paresthesia throughout the arm, and subjective weakness in elbow flexors and extensors, as well as grip strength. Physical exam of left upper extremity revealed 4+/5 grip strength, and 4+/5 triceps strength. There was no swelling, discoloration, or erythema. There were no sensory changes. Patient was being managed with gabapentin, physical therapy, and elbow bracing, which were not helping. While she did not meet all the classic diagnostic criteria for CRPS, SGB series was performed and did significantly improve pain and strength.

Method: Since this is a single-patient case study, the next step in validating this hypothesis would be a case series.

Results: We found that despite the absence of allodynia, over the course of  of 6 months of treatment the patient saw significant improvement in vasomotor and pseudomotor changes. ROM also improved with the inclusion of orthotics and occupational therapy.

Conclusions: While this patient did not fall into the classic and most commonly accepted
criteria for CRPS, she responded well to SGB series. While the Budapest criteria is helpful in
identifying patients who may benefit from this procedure, it is not all inclusive. From an
interventional pain management perspective, we can potentially consider SGB as a diagnostic
tool for the diagnosis of CRPS. Similar to how we use medial branch blocks to confirm the
diagnosis of facet-mediated pain, SGB can be used to diagnosis atypical CRPS.

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