Probable cervical midline epidural septum complicating the treatment of a patient with upper extremity sympathetically maintained pain

Marc A. Valley, George J. Sheplock, James N. Rogers

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

We present a woman who developed left arm sympathetically maintained pain (SMP, or "shoulder-hand syndrome") as a result of brachial plexus injury. After confirmatory diagnosis with both stellate local anesthetic block and intravenous phentolamine infusion, the patient had a cervical epidural catheter placed and a local anesthetic infusion started. After numerous unilateral blocks were obtained, a cervical epidurogram demonstrated a probable cervical midline epidural septum. Catheter placement was adjusted, and a successful chemical sympathectomy was performed for 6 days. This resulted in significant relief of the patient's shoulder pain as well as almost complete resolution of the patient's left arm SMP symptoms. This case represents, to our knowledge, the first documentation of the use of phentolamine for the diagnosis of SMP secondary to pathology at a site proximal to that of symptomatology, as well as the first documentation of presumptive cervical midline epidural septum.

Original languageEnglish (US)
Pages (from-to)208-211
Number of pages4
JournalJournal of Pain and Symptom Management
Volume9
Issue number3
DOIs
StatePublished - Apr 1994

Keywords

  • Brachial plexopathy
  • cervical epidural catheter
  • diagnosis, phentolamine infusion, treatment
  • reflex sympathetic dystrophy
  • shoulder-hand syndrome
  • sympathetically maintained pain

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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