Treatment of post-traumatic occipital neuralgia with ultrasound-guided greater occipital nerve hydrodissection in the emergency department

Abstract

Background: Nerve hydrodissection (HD) has previously been described as a treatment for carpal tunnel syndrome and other musculoskeletal disorders; however, its use in the treatment of occipital neuralgia (ON) has rarely been reported. This is the first report of HD used to treat ON in the emergency department (ED). Case report: A 34-year-old male presented to the ED with a 3-month history of posterior neck and scalp pain consistent with ON. He failed multiple outpatient therapies including oral medication and trigger point injections. An ultrasound (US)-guided HD of the greater occipital nerve (GON) was performed successfully. A 25 g needle was inserted in-plane and a solution of 9 mL normal saline and 1 mL 1 ​% lidocaine was injected within the fascial plane containing the GON until muscle layer separation was achieved.Why should an emergency physician be aware of this? A case of refractory ON failing conventional therapy was successfully treated in the ED using US-guided nerve HD.

Keywords

• Greater occipital nerve
• Occipital neuralgia
• Hydrodissection
• Nerve block
• Ultrasound