Nerve block in the setting of radiation therapy

[ghost dog]

I have a case for everyone:

Lady with moderate supraspinatus tendinosis of the shoulder and full thickness tear. Ortho doesn't want to touch her, and she hasn't responded to physio.

She has had minimal response to meds / long acting opioids / elavil / NSAIDs etc. I just started her on Lyrica.
To complicate matters, she is about to undergo radiation therapy to her upper chest / lung for a questionable cancer.
She has severe pain.

The advisability of attempting ( i.e. in the setting of rad Tx ) a suprascapular nerve block ? The primary concern here would be that of
increased risk of bleeding.

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[Ligament]

I have a case for everyone:

Lady with moderate supraspinatus tendinosis of the shoulder and full thickness tear. Ortho doesn't want to touch her, and she hasn't responded to physio.

She has had minimal response to meds / long acting opioids / elavil / NSAIDs etc. I just started her on Lyrica.
To complicate matters, she is about to undergo radiation therapy to her upper chest / lung for a questionable cancer.
She has severe pain.

The advisability of attempting ( i.e. in the setting of rad Tx ) a suprascapular nerve block ? The primary concern here would be that of
increased risk of bleeding.

Nothing to worry about IMHO. Do her a favor and proceed.

 

[ghost dog]

Nothing to worry about IMHO. Do her a favor and proceed.

Cheers

 

[epidural man]

Nothing to worry about IMHO. Do her a favor and proceed.

Agree

 

[lobelsteve]

Yup.

But XRT for questionable cancer? Do they have CT, PET, Bx up there?
No idea if they just blast away for suspected malignancy- but sounds aggressive.

 

[ghost dog]

Yup.

But XRT for questionable cancer? Do they have CT, PET, Bx up there?
No idea if they just blast away for suspected malignancy- but sounds aggressive.

It's a complex case, which I oversimplified for the sake of my interventional question.

This lady presented with another shoulder MRI abnormality : pleura
mass (i.e. in addition to her rotator cuff path). A bone scan was then performed which was then worrisome for bone mets at the right upper ribs. However, she also has some fairly persuasive MSK findings - a positive empty can sign.

Should be interesting to follow her and see how she does with rad TX, and suprascapular blockade.

 

[mille125]

It's a complex case, which I oversimplified for the sake of my interventional question.

This lady presented with another shoulder MRI abnormality : pleura
mass (i.e. in addition to her rotator cuff path). A bone scan was then performed which was then worrisome for bone mets at the right upper ribs. However, she also has some fairly persuasive MSK findings - a positive empty can sign.

Should be interesting to follow her and see how she does with rad TX, and suprascapular blockade.

i would proceed

 

[nvrsumr]

I think I missed something... suprascapular nerve block for RTC tear rather than subacromial bursa steroid injection?

 

[jsaul]

I think I missed something... suprascapular nerve block for RTC tear rather than subacromial bursa steroid injection?

agree. why do a nerve block for a day of pain relief.

 

[Jcm800]

agree. why do a nerve block for a day of pain relief.

Agree, if sub acromial doesn't help, then supra scapular block and prf of that nerve...shocked at how well it works

 

[ghost dog]

Agree, if sub acromial doesn't help, then supra scapular block and prf of that nerve...shocked at how well it works

This is where I am in the Tx pathway at present (i.e. supra scapular block pending).

 

[ghost dog]

This is where I am in the Tx pathway at present (i.e. supra scapular block pending).

Update: pt seen by rad onc, who determined that this "mass" was in fact old and related to past rad TX for an old breast cancer. Therefore pt not rad TX candidate.

Pt obtained dramatic relief with suprascapular block.