this is Miss Joseph um Miss Joseph suffers from a cervical disc bulge and had presented with pain in her neck head and ring down to the shoulder which is very common with cervical dis disease the first procedure I did was an oipal nerve block which gave her 75% relief of her headaches today I'm going to do a super scapular nerve block many other physicians may opt for an epidural at this point however I feel the Su scapular nerve block is way less invasive and it usually works pretty well and most patients can avoid a cervical epidural by doing this type of injection which is um going to be done under the supinatus muscle suprascapular nerve is a branch of C5 and C6 it does not go down to the hand however many patients will get relief of radicular symptoms from this shot and that's possibly because of the peripheral action of the local anesthetic or the steroid having some sort of either systemic uptake or even just the localized relief of pain helping the patient overcome the acute phase more intense chronic phase I could say uh I've seen a lot of people do very well with this shot and because I'm far away from the spinal cord it's much less risky than a cervical epidural so I'm going to first image her supinatus muscle increase depth okay so right here we have an image of the supercap nerve under the transverse scapular ligament at the bottom left of my screen cleaning her skin first going to spray her with a vapor coolant spray it's going be a little pinch Okay you Okay mhm great and the Ys going down to the nerve passing through the ligament right here and to aspirate now negative injecting I'm going to reposition to the other side of the nerve and inject the rest I gave her a mixture of bivic 4% with 10 mg of depedal which is another advantage of this procedure unlike a cervical epidural patients often do not need as much steroid and they do quite well are you in any pain right now no little soreness maybe or yeah a little okay can you lift your arm up it may feel a little heavy yeah a little bit okay and the block takes 20 minutes to fully set so using the ultrasound I can work around her cervical problem I don't need to go directly to the epidural space of course epidurals in the neck do work quite well and if I need to do it I'll do it but for now she's doing very well with the headache relief from the greater occipital nerve block as well as she has a chance to get some relief of the radiating pain down to her shoulder with the supercap nerve block thank you
