USG-guided diagnostic block and hydro dissection for spinal accessory nerve entrapment syndrome

Sukhdeo Satyanarayan Gupta; HA Bhavya Reddy; Hari Poudel; Sayan Manna; Gautam Das

doi:10.4103/jrap.jrap_3_21

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CASE REPORT

Year : 2020 \| Volume : 6 \| Issue : 3 \| Page : 45-47

USG-guided diagnostic block and hydro dissection for spinal accessory nerve entrapment syndrome Sukhdeo Satyanarayan Gupta¹, HA Bhavya Reddy², Hari Poudel³, Sayan Manna¹, Gautam Das⁴ ¹ Department of Pain Medicine, Daradia Pain Hospital, Newtown, Kolkatta, West Bengal, India ² Department of Anaesthesia, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India ³ Department of Pain Medicine, Daradia Pain Hospital, Newtown, Kolkatta; Department of Anaesthesia, Manipal Teaching Hospital, Pokhara, Nepal, West Bengal, India ⁴ Department of Pain Medicine, Daradia Pain Hospital, Kolkatta, West Bengal, India Correspondence Address: Sukhdeo Satyanarayan Gupta 403/B Building No. 4 Parishram CHS, Chakkikhan Santacruz East, Mumbai - 400 055, Maharashtra India Source of Support: None, Conflict of Interest: None DOI: 10.4103/jrap.jrap_3_21

Spinal accessory nerve entrapment is difficult to diagnose due to its overlapping clinical features with other common diseases and nerve entrapments. It severely affects the life of an individual as normal neuronal physiology of the nerve is important for proper functioning and stability of the shoulder girdle. The patient develops symptoms like pain over the shoulder and neck, drooping of the shoulder, and weakness of overhead abduction of the arm. Ultrasound-guided block of this nerve has been described in the literature, but hydro-dissection using ultrasound as treatment has not been described yet. We have reported a case of spinal accessory nerve entrapment following sebaceous cyst excision in the posterior neck which was diagnosed clinically and confirmed using ultrasound-guided block and managed simultaneously by hydro-dissection. A case of 56 years female who underwent sebaceous cyst excision in the posterior triangle of the neck on the right side in May 2016. After 6 weeks of surgery, the patient developed pain in the right shoulder and gradually developed weakness in the overhead abduction of the arm. She went from one hospital to another for her pain relief but her pain remained undiagnosed and untreated. She came to Daradia Pain Hospital with complaint of pain in her right shoulder.



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