Skedros John G, Kiser Casey J, Mendenhall Shaun D
Utah Bone and Joint Center, Department of Orthopaedics, Salt Lake City, UT 84107, USA.
Case Rep Med. 2011;2011:968181. doi: 10.1155/2011/968181. Epub 2011 Jun 7.
This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.
本报告描述了一名患者，该患者在因术后僵硬进行肩部手法治疗后，接受了一系列每日一次的肌间沟神经阻滞以治疗疼痛。她经历了持续数周的急性呼吸功能不全。所有这些症状的典型和非典型病因均被排除。她的主治肺科医生推测同侧颈动脉体受到了损伤。然而，随后确定，艾迪生病引起的应激反应不佳以及早发型重症肌无力的加重，最能解释这些症状及其持续时间。该患者的情况并非肌间沟神经阻滞的典型反应，因此在没有潜在怀疑的情况下，不建议对重症肌无力或艾迪生病进行术前检查。我们描述本报告是为了告知医生，如果典型的检查排除了肌间沟阻滞并发症的所有常见病因，应考虑对这些诊断进行检查。
