this patient is suffering with a cervical pain that's right over the occipital nerve and the upper cervical regions his MRI was clean so I'm I'm assuming he has some sort of myofascial pain syndrome related to a occipital neuralgia have you ever had trigger point injections in your neck no no okay so we'll do some trigger points with the nerve block just to try to alleviate his symptoms so I'm going to scan at the level of C2 looking for the ocal nerve so the spinus process is Central over here I'm going to scan laterally and you see the planes of the oblas capus inferior muscle and the semispinalis muscle right here can angle my probe a little bit to try to get the ideal location and then I'm going to Target the nerve in that plane and sometimes it doesn't look like just one nerve it could appear as multiple nerves because they can converge in this area you're going to feel little pinch to them Hydro dissecting between the nerve muscles does it feel like I'm in the spot of your pain yeah you are say and it's crossing over between the muscle planes to get the nerve now you have some pain in this region like this normally yeah okay now in the event that other muscles are involved I'm going to do some trigger points as well as some par vertebral injection to try to see if I could get the medial branch nerve at this level and denervate any of the tissue we're not looking this is not purely a diagnostic block where I'm just doing one thing I'm just trying to get him out of pain low pinch capture image NE is right above the articular pillar aspiration capture image taking a look here the sternomastoid and as you can see the ler oxal nerve come up from the plexus which I'll try to Target right now little pinch sorry okay okay so this patient's pain physician referred him for an injection of the upper neck his MRI was normal so I didn't really want to do radio frequency ablation of his nerves or epidurals he has pain right over the occipital nerve when he he palpates it with some radiation but not not going all the way up to his head so I wasn't really sure if it was just a nerve impingement or just some myofascial pain to take care of the problem I gave him some trigger points with lidocaine as well as an occipital nerve block with lidocaine and a um superficial cervical plexus mainly targeting where the lrock simple nerve should be I actually didn't see it here but it should cover the area as well as a medial branch close to the C2 Level under ultrasound guidance and this should give him some symptomatic relief in my experience even without steroid or PRP lioc alone can last days weeks even months or even be Curative so you don't always need steroids to get long-term outcomes with your patients
