PROBABLE CERVICAL MIDLINE EPIDURAL SEPTUM COMPLICATING THE TREATMENT OF A PATIENT WITH UPPER EXTREMITY SYMPATHETICALLY MAINTAINED PAIN

We present a woman who developed left arm sympathetically maintained p ain (SMP, or ''shoulder-hand syndrome'') as a result of brachial plexu s injury. After confirmatory diagnosis with both stellate local anesth etic block anti intravenous phentolamine infusion the patient had a ce rvical epidural catheter placed and a local anesthetic infusion starte d. After numerous unilateral blocks were obtained, a cervical epidurog ram demonstrated a probable cervical midline epidural septum. Catheter placement was adjusted, and a successful chemical sympathectomy was p erformed for 6 days. This resulted in significant relief of the patien t's shoulder pain as well as almost complete resolution of the patient 's left arm SMP symptoms. This case represents, to our knowledge, the first documentation of the use of phentolamine for the diagnosis of SM P secondary to pathology at a site proximal to that of symptomatology, as well as the first documentation of presumptive cervical midline ep idural septum.