Chronic hand pain poses a clinical challenge, especially when standard diagnostic tests return negative results. This case report details a 45-year-old woman who experienced persistent stiffness and pain in both hands for 20 years, which was effectively treated with a stellate ganglion block (SGB). The patient, employed in an office setting that required extensive computer use, noticed her symptoms worsened during busy work periods. Despite negative blood tests for rheumatoid factor, anticyclic citrullinated peptide antibody, and other inflammatory markers, she endured prolonged morning stiffness and pain. Previous treatments, including nonsteroidal anti-inflammatory drugs, were either ineffective or poorly tolerated. After receiving three weekly SGB treatments, the patient reported significant relief from pain and stiffness, with her Numerical Rating Scale score dropping from 7 to 2 and stiffness decreasing by about 50%. Similar improvements were noted with left-sided SGB treatments. At a three-month follow-up, the patient remained mostly symptom-free, experiencing a notable enhancement in her quality of life and work performance. This case indicates that SGB may serve as an effective alternative for treating seronegative chronic hand pain syndromes, particularly in patients unresponsive to traditional therapies. The mechanism behind SGB's effectiveness is complex, involving the modulation of sympathetic nervous system activity, inhibition of pain signal transmission, and promotion of vasodilation. While this case showed remarkable treatment outcomes, similar results may not be guaranteed for all patients. More research is necessary to determine the long-term efficacy and safety of SGB for similar patient populations and to assess its potential cost-effectiveness in managing chronic pain conditions.
| Published in | International Journal of Medical Case Reports (Volume 3, Issue 3) |
| DOI | 10.11648/j.ijmcr.20240303.11 |
| Page(s) | 22-25 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Stellate Ganglion Block, Chronic Hand Pain, Seronegative Arthritis, Ultrasound-guided Injection, Chronic Pain Management
| [1] | van Delft ETAM, Jamal M, den Braanker H, Kuijper TM, Hazes JMW, Lopes Barreto D, Weel-Koenders AEAM. A systematic review on time trend incidence of rheumatoid arthritis in outpatient rheumatology clinics. Front Med (Lausanne). 2022 Aug 24; 9: 933884. |
| [2] | Bissonnette R, Warren RB, Pinter A, Agner T, Gooderham M, Schuttelaar MLA, Crépy MN, Stingeni L, Serra-Baldrich E, Baranowski K, Korn S, Kurvits M, Plohberger U, Strange Vest N, Schliemann S; trial investigators. Efficacy and safety of delgocitinib cream in adults with moderate to severe chronic hand eczema (DELTA 1 and DELTA 2): results from multicentre, randomised, controlled, double-blind, phase 3 trials. Lancet. 2024 Aug 3; 404(10451): 461-473. |
| [3] | Schmid AB, Fundaun J, Tampin B. Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management. Pain Rep. 2020 Jul 22; 5(4): e829. |
| [4] | Theis KA, Murphy LB, Guglielmo D, Boring MA, Okoro CA, Duca LM, Helmick CG. Prevalence of Arthritis and Arthritis-Attributable Activity Limitation - United States, 2016-2018. MMWR Morb Mortal Wkly Rep. 2021 Oct 8; 70(40): 1401-1407. |
| [5] | Fallon EA, Boring MA, Foster AL, Stowe EW, Lites TD, Odom EL, Seth P. Prevalence of Diagnosed Arthritis - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023 Oct 13; 72(41): 1101-1107. |
| [6] | Hey M, Wilson I, Johnson MI. Stellate ganglion blockade (SGB) for refractory index finger pain - a case report. Ann Phys Rehabil Med. 2011 May; 54(3): 181-8. English, French. |
| [7] | Shan HH, Chen HF, Ni Y, Yang JX, Zhou XL. Effects of Stellate Ganglion Block Through Different Approaches Under Guidance of Ultrasound. Front Surg. 2022 Jan 17; 8: 797793. |
| [8] | Feigin G, Velasco Figueroa S, Englesakis MF, D'Souza R, Hoydonckx Y, Bhatia A. Stellate ganglion block for non-pain indications: a scoping review. Pain Med. 2023 Jul 5; 24(7): 775-781. |
| [9] | Kumar N, Thapa D, Gombar S, Ahuja V, Gupta R. Analgesic efficacy of pre-operative stellate ganglion block on postoperative pain relief: a randomised controlled trial. Anaesthesia. 2014 Sep; 69(9): 954-660. |
| [10] | Shi ZM, Jing JJ, Xue ZJ, Chen WJ, Tang YB, Chen DJ, Qi XY, Huang L, Zou YQ, Wu XZ, Yang F. Stellate ganglion block ameliorated central post-stroke pain with comorbid anxiety and depression through inhibiting HIF-1α/NLRP3 signaling following thalamic hemorrhagic stroke. J Neuroinflammation. 2023 Mar 21; 20(1): 82. |
| [11] | Xu, Qiao, Lei Li, Ke Yan, Siqi Ye. Mechanism of Stellate Ganglion Block Anesthesia Inhibiting Neuronal Apoptosis in Rats by Down-regulating Bax gene. Wirel. Pers. Commun. 137 (2024): 1843-1860. |
| [12] | Gunduz OH, Kenis-Coskun O. Ganglion blocks as a treatment of pain: current perspectives. J Pain Res. 2017 Dec 14; 10: 2815-2826. |
| [13] | Zhou C, Li M, Zheng L, Chu Y, Zhang S, Gao X, Gao P. Efficacy and mechanism of stellate ganglion block in patients undergoing carotid endarterectomy. Vascular. 2023 Aug; 31(4): 708-716. |
| [14] | Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management: past, present, and future. Am Psychol. 2014 Feb-Mar; 69(2): 119-30. |
| [15] | Espinoza MA, Bilbeny N, Abbott T, Carcamo C, Zitko P, Zamorano P, Balmaceda C. Cost analysis of chronic pain due to musculoskeletal disorders in Chile. PLoS One. 2022 Oct 27; 17(10): e0273667. |
APA Style
Kang, D. H., Ryu, S. J., Kim, D. S., Kim, J. D., Chung, H. J., et al. (2024). Improvement of Chronic Morning Hand Stiffness and Pain with Stellate Ganglion Block in a Seronegative Patient: A Case Report. International Journal of Medical Case Reports, 3(3), 22-25. https://doi.org/10.11648/j.ijmcr.20240303.11
ACS Style
Kang, D. H.; Ryu, S. J.; Kim, D. S.; Kim, J. D.; Chung, H. J., et al. Improvement of Chronic Morning Hand Stiffness and Pain with Stellate Ganglion Block in a Seronegative Patient: A Case Report. Int. J. Med. Case Rep. 2024, 3(3), 22-25. doi: 10.11648/j.ijmcr.20240303.11
AMA Style
Kang DH, Ryu SJ, Kim DS, Kim JD, Chung HJ, et al. Improvement of Chronic Morning Hand Stiffness and Pain with Stellate Ganglion Block in a Seronegative Patient: A Case Report. Int J Med Case Rep. 2024;3(3):22-25. doi: 10.11648/j.ijmcr.20240303.11
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijmcr.20240303.11,
author = {Dong Hee Kang and Sie Jeong Ryu and Doo Sik Kim and Ju Duck Kim and Hyung Joo Chung and Ji Wook Kim},
title = {Improvement of Chronic Morning Hand Stiffness and Pain with Stellate Ganglion Block in a Seronegative Patient: A Case Report
},
journal = {International Journal of Medical Case Reports},
volume = {3},
number = {3},
pages = {22-25},
doi = {10.11648/j.ijmcr.20240303.11},
url = {https://doi.org/10.11648/j.ijmcr.20240303.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20240303.11},
abstract = {Chronic hand pain poses a clinical challenge, especially when standard diagnostic tests return negative results. This case report details a 45-year-old woman who experienced persistent stiffness and pain in both hands for 20 years, which was effectively treated with a stellate ganglion block (SGB). The patient, employed in an office setting that required extensive computer use, noticed her symptoms worsened during busy work periods. Despite negative blood tests for rheumatoid factor, anticyclic citrullinated peptide antibody, and other inflammatory markers, she endured prolonged morning stiffness and pain. Previous treatments, including nonsteroidal anti-inflammatory drugs, were either ineffective or poorly tolerated. After receiving three weekly SGB treatments, the patient reported significant relief from pain and stiffness, with her Numerical Rating Scale score dropping from 7 to 2 and stiffness decreasing by about 50%. Similar improvements were noted with left-sided SGB treatments. At a three-month follow-up, the patient remained mostly symptom-free, experiencing a notable enhancement in her quality of life and work performance. This case indicates that SGB may serve as an effective alternative for treating seronegative chronic hand pain syndromes, particularly in patients unresponsive to traditional therapies. The mechanism behind SGB's effectiveness is complex, involving the modulation of sympathetic nervous system activity, inhibition of pain signal transmission, and promotion of vasodilation. While this case showed remarkable treatment outcomes, similar results may not be guaranteed for all patients. More research is necessary to determine the long-term efficacy and safety of SGB for similar patient populations and to assess its potential cost-effectiveness in managing chronic pain conditions.
},
year = {2024}
}
TY - JOUR T1 - Improvement of Chronic Morning Hand Stiffness and Pain with Stellate Ganglion Block in a Seronegative Patient: A Case Report AU - Dong Hee Kang AU - Sie Jeong Ryu AU - Doo Sik Kim AU - Ju Duck Kim AU - Hyung Joo Chung AU - Ji Wook Kim Y1 - 2024/12/07 PY - 2024 N1 - https://doi.org/10.11648/j.ijmcr.20240303.11 DO - 10.11648/j.ijmcr.20240303.11 T2 - International Journal of Medical Case Reports JF - International Journal of Medical Case Reports JO - International Journal of Medical Case Reports SP - 22 EP - 25 PB - Science Publishing Group SN - 2994-7049 UR - https://doi.org/10.11648/j.ijmcr.20240303.11 AB - Chronic hand pain poses a clinical challenge, especially when standard diagnostic tests return negative results. This case report details a 45-year-old woman who experienced persistent stiffness and pain in both hands for 20 years, which was effectively treated with a stellate ganglion block (SGB). The patient, employed in an office setting that required extensive computer use, noticed her symptoms worsened during busy work periods. Despite negative blood tests for rheumatoid factor, anticyclic citrullinated peptide antibody, and other inflammatory markers, she endured prolonged morning stiffness and pain. Previous treatments, including nonsteroidal anti-inflammatory drugs, were either ineffective or poorly tolerated. After receiving three weekly SGB treatments, the patient reported significant relief from pain and stiffness, with her Numerical Rating Scale score dropping from 7 to 2 and stiffness decreasing by about 50%. Similar improvements were noted with left-sided SGB treatments. At a three-month follow-up, the patient remained mostly symptom-free, experiencing a notable enhancement in her quality of life and work performance. This case indicates that SGB may serve as an effective alternative for treating seronegative chronic hand pain syndromes, particularly in patients unresponsive to traditional therapies. The mechanism behind SGB's effectiveness is complex, involving the modulation of sympathetic nervous system activity, inhibition of pain signal transmission, and promotion of vasodilation. While this case showed remarkable treatment outcomes, similar results may not be guaranteed for all patients. More research is necessary to determine the long-term efficacy and safety of SGB for similar patient populations and to assess its potential cost-effectiveness in managing chronic pain conditions. VL - 3 IS - 3 ER -
Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
Information