Don't know a thing about workman's comp since I'm self employed but can say a bit about scalene blocks.

I had initial diagnostic ones that used a small amount of steroids (can't remember but believe it was methylprednisilone) and also a lidocaine type block (was something similar to lido but wasn't lido, don't think it was lanacane... really do need to get my med copies from Hopkins). For me, those 2 injections helped a bit but not for more than a few hours. To me they were more for diagnostic purposes than actual help. I had mine done at Hopkins where they used a CAT scan at the same time to properly guide the needle. They did hook me up to a saline IV but didn't numb the area any. Didn't need an numbing though as the doc that was doing the actual injections was extremely good (unfortunately he's rotated out to a different dept for his residency, boo hiss).

The botox injections I had 2 weeks later were a totally different story (same doc did that too). The scalene injection wasn't too bad at all (that one also just had a saline IV with no numbing at injection site). If I remember rightly, I think he did the initial placement needles using the CAT scan and then did the one injection. That one stung a bit due to volume amount but wasn't enough to make it memorable. Because I had only a small portion of the total vial injected into the scalene, there was quite a bit left so he offered to also do trigger points along my back and shoulders (of which I have many nasty little ones and big ones). I really liked the doc and admired his skill but he definitely took some glee in finding those trigger points and if I didn't know better, I'd almost say it was almost a sadistic glee. Brief as the injections were to the points, they weren't fun. I had I think 12 done or somewhere close to that. More on my right side than on my left (the right side is where I'm getting my upcoming surgery).

Immediate after effects were pretty much nil. I think I asked for some Tylenol afterwards and took and a 200 mg ibuprofen when I got in the car but I had no probs driving at all back home (3 hour drive). Most of the discomfort was from a headach from lack of food because I had to have empty stomach in case I had complications (just standard procedure on that).

The next morning was a bit hairy tho. Not sure if it was the botox injection or the combo of that and the trigger points but I woke up with a dead right arm for a bit. Course I was 3 hours away from Hopkins so had to go to my local hospital ER just to make sure I wasn't having a problem with circulation. The dead part didn't last long at all and I probably didn't need to go but Freischlag and I figured better safe than sorry. So I got to "enjoy" the ER for 5 hours. Fun, fun. Of course it'd pretty much cleared up by the time they got me back to a room but I still had to stick around another couple of hours to see the ER doc (who was actually quite nice and concerned to make sure everything was OK but by then the symptoms had disappeared).

Later that evening I started having a lot of discomfort (pain probably is a better word) in my sternocleido mastoideus and trapezius muscle areas. Not a clue what caused that as I didn't have any of that with the previous diagnostic injections. Freischlag said that botox can be irritating but I've had a number of injections through the frown lines to help my migraines and never had any issues there. She also said that the close time between the initial dx injections and the botox injections was probably also a big factor and that she would be changing her treatment protocols to make sure others had longer rest times between injections. In defense to Frieschlag, the short time was totally my doing. The CAT scan doc (not the injecting doc) was going away on vacation for over a month and I wanted to get the injections done before he left so I pulled a bunch of strings to get slipped in much quicker than would normally have happened. Can't say being the canary to that coal mine mishap was fun but at least I've helped others avoid my mistake.

Anyway, that pain lasted about a week before it faded completely. But I did start feeling better by about day 3 as to my TOS symptoms. And I had about a month and a half of no spasms, migraines, hand numbness, or pain of any kind and was able to go TOTALLY off painkillers, neurontin, and sleep meds. It was heaven! I was even able to touch my toes without any problems at all which I've not been able to do in a LONG time. I was not a happy camper when the botox started to fade.

Was going to go for more injections when it started wearing off but had to hassle with getting authorization from my insurance for the CAT scan part (everywhere in Hopkins BUT the radiology dept takes my ins. so had to jump thru hoops upon hoops) and then when I got the approval, the CAT scanner broke down and was out of commission for almost 2 months while they repaired it. By the time that got all fixed it just got to the point that I was having enough changes in symptoms that surgery was becoming obviously my best option to resolve my problems (much as I'm not really thrilled with the idea of it).

I know some in the forum have had bad or pretty much useless botox experiences but for mine, they were almost miraculous. My migraines have dramatically diminished in both numbers and severity. A couple of Midrin usually killed the headaches within a few hours and that wouldn't have even begun to do any good previous to the botox. After my C5-C6 fusion the migraines shifted drastically from being just 4 days of unrelenting pain to so bad that I was vomiting uncontrollably for hours on end even with IVs of meds being pumped into me to stop the pain and vomiting and the docs wanting to do spinal taps on me... those were not fun at all.

I got the botox last July and I'm just noticing within the past month or so that the migraines are starting to show up a bit more often and the hands are starting to go back to numb more at night (tho now it's more the whole arm rather than just the hands). I did find a wonderful pillow at Walmart (a squishy bead massage pillow shaped like those travel pillows you put around your neck) that I think has helped immensely on my night posture so I don't collapse the neck and shoulders as much. I'm fairly certain that that's probably helping stave off the worst of the returning symptoms. If I don't use the pillow, the TOS probs come back with a VENGANCE like they're trying to make up for lost time.

In my situation, if the botox injections had been an option to continue with over the long haul, I would have definitely gone that route. Freischlag says that they lose effectiveness with each injection and can be more irritating each time. Don't know if that's the case or not. Bit moot for me but for someone else, if done properly at a skilled facility, that might be a helpful treatment. I know it certainly helped me. I'll keep my fingers, eyes and toes crossed for you that your lanacane injection will be helpful for you and that you get some relief.

Mary