Anyone had a scalene block?
 

I was just wondering how many people have had a scalene block specifically testing for scalene nerve/vascular compression? If you have, where did you have it done and what technique was used?

The reason I'm wondering about this is because my local pain medicine anesthesiologist thinks that a scalene block means numbing the entire arm as though for shoulder surgery. Apparently there must be at least two types of scalene blocks...one that relaxes the muscle and another that numbs the brachial plexus. I would really like to find someone that performs the former, either in Minnesota or elsewhere, as I'm sure others would, too. Are only the top TOS docs doing these types of blocks????

I know others have had that block as a test- I'll bump this up for replies.

i had one with dr jordan (right side) and another with dr sanders (left side).

both were specifically for the purposes for detecting TOS.

i will pull up a thread on a recent paper by dr jordan and others re: their scalene block.

johanna

I had to travel to CO to have Dr Sanders provide this. It is a dx test, not a treatment. I had it because I wanted to be absolutely certain before going fwd with surgery. I have to say though that it was not 100% convincing. My pain was reduced and my ROM increased but it only lasts 10-15 mins. I wish that Dr Sanders had a jungle gym or something in his office to let me try something I hadn't been able to do for so long. I think that would have felt more convincing. Sitting there and being able to turn my head further and have less pain was nothing compared to the visual I observed with the venogram. It is really something to see your pinched nerves and vessels so clear on a TV screen.

Yeah, I was wondering if it's worth flying all the way to Colorado just for a diagnostic scalene block. Maybe I'll have to check into the venogram instead!

I was told that the venogram is complementary to the ultrasound you've had. The surgeon had already determined the need for surgery w/the ultrasound but he wanted it to see the condition of my compressed vein. I didn't get to look at the ultrasound pix yet but it may also be very convincing. I recall that you had very large numbers on your ultrasound so you may not need a venogram. Is it to convince you? Dr Sanders guideline for the scalene block was that it would be an indication of how I would likely FEEL after successful surgery & recovery.

At any rate I felt it was good for me to have a 2nd opinion so I'd feel comfortable going fwd with surgery. Having an experienced Dr like Sanders review my tests & records, give me an exam, the scalene block, test me for pec-minor syndrome, and evaluate my TOS was well worth the trip.

Hi Fern,

Yes, I'm hoping that by additional tests and/or a second opinion, I can ultimately make a decision either way regarding having the surgery. I had a phone consultation with Dr. Sanders in Colorado and it most likely scheduling and in person consultation with him for the end of September. I tried contacting the vascular Institute earlier last week, however they haven't called me back. I know they require a doctor's referral for an out-of-state consultation, and I have my GP in the wings waiting to give that referral. Or at least I hope she's waiting in the wings, as she seems to be one of those doctors that believes TOS is so rare that it can't possibly be my real diagnoses. I'm hoping that she would like additional confirmation, as well.

Also, I looked out my ultrasound results and checked out the high numbers you had mentioned. I have peak systolic velocities for both arteries and veins in both arms, though I'm not sure I posted them all in that other link. Probably should check that first before writing this, but regardless, I'm really interested in hearing what your results are for the ultrasound once you get them back. My venous in the upper right extremity went from the values of 76 in my lap, then to 74, 33, 172, 63, and 80 (@180 degrees) as my arm went up in the air. My left side, on the other hand, stayed in the lower digits with 71 in my lap, then 24, 27, 39, and 0 at 180 degrees. But of course, we have no reference for what's normal, so it's hard to say. I did find one paper on the Internet that showed normal velocity for arteries as being between 60 and 100 cm/sec, but I don't know how that would translate to venous return. :confused:

Anyway, I'm just hoping that a scalene block might give me a hint as to if my scalenes are the problem or not. Wow, only 15 minutes of relief, that is very brief! Did Sanders also do an EMG of the Medial antebrachial cutaneous nerve? I heard he does that as well. I'll be asking his secretary regarding it when I speak with her on Friday to set up the appointment.

Sorry if I'm rambling, folks, I've had the flu all weekend and am still feverish.

Melissa