Improvement of Chronic Morning Hand Stiffness and Pain with Stellate Ganglion Block in a Seronegative Patient: A Case Report

Chronic hand pain poses a clinical challenge, especially when standard diagnostic tests return negative results. This case report details a 45-year-old woman who experienced persistent stiffness and pain in both hands for 20 years, which was effectively treated with a stellate ganglion block (SGB). The patient, employed in an office setting that required extensive computer use, noticed her symptoms worsened during busy work periods. Despite negative blood tests for rheumatoid factor, anticyclic citrullinated peptide antibody, and other inflammatory markers, she endured prolonged morning stiffness and pain. Previous treatments, including nonsteroidal anti-inflammatory drugs, were either ineffective or poorly tolerated. After receiving three weekly SGB treatments, the patient reported significant relief from pain and stiffness, with her Numerical Rating Scale score dropping from 7 to 2 and stiffness decreasing by about 50%. Similar improvements were noted with left-sided SGB treatments. At a three-month follow-up, the patient remained mostly symptom-free, experiencing a notable enhancement in her quality of life and work performance. This case indicates that SGB may serve as an effective alternative for treating seronegative chronic hand pain syndromes, particularly in patients unresponsive to traditional therapies. The mechanism behind SGB's effectiveness is complex, involving the modulation of sympathetic nervous system activity, inhibition of pain signal transmission, and promotion of vasodilation. While this case showed remarkable treatment outcomes, similar results may not be guaranteed for all patients. More research is necessary to determine the long-term efficacy and safety of SGB for similar patient populations and to assess its potential cost-effectiveness in managing chronic pain conditions.