Now, we transition to the stellate ganglion. The clinical correlation here is going to be
a stellate ganglion block. But first, we need to understand the relevant anatomy
of a stellate ganglion. The stellate ganglion forms from fusion of the inferior cervical
and the first thoracic sympathetic ganglia. This fusion is identified in the image.
This area here represents the stellate ganglion. The stellate ganglion is located anterior
to the transverse process of vertebra C7. However, in this illustration, it’s a bit inferior
to that normal location. Anatomic variation is something that we expect. The next consideration
with the relevant anatomy is that of the carotid tubercle. The carotid tubercle is identified
in the image right in through here. A carotid tubercle is also known by its eponym, Chassaignac
tubercle. The carotid tubercle is the anterior tubercle of the transverse process of cervical
vertebra number VI. This is an important landmark in the performance of the stellate ganglion
block because the physician performing this procedure will make the injection at this landmark
superior to the stellate ganglion. Then the nerve blocking agent will diffuse and ultimately
diffuse inferiorly and have its influence or its effectiveness at the level of the stellate ganglion.
There are very important anatomic relationships in this area that the physician should be aware of.
Not all of them really are identified in this slide. But you think about this area of the neck
and what lies here, you would have your common carotid artery. You’d have your internal
jugular vein. You can see brachial plexus elements right in through here. So, one has to have
great skill and expertise in performing this clinical procedure. Now that we talked about
the relevant anatomy of the stellate ganglion and how it’s used for the block, why would one
want to perform the stellate ganglion block? So, we’re going to look at the indications here.
First, this can be performed to treat individuals that have complex regional pain syndrome.
This will then meet afferents that are coming from the periphery toward the spinal cord.
It can also be treated to inhibit excessive sweating or hyperhidrosis. As you may recall,
sympathetics stimulate the sweat glands, so blocking that can be useful here.
A third consideration is vascular insufficiency. It can also be performed to treat refractory
angina. Then lastly, in individuals that have amputations of either upper limb,
it can be used to treat phantom limb pain.