Lesser occipital nerve CSI

[Linh]

Hi Steve,

We got a referral from a neurologist to perform steroid injection around the lesser occipital nerve. How would you identify this nerve and differentiate it from the great auricular nerve?

Best regards,
Linh

[Stephen Bird]

Hi Linh,

This is a little tricky as the two nerves are close together.

I use a high res , high frequency transducer and scan the sternocleidomastoid muscle.

The Greater auricular nerve and the lesser occipital nerve both run on the surface of that muscle and the lesser occipital is the more posterior one.

So if you can find 2 nerves you can be sure, if you only find one, make sure it is on the posterior edge of the muscle.

In practice I doubt it makes that much difference as if you use reasonable volume (5cc) you will conduct a field block and get both nerves regardless,

When I have done one they always get a numb ear as well as occipital area so I am sure we get spread to both nerves.

Steve

[Linh]

That’s what I thought too. The volume injected is enough to cover that small area anyway. Certainly a very uncommon referral. We have the 22MHz Hockey but still find it hard to differentiate it from the different muscle/fat layers. Thanks Steve.

[Stephen Bird]

Yes, it is tricky,

Use the SCM surface as an isolation plane as only fat and nerves can live on its surface.

In the end it is a “field block” that will get both nerves.

I guess there is no damage done if you bathe the GAN at the same time as you are trying to get the LON.

Steve

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