so this is a patient who presents with a cervical radiculopathy he also has axial symptoms as well his his cat scan shows c56 c67 facet orthopathy as well as foraminal stenosis and he presents with some numbness and pain down his left arm the pain passes from his neck through his shoulder he's had a power vertebral nerve block by his pain physician which has not given him relief and he's here today for treatment to avoid epidural steroid injection and the risk of that we're performing ultrasound guided interventions along the par vertebral space the nerves as they exit the spine I'm using a mixture of line and dexamethazone for those blocks so first I'm going to scan his neck I'm finding the super cicular brachial plexus which I trace up the spine to the extraoral space and we're tracing the nerves as they go back into the frame and the nerves are hypo aoic and they're disappearing that right there is a posterior tubic and here is the articular pillar of the spine moving forward I'm going to put the Doppler on to see if there's any blood vessels okay so there's no blood vessels in our way here the hypoc coic circles are nerves and there's a blood vessel right next to one of the nerves which we'll try to avoid here are the nerves once again c56 is uh CTIC and he has impingement of C6 as well as C7 which is centered right here and I'm going to deposit a little bit of local anesthetic with Dex methone in the vicinity a low pinch okay sorry anything shoot down your arm just let me know okay just let me know what you feel here's my needle coming near the C6 nerve anything shooting on your
arm you're just feeling in the neck no it was going down my back back down your back okay I'm taking this need back we're going to look at the articular pillars now and Target the power vertebral space where the medal Branch nerves pass does your pain Come From Below this point or at this point at that point okay and the patient is um has a crease in his neck at that point which is typically where the most movement occurs and that's where he's complaining of pain little pinch right here sorry it's okay okay depositing the local on the articular pillar and go one level down now pinch again I'm also depositing some of the trigger points in his neck superficial sorry okay so I'm going to do two more things and then we're done okay okay okay well first we'll do the accessory what we see here is sternal K mastoid the big muscle here and going posterior to it we'll see the region of The Superficial cervical plexus of the tail of the muscle I'm going to depos a little bit of local there for his neck pain pinch and come posterior looking for the plane of the accessory nerve which is between the C master oid and the trapezius muscle the nerve heads towards the trapezius after it leaves the jugular framing little pinch okay I think we're done