Seems like a better history and physical exam would be the best way to answer that question. Is pain more neuropathic or mechanical? Does it hurt more to move the neck or the shoulder? As a last resort, I’d inject the should as a diagnostic test rather than the neck. Much lower risk and more likely to give a clear diagnostic picture. A good SNRB will also partially anesthetize the shoulder.
There are multiple ways to answer this Q without doing a SNRB.
Do a glenohumeral injection with 5 mL ropi or any LA really and see if pain goes away. Easiest way to differentiate. Same if differentiating hip vs L2/3 radic.
The only question answered by a CESI is “Will a CESI help their pain?”
I getcha.
This is why surgeons bring great interventionalists into the practice, and why fellows should cold call ortho practices and NS practices.
Looks good. Poking EJ not the worst thing, though 5 deg more/less of oblique still probably gives you a good trajectory and off the EJ. Def no more medial.
I had a patient who loved his lumbar ESI injections because it also cleared his psoriasis for six months.
Nice job. I try to avoid all vasculature. If you look at your MRI, superficial vessels will be in the way. Try not to penetrate internal carotid, need to look at more than the vertebral artery alone IMO. Reviewing MRI and measuring planned trajectories, there have been a number of times IC in the way, especially upper cervical. Need to be able to identify. For those cases I use a modified lateral approach. Use small gauge needles. What size needle is that by the way? Looks 22 in oblique but 25 in AP.
25 2.5
Those aren’t even good pictures of spill over. I’ve had some that show the contrast dumping anterior over into the neuroforamen
pubmed.ncbi.nlm.nih.gov
Just asking as question- your posterior to anterior approach makes it point to vert. Was that intent upon?
