Interscalene Brachial Plexus Nerve Block Injection

Pain signals normally travel along the nerves to the brain, where they are experienced as pain. The brachial plexus is part of a network of nerves that provide sensation to the hand, arm, and shoulder. When these nerves are irritated or compressed, it can cause persistent or debilitating pain to the upper extremity.

An interscalene brachial plexus nerve block is an injection of local anesthetic near this nerve plexus.This is the same type of medication used to “freeze” your gums at the dentist. By numbing the nerve, this procedure temporarily interrupts or reduces the transmission of pain signals from the upper extremity and provides relief.

A steroid medication like cortisone may also be included in the injection to reduce inflammation in the surrounding tissues and reduce pressure on the nerve.

This procedure is typically recommended for people dealing with specific types of pain that have not responded to other treatments. 

These include:

Rotator Cuff Injuries: Whether due to overuse or trauma, rotator cuff injuries can cause debilitating shoulder pain. An interscalene nerve block can provide relief and make it easier for you to participate in physical therapy.

Post-Surgical Pain: Pain following shoulder surgeries, such as rotator cuff repair or joint replacement, can be effectively managed with this nerve block.

Frozen Shoulder (Adhesive Capsulitis): This procedure can reduce pain and help restore normal shoulder movement. 

Fractures: Upper arm or shoulder fractures may cause severe pain, which can be alleviated with a nerve block injection.

By blocking pain signals and reducing swelling around the affected area, this procedure can reduce pressure on your nerves, decrease your pain, and improve your mobility.

The primary benefit of a nerve block is pain relief, which can significantly improve your quality of life. For many patients, these injections:

• Provide immediate and long-lasting relief from pain in the shoulder, arm, and hand
• Reduce the need for oral medication, including potentially addictive opioids
• Improve mobility and function so you can resume your normal activities and participate more fully in physical therapy 
• Help identify the source of upper extremity pain for further treatment planning.
• Serve as a non-invasive alternative to surgery or other intensive treatments.

Most patients can return to their regular activities shortly after the procedure, with little to no downtime required.

Depending on the condition being treated, the majority of patients have significant pain relief, lasting from several weeks up to one year. 

While some people get good results after a single injection, it’s important to understand that the pain relief from a nerve block injection is usually temporary. Over several weeks to months, the effects of the medication will gradually wear off.  Depending on your condition and results, the injections can be repeated up to 3-6 times per year to get sustained relief.

Our expert clinicians use ultrasound guidance to ensure each injection is placed with 100% accuracy. When injected blindly, even the most experienced clinician can miss the intended target up to 30% of the time. Ultrasound-guided injections ensure maximum effectiveness and reduce the risk of complications.

Yes, interscalene brachial plexus nerve blocks are considered a very safe procedure. When performed by skilled clinicians, the risks are minimal. Most side effects, like weakness or tingling in the arm, are mild and temporary. 

At Wilderman Medical Clinic, our clinicians use ultrasound imaging to precisely guide the injection to the target area. This minimizes the chance of side effects and ensures you get the best possible results.

Nerve blocks are safe for most people, but people with some conditions may not be a good candidate for this procedure:

Medication Allergies: Patients with known allergies to the anesthetics or other medications used should not undergo this procedure.

Active Infections: Infections at or near the injection site can increase the risk of complications.

Bleeding Disorders: Individuals with clotting abnormalities or those taking blood-thinning medications may require special precautions.

Severe Health Conditions: Uncontrolled diabetes or significant heart or lung issues could make this procedure unsuitable for you.

Pregnancy: This treatment is typically avoided during pregnancy to minimize potential risks.

Our team will thoroughly review your medical history to make sure this procedure is right for you.

At Wilderman Medical Clinic, we take every precaution to ensure your safety. Serious complications from nerve block injections are rare, but there are some potential risks including:

Temporary Numbness or Weakness: Mild numbness in the arm is a common but temporary side effect. 

Bruising or Swelling: Minor irritation at the injection site is possible but usually resolves within a few days.

Infection: Although rare, there is a slight risk of infection.

Allergic Reactions: Be sure to inform your clinician of any medication allergies.

Incomplete Pain Relief: While many patients achieve significant relief, results can vary, and some may find the effects to be partial or short-lived. Additional treatments may be needed to achieve the desired results. 

Accidental Injection into a Blood Vessel: While extremely rare, nerve block medication injected into the bloodstream has the potential to cause seizures.

Our clinicians will discuss these risks with you in detail and take all necessary precautions to make sure you have a safe and comfortable experience.

From consultation to recovery, your comfort and safety is our top priority: 

Consultation: Before your procedure, our physicians will discuss your medical history, symptoms, and treatment goals to determine if a nerve block is the right option for you.

Preparation: The skin is cleansed with a sterilizing solution and a local anesthetic medication is usually given to numb the skin. You will be placed in a position that is comfortable for you while providing access to the injection area which is at the base of the neck near the collarbone.

Ultrasound-Guided Injection: Next, our experienced clinician will use ultrasound to precisely locate the target area. A thin needle is directed to the desired location, and the medications are injected. The whole process typically takes less than 30 minutes. It is normal to feel a temporary sensation of burning, tingling, or mild pressure in the area of the injection. Most patients report only minimal discomfort.  

Recovery: After the injection, a small bandage is placed on your skin. You will be given time after the procedure to make sure you feel good and are not having side effects before leaving the clinic. For your safety, you will be required to have a driver pick you up to ensure you get home safely.

Most patients can resume normal activities within a few hours, although rest is recommended for the remainder of the day. Minor soreness for a week after the procedure is normal.

We follow up with all of our patients after their procedures, typically within 2-4 weeks.

At Wilderman Medical Clinic, we are committed to delivering exceptional pain management results so that you can get back to your life pain-free.

Contact us today to schedule a consultation to learn whether an interscalene brachial plexus nerve block is right for you.

Serchan P, Griseto L, Armissoglio G, Iohom G. Ultrasound guided interscalene brachial plexus block. Med Ultrason. 2023 Sep 29;25(3):347-351. doi: 10.11152/mu-3885. Epub 2023 Feb 7. PMID: 36780597.

https://stanfordhealthcare.org/medical-treatments/b/brachial-plexus-block.html