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Central nerve blocks
#36401 Post-traumatic compressive C6 cervicobrachialgia, not all that glitters is gold
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  1. Arturo Cohen Sanchez1,
  2. Juan Bernardo Schuitemaker Requena2,
  3. Lorne Antonio Lopez Pantaleaon3,
  4. Ana Teresa Imbiscuso Esqueda4,
  5. Veronica Margarita Vargas Raidi5,
  6. Ivan Rodriguez Gallardo1,
  7. María Minoves Botey1 and
  8. Agnès Nadal López6
  1. 16th year Medicine Student, Universitat de Vic – Universitat Central de Catalunya Facultat de Medicina, Vic, Spain
  2. 2Pain Medicine, Grup Creu Groga, Calella de Mar, Spain
  3. 3Anesthesia and Pain Medicine, Hypnos S.L.P., Sant Cugat del Vallès, Spain
  4. 4Anesthesia and Pain Medicine, IAS Hospital Santa Caterina, Girona, Spain
  5. 5Anesthesia and Pain Medicine, Consorci Sanitari del Maresme. Hospital de Mataró, Mataró, Spain
  6. 65th year medicine student, Universitat de Vic – Universitat Central de Catalunya Facultat de Medicina, Vic, Spain

Abstract

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Background and Aims Patient after a fall with right craniofacial-cervical trauma. Diagnosed with cervical spine straightening and C5-C6 disc protrusion. Reports persistent left cervicobrachialgia. Studies reveal left humeral tuberosity fracture and tendinitis. Despite rehabilitation, referred to pain consultation due to symptom persistence.

Abstract #36401 Figure 1
Abstract #36401 Figure 1

Atrophy of the left trapezius along with reduced strength in the upper and middle trapezius

Abstract #36401 Figure 2
Abstract #36401 Figure 2

EMG: moderate to severe partial axonotmesis of the left accessory spinal nerve

Abstract #36401 Figure 3
Abstract #36401 Figure 3

Nerve MRI: extensive neuropathy along the spinal accessory nerve pathway

Methods Physical examination shows atrophy of the left trapezius and sternocleidomastoid muscles, along with reduced strength in the upper and middle trapezius (figure 1). Post-vaccination Parsonage-Turner syndrome or accessory spinal nerve injury is considered. Electromyography reveals moderate to severe partial axonotmesis of the left accessory spinal nerve (figure 2). Magnetic resonance imaging shows extensive neuropathy along the nerve pathway (figure 3). The patient receives conservative treatment with analgesics, corticosteroids, pregabalin, clonazepam, and intensive rehabilitation. Significant improvement in pain and muscular recovery is observed at 6 weeks. Electromyography at 8 weeks demonstrates increased amplitude of the motor evoked potential, indicating progressive and adequate reinervation. In conclusion, accessory spinal nerve injuries are uncommon after mild trauma and are typically associated with oncological surgery. Initial treatment should be conservative, considering surgical options only if conservative treatment fails. Additionally, the use of platelet-rich plasma may hold promise in the treatment of such injuries. Comprehensive physical examination and appropriate ancillary tests are essential for accurate diagnosis and proper management, as pathological imaging does not always explain clinical findings.

Attachment EMG 1.png

  • Chronic pain
  • neuropathic pain
  • nerve injury
  • Spinal accessory nerve

https://doi.org/10.1136/rapm-2023-ESRA.385

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