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Mathias P. Dasch, M.D·.

Second Edition.

I Thieme
With local Anesthetics
IV

Library oI Congress Cataloging-in-Publication Data Important Note: Medicine is an ever-changing


is available from the publisher. science undergoing continual development. Re­
search and clinical experience are continually
expanding our knowledge, in particular our
knowledge of proper treatment and drug ther­
apy. Insofar as this book mentions any dosage
or application, readers may rest assured that the
1st English edítíon published 1985 by KarL authors, editors, and publishers have made eve­
F. Haug Verlag, Heidelberg. Formerly titIed 'The ry effort to ensure that such references are in
Illustrated Atlas of the Techniques of Neural accordance with the state of knowJedge at the
Therapy with Local Anesthetics." time of production of the book
Nevertheless. this do es not involve, imply, or ex­
This book ist an authorized translation of the press any guarantee or responsibility on the part
5th Germa n edition published and copyrighted of the publishers in respect to any dosage in­
1994 by Karl F. Haug Verlag, Heidelberg. Title of structions and forms of applícations stated in the
the German edition: Bildatlas der Neuralthera­ book. Every user is requested to examine care­
pie mit Lokalanasthetika fu]]y the manufacturers' leaflets accompanying
each drug and to check, if neeessary in consul­
tation with a physician or specialist, whether the
dosage schedules mentioned thereín or the con­
traindications s tatecl by the manufacturer5 díffer
from the statements made in the present book.
Such examination is particularly important with
drugs tha t are either rarely used or have been
newly released on the market. Every dosage
schedule or every form of applieation used is en­
tirely at the user's own risk and responsibility.
Translated by The authors and publishers request every user
Arthur Lindsay, Ponte Cremenage, Switzerland to report to the publishers any discrepancies or
John Grossmann, Berlín, Germany inaccuracies noticec1.

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v

e or

Neural therapy is not just another injection technique. It is a complex, safe, ancI very
effective healing system for our time. The development of neural therapy has a long
history. It stretches back to the discovery by Vienna's falnous neurologist, Siglnund Freud,
of tbe topical anestbetic effects of cocaine in 1883, and to the publication in Germany of
the first textbook on healing anesthesia by Spiess only one year after Einhorn synthesized
the first phannaceutical local anesthetic, procaine, in his laboratory in 1905. Spiess de­
scribed the technique of "trigger point injections," which some 60 years later were to
change pain management in the US forever through tbe wonderful work and further
development of this small but important aspect of neural therapy by the late Dr. Janet
Travell. Dr. Travell was personally familiar with and inspired by the work of two German
lnedical doctors, dentists, and brothers: Ferdinand and Walter Huneke.

Ferdinand Huneke is credited with being the father of modern neural therapy. He under­
stood the ímportance of injecting surgical scars, following his first clinical observation in
1925 of a profound healing reaction after treating an oId osteomyelitis scar in a young
woman. Under the term preemptive anesthesia, his method is only now fínding gradual
acceptance in surgical departments, sorne 75 years after his initial discovery and publi­
cations. Huneke also collected and refined the original techniques for autonomic ganglion
blocks with local anesthetics, nerve blocks, and the first epídural injections.

Many of the early injection techniques were first described by French physicians, amongst
them the famous surgeon, Leriche. Leriche had originally developed surgical techniques
for pain control, which included severing the thoracic syn1pathetic chain and cutting
nerves in pain patients injured during WWI. As a much less invasive alternative he had
developed injection techniques for each surgical procedure by 1925 and named the pro­
caine injection the surgeon's "bloodless scalpel." Unfortunately, 75 years later surgical
sympathectOlnies for pain control are still done in SOlne hospitals, but have largely been
replaced by nerve blocks and regional anesthesia procedures wo-rldwide. Most of the in­
jection technjques used today have already been published and usecl extensively by tl1e
early physicians at the beginning of the last century. Many of their wonderfully intelligent
and helpful techniques have been recently republished and renamed under dífferent au­
thors' nalnes and with different indications, n10st often not giving credit to Huneke,
Leriche, and the real pioneers in this field. Many injection procedures had been almost
forgotten, sllch as the Frankenhauser ganglion block, one of the most profound healíng
techniques for problems of the peJvic floor.

The author of this con1prehensive review of all relevant techniques, Mathias Dosch, is
the son of Peter Dosch, one of a handful of the original Huneke students, colleagues,
friends, and mentors, who ensured the handing down of these precious healing tech­
niques to thousands of doctors of the next generations all over the world.

Neural therapy has become a traditional European healing system focusing on the health
of the autonomic nerVOllS system. Much ofthe neurophysiological understanding ÍS based
on the work of the early physiologists of the last century, especiaIly the 5chool of the
Russian genius, Pavlow. The scientific basis of neural therapy rests on a simple neuro­
physiological truth: injury and ilIness often result in long-lasting dysfunction of the au­
tonomic nervous system. The autonomic nervous system controls and regulates or coreg­
ulates most metabolic, immunological, healing, digestive, hormonal, and many other sys-
VI Foreword

temic functions. It controls such diverse issues as blood flow, pancreatic enzyme and
insuli n p rod u ction , and metabolic activity of the liver. Relatively new is the fin d i n g that
the neurotransmitters produced in the ganglía and transported to the synap s es of the
autonomic nervous systen1 are released in the endothelium of bJood vessels and activa te
or inactivate specific portions of the immune system. S ca rs c a n c r ea te a b normal s ign a ls
that affect the autonomic nervous system and its branches for years after an injury or a
surgery. Toxi city can offset an autonomic gan gl ion. Unhealed emotional trauma and
c onflicts can r ea ch the autonomic nervous system via the limbic hypothalami c axis and
change the fine orch estrat ion of impulses flowing in the autono m i c nervous system. A
simple inj ection of procai n e into the exact location where the abnormal impulse s ta rt s
can restore order in the system and Jead to deep he al i ng , often i nstantly ! It may be an
inje ct ion into a s urgi ca l scar, a gan glion , or a vein. Commonly the site inj ect ed is loc ate d
far away from the location of the patient's sympto m .
The neural ther a py t echn i ques con1prise an entire heali n g system that is scien tifi c ally
sound. The techniques can be learned frOlTI this book. The thinking behind neural the rap y
can b e Jearned b y a t ten d in g hands-on workshops and by apprent i cesh ip with an expe­
rienced phys i cian. Good history-taking and newer biofeedback methods such as auto­
nomic re sponse t esting (ART) and electrodermal te sting (EAV) hav e been able to predi ct
which scar or which ga nglion should be treated.
Neu ral Ther a p y is pr a cti ce d today in all European countries, Mexico, and Ce ntral and
South America. In Fra n ce ao offshoot of this work is known under the name m esot herapy.
In the US, s orne of t hese won derful t echniqu es have a lready becOlne a well-established
par! of " region al anesthesia," "nerve blocks," a nd other pain control pr oce dures, with most
physicians be i ng unaware of tile long history of t h ese techní qu es . John Bonica, who
est ablished th e fi rst ren o wne d lTIulti d isc ipl i n a ry pain cl i nic in Seattle, was fully aware of
the work ofFe rdinand Huneke and ha d studied his work d iligently . l n his ground-breaking
2-volume textbook on the manage ment of c hroni c p a i n , many pro ce d u res are descri bed
which he fírst encountered in Huneke's writing ( personal cornmunication). However, for
complex academic a n d pol í t ic a l reasons he choose not to refer to the source in his writ­
ings. The traditionaJ tea c hi n g of neural therapy in the Englísh-speaking co u ntries has
made great progre ss in the last 14 y e ars under the leadership of the American Acaden1Y
of Neural Therapy. Hundreds of phy s ici ans have taken the workshops and ha ve incorpo ­

r at ed ne u ral t her a py s afely and successfully into their pract i ce . The H omeop a t hic Medical
Board in the state of Nev ada i s the first major medical organization to have incorporated
neural therapy ínto thei r statutes and to re qu i re this knowledge to be part of the materi al
for the licensing exam.
Neural therapy is a healing techni qu e that will often help where all other methods have
failed. Often healing oc c ur s so r api dJ y and unexpe ctedly that it ís r efe rred to as Jight ni ng
rea ction ( o r H uneke P he n ome non ) . It is safe, often noninvasive, and can be a pp l ie d to
common p robJe ms in all areas of medicine: general practice, ENT, ophthalmology, gyne­
cology , internal medicine, paín management, pediatrics, psychiatry, a nd aH other sp e cia l­
ties a n d subspec ial ties . Thousands of clients have be en he lped already in Australia, Ca n­
ada, th e US, a nd the UI< and countless patients in other co untr ies . It is a heali n g system
whose tiIne has come.

Dietrich Kl ingha r dt, M.O., Ph.D. Fe bru ary 2003


Bellevue, WA
www.neuraltherapy.com
VII

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Needle Size E q uivalents . . . .. . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Se'gmental Therapy . . . . . . ... . .. .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3


The Segmen ts of the Body ( He a d 's Zones) ... . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . .

Internal Organs and Their Related rain and Reactive Segme n ts ... . . . ...... . ...... 6
SUlnmary of the Prin cipal Inj ection Points in t he Seglnental Treatment
of the Disorders of the: . .
. . . . .
. . . . . . . . . . . .
. . . . . .
. . 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Segmental T herapy in Cardiac Disorders . . . . ... . . . . ... ... . . .. .. . . . . . .. . . . . . .. .. .. 10


Seg mental Therapy in Cardiac Disorders ............ .................... . . ....... 11
Se g lne ntal Therapy in Disorders of the Lun gs .................................... 12
Segmental Therapy in Diso r ders of the Lungs .. . . . . . . . . . . . . . . .. . .. 13 . . . . . . . . . . . . . _ .

Se gme n ta) T herapy in Disorders of the Liver and Gallbladder ..................... 14


Segmental T herapy in Di sorder s of the Liver and Gallbladder ..................... 15
Segmenta) Therapy in Gastric Disorders . . . . . . . .. 16
. . _ . . . . _ . . . . . _ . . . _ . . . . . . . . . . _ . _ .

Segmental Therapy in Gas tr i c Disorders . . . . . . .. . ... . .... . ...... . . . . . .... . . . ... . . 17


Summary of t he Principal Injection Points on the Head (Ante rior Aspec t ) .. . . . . . . . . 18
Surnmary of the Princi pa l I njec t ion Points on the Head (Lateral Aspect) ........... 20
Frequently Used Inj ec tio n Points on the Back of the Head, on Neck and Shou lders . 22 . .

The Lightning Reaction and the Search for an Interference Field 25 . . . . . . . . . . . . . . .

Techn ique . . . . . . . . .. . . . . . . . .. . . . ... . .. . . ................ . . . . . . 27


. . . . . . . . . . . . . . . _ .

List of Inj ec tions ............ . ..... . . . . . . . . . . .. . . . . . . . ........ . .. . . . . . . . .. . . . . . . 28


Head, Neck .. . . . . . . . . . .. ... .. .. . . . . . . . . . ... . ... . .... . . . . . . . . . .. . . . . . . . . .. . . 28
. . _ .

Chest, Back, Abdomen, Pelvis .. . . .. . . . . . .


. . . 28
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Extremities: Anns, Legs . . . . . . . ..


. . . .. . . . . ... .
. . . . . . . . . 29
. . . . . . . . . . . . . . . . . . . . . . . . .

Head, Necl{ . . . . _ . . . . . . . . . . . . . . . ....... ......... .... .. ............ .............. 30


I nj ectio n to and into the Telnpo r al Artery . 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Injection t o the Upper Cervical Gan g lion and the Retrosty loi d Re gi on . .......... . . 32
Injection to the C ilia ry Gangl io n ................................................ 34
Injection to the Mandi bular Nerve Near the Gasse rian Gan gl io n . . . . . . . . . . . . . . . . . . 36
I njec tion to the S p he no p a la tine Gang lion and the Maxillary Nerve ...... .. . .... ... 38
Injection to the Stellate Ga ngl i on ............................................... 40
I nj ec ti on to the Stellate Ganglion (Accord in g to He rge t) .......................... 42
Inject ion to the Stellate Ganglion (Acc ordi ng to Leriche and Fontaine,
as Modified by P Dosch ) ........................................................ 44
I nj ecti on to the Stellate Ga n g l i on (According to Reischauer) . . . . . . . . . . . . . . . ....... 46
I njec ti on under the Scalp ....................................................... 50
Injection to the Mastoid Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Injec t i on to the Glossopharyngeal Nerve . . ... ..... .... ................... . ....... 54
Inj ection to t h e Infraorbital Nerve. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . ..
. 56
Injection to the Superior Laryngeal Nerve . . . . . . . ..... . . .. . .
. . . . . . . . .. . . . . . . . . . . . 58
Injection to the Mental Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . _ . 60
Inject i on to the Occip ital Nerve . .. . . . . . . . . . .. . . . .
. . . . . . . .. .
. . . . . . . . . . . . ... . . . . . . 62
Injec tion to the Phrenic Nerve C3-C5 . . ... ...... ..... . ... . . . .. . . . .. . . ... . . . . .. . . . 64
VIII Contents

I nj ect i on to the Lateral Supraorbital Nerve . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66


l nject ion to the Deep Cervical Plexus (2-C4 . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 68
Injection to the Superficial Cervical Plexus . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Injection into the Thy ro i d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
I njection to the Palati ne Tonsil ................................................. 74
Injection into th e A de n oid s ( Ph a ryngeal Tons il ) and the Pharyngeal Hypophysis ., 76
Test I nj ecti ons to the Teet h . . . ... . . . .... .. .. ..... . ........... . . .... . . .......
. . _ 78

Chest, Back, Abdomen, Pelvis . . . .. . . . .. . . .. . . . . _ . _ . . . . . . . . . . . . . . . . . . . . . . . . . . _ _ 80


Injection to the I n tercos tal Nerves .. . . . ... .. . . . ... .. ..........
. . . . . . . . . . . . . . . . _ _ 80
Epidural Anesthesia . . .... . . ....
. . . . . . . . . . .. ...... . ... . . .......... . .
. . . . . . . . . . . _ 82
Injection into the Posterior S acr al Fora m ina . . . .. .... . . . . . . . .. ... . . . . . . . . . . . . _ _ _ . 86
Injection to the Abdominal Sym pathe tic (haio (According t o Vi sh n e vski ) ......... 90
Injection to the LUlnbar Sympathetic Chain ... .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . _ 94
I nject i on into the Region of the Root of the Sciatic Nerve L3-L5 ...... . . . . . . . . . . . . 98
I njection to and into the SacraI Plexu$ ....... .. .. .... ... .. . ... .............. .. .. 10 2
P res acral Infi ltration Accor di ng to Pendl . .. . . .. . . ...... ... ... . . .. ... .. . . . . . . . . . _ 106
Injection into the S a croilia c J o i nt . . . . .. . . .. . .
. . . . .. . . . . . ..
. . . . . . . . . . . . . . . . . . . . . _ 108
I njec t ion to Frankenhauser's Ganglía (Uterovaginal Plexus) . .. .. . . . . . . . . . . . . . . . . . 110
Injection into the PeJvic Reg i on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 112
I njecti on into the Ep iga strium ... . .. . . . . . ... . . . . .
. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 1 14
l nject i on to Vogler's Points ... . . . . . . . . ..
. . . . . . . . . . . ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . 11 6
Tnj ectíoo to the Xiphoid . . . .. ...... ..... .... . . . ......... . ... ...... ....... . ..
. . . _ 118
lnjection to the Pudendal Nerve .. .. . . . . . ... .....
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
I nj ection into the Prostate ........ .... ..... ....... . ..... ........... . ... . ........ 124
I nject i on into the Prostate (Suprapubic I njec tion According to Hopfer) .... .. .. . .. . 126

Extremities: arms, legs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .


. 128
.
I nject i on to and i nto
the Brachial Artery ........................................ 128
lnj ect ion to the Subclav i an Artery .............................................. 130
lnje cti on ioto the Elbow Joint . . . . .. . . . . . . . .. . .
. . . _ . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . 132
Injection into the Wr i s t ]oint . . . . . . .... . . . . .
. . . . . . . . . ... .
. . . . . . . . . . . . . . . . . . . . . . . 134
Injection into the Shoulder Joint . . . . .. ..... . . ... . ... .
. . . . . ... .. .. . . . . . . . . . . . . . _ _ 136
I njection to the Median Nerve ............ ..... ... ....... . ....... . ...... . . ..... 138
.

f nj ect i on to theRadial Nerve . . .. . . . . . . . ..... .. . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . 140
Injection to the Ulnar Nerve . . ... . .... ........ ..... . .. . ... .. ..........
. . . . . . . . _ . 144
Ri n g- b lock Anes thes i a of Fing er s and Toes ... . . .. . .. . . ...... . . . . " . . . . . . _ . . . . . . . 146
Injection to the Brachial Plexus (5-T1 . . .. . . . .. . . . ... .. ..
. _ . . . . . . . . . . . . . . . . . . . _ _ 148
Injection to and into the Femoral Artery . . .. . . ....... . . . .. . ........ . . . . . ........ 152
Injection to and into the Posterior Tibial Artery ................................. 154
l nj ections into the Hip Joint . . . . .. . ... ....
. . . . . .. . . . .. . ... ....
. . . . . . . . . . . . . . . . . _ 156
lnjection into the Knee Joint . . . ... . .. . . . _ . .. .. .. .. . ..
. . . . . . . . . . . . . . _ . . . . . . . . . . . 1 60
Injection ¡nto the AnIde Joiot . .. .. .. ... ..... .. . . ... . ...... . . . ............ . ....
. . 162
Injection into the ]oints of Fingers and Toes . . . . . . . .. . . . . . .. . . . . . . . . . . . . . _ . . . . . . . 164
Injection to the Late r al Cutaneous Femoral Nerve . . . .. . . . ..... . . . .. . . . . . . . . . . . . _ 166
Injection to and into the Fe m ora l Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. 168
lnj ectio n t o the Fibular Nerve .... .. .. .. . . ... . . .. ....... . ...... .
. . . . . . . . . . . . . . _ . 170
Tnjection to the Obturator Nerv e .... .. . . .... . . ....... . ..... . . ..... ..
. . . . . . . . . . . _ 172
Injection to the Tibial Nerve . .. ... .. ...... . . . ....... . . . . . . ........ .. . . . .. ....... 174
Inj ect i on to the Tro chanter Major . . . ... . . .. . . .. .
. . . . " 176
. . . . . . . . . . . . . . . . . . . . . . . . . .

Quaddle Therapy . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . .. . .. . . . . . . . _ . . ..... 178


Contents rx

Intramuscu lar Infiltration . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 79


Quaddles in the Regían of the Knee 10int . . . . . . . . . . . . . . . . . . . . . . . _ . _ . . . . . . . . . . . . . . 1 80
Quaddles in the Sacroiliac Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 82
Quad dles in the ParasternaI Regi on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 84
Quaddles ta the Pelvic Regian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 86
,Intravenous Injection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
lnjections into Scars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 90

Interference Fields in the Teeth and Jaws . . . . . . . . . . . . . . . . . . . . . . . . . . . . __ . . . . . . . . . 193

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
1

I . �r , uctlon

For many years, neural therapy according to Huneke was unjustly forced into an outsider's
role as a fri ng e method in m edic ine Now, more than fifty years arter íts d is co very, the
.

recognition is at last growing alTIOng medical practítioners a t universities and hospitals


that the selective use of local anesthetics can greatly enrich a n d ex p a n d the conventional
therapeutic armory, since physicians such as Adler, P Dosch, Gross. Harr e r Kibler. ,

Schoeler. Siegen, and the Vi e n nese tea m of Bergsma nn, Fleischhacker, Hopfer. Kellner,
Pischinger, Stacher. and others have shown by theír work that the effects of neural therapy
can be proved objectively.
For years. lnore t h a n 50 % of all established practitioners in West Gern1any have been
using neural therapy successfully in their day to d ay practice for both diag n ostic and
- - ,

therapeutíc purp o ses.


In 1928, the brothers Ferd in and and Walter Huneke p u bl i shed a joi nt paper 011 'Unfamili ar
reInote effects of local anesthetics' (Unbekannte Fernwirkungen der Lokalanasthesie).
They reported the successful treatlnent of pain fu l conditions in segmental areas and drew
attention to the importance of injecting the co rr ee t site. They $oon re cognized that when
pr o cai n e is injected, previous ly unknown reflex-like reactions are prod u ced via Head's
zones. In additíon to the purely intravenous injections with which they had begun. they
discovered that paravenous and i n tr amuscular injections could also be effective. For this
type of treatment Kibler sugge s ted the na me of 'segmental therapy with local anesthetÍcs:
2 Introduction

eedle Size Eq . ivalentj

Size No. Size ( m nl) Size (inches)

1 0.90 x 40 mm 20G x 1- 1 /211

0.90 x 120 mnl 20G x 4-6/8"

0.80 x 80 mm 21Gx3-1/SI1

12 0.70 x 30 m nl 22G x 1- 1 /4"

0 . 5 0 x 21 mm 25G x 13/16"

18 0.45 x 23 mm 26G x 15/16"


3

egrnentalThe py

Head and Mackenzie observed that diseased organs regularly p roduce reactions and
changes in certain clearly defined skin and subcutaneous zones. FrOln this they deduced
that there must be a relationship between any given organ and certain areas 011 the body's
surface, the cutaneovisceral refl ex channels. They found that the hun1an body can be di­
vided ínto thirty segments (p. 4). Vogler and Krauss discovered other reJationships. be­
tween bones and periosteum on the one hand and organs on the otber, the osteovisceral
reflex channels. The fact that a dis ease d organ can be positive l y influenced by skin ir­
ritatíon has long been known to empíri cal medicine. Physical medicine makes use of this
empirical knowledge; treatment by m eans of skin irritatíon su eh as Ponndorfs and
Baunscheidt's vaccinations, moxa, cupping, Kneipp therapy etc, has becon1e a standard
component of modern physical medicine.
In neural therapy according to Huneke we know three possible means of producing a
segmental effect:
1. Injection directly to the painful site: accurately placed procaine or lidocaine injections
are effective in treating painful disorders in muscles, tendo ns ligalnents bones, joints,
, ,

and nerves; for contusion, hematOlnas, abrasions, painful scars, and all forms of trau­
matic damage (see Quaddle the rapy, p. 78).
2. Painfu J areas can be treated effec tively by parave rtebral procaine or lidocaine injec­
tions in the releva nt segment.
3. Procaine or lídocaine treatment of the sympathetic chain and íts ga ngl i a : the abdom­
inal and lumbar sympathetic cbain; the ciliary, Gasserian, sphenopalatine, and stellate
ganglia; and the upper and lniddle cervical ganglia.
For the Jower extr e m i ties, ín addition to tbe injection to the sympathetic chain, we favor
that to the root of the sciatic ne rve and an epidural or presacral infiltration. If segmentaJ
therapy produces no lnarked improvement in the pat i ent s condition, the physi c i an must
'

always bear in mind the possibilíty of an interference field (p. 26).


4 Segmental Therapy

The �" g e ts of the ... ody Head's Zon s'


-

There are thirty segments in the hUlnan body:

C1-C8 Cervical s egments


T1-T12 Thoracic segments
Ll-L5 Lumbar segments
51-SS Sacral segments
The Segments of the Body (Head's Zones) 5

Fig. 1
6 Segmental Therapy

Internal Organs and Their Related Pain and Reac ivp egments

Organ M ain i ncid e nce Re activesegments

He art C3-C41eft T1-T6 left C3-T8, trigeminal nerve,


mainly on el ft

Lungs, bronchi C3-(4 T3-T 5 (3-(8 T 1-T9


left or righ t left or right e
l ft or right left or r i ght

Es ophagus T5 T5-T8

Stomach C3-(4Ieft T2, T7-T9 e


l ft (3-C4Ief t T5-T9
nl ai nly left

Small intestine T9-T 11 (3-C4 T5-T12

Ascending and T11-L1 (3-(4 I10-L3


de sce n ding colon left or r ight left or righ t left Dr right

Liver, gallbladder C3-C4 right T6- T1O right C3-C4 right T5-T11 ríght
trigemi t ri geminal J rig ht

P ancre as C3-C4 Jeft T8 left C3-C4 left T7- T10 left


S pl ee n TS -T9 Ieft (3-(4Ieft T7-T 1 1 e
l ft

Kidney and urete r left or right Tl0-T12,L1 C3-C4 T8-L4

Bl adder Bil T1 2-L3 , S2 Bi l ate rally I10-L5, Sl-S4

Uterus, ov aries, Bil T11-L 3 Bi later al1y T1 0- L3


tubes, testes,
epi

Re ctum B il a Tl0-L3 Bi I10-U, 52


Internal Organs ancl Their Related Pain and Reactive Segments 7

Fig.2
Summary ofthe Principal Injection Points in the Segmental Treatment 9

SUIlIT a �<r of wh � Priuci '" Ir.jection Points in the Segmental


Trea":':le t of the Disord f> o� toe:

Heart
Lungs
Liver and gallblad d er
Stonlach
10 Segmental Therapy

eglnental Thera y i Cardh _ Di_ or s

• Standard points o Points where reactions are frequently obtained


_ S eg me ntal reactíons frequent

Fig.3

The basic treatment in all cardiac disorders that faíl to responcl clearly to strophantin and
other glucosides is an intravenous injection into the left cu bi tal vein (p. 188).
In addition, set two to four quaddles (p. 184, 185) by the side of the sternum over the
first to t h ird intercostal spaces, and a fur the r quaddle in the angle formed by the lower
left thoracic margin and the xiphoid process.
The reflex zones of the heart are 011 the left side of the chest ; they extend frO lTI the left
of the sternum to the left clavicle and over the left shoulder to the left side of the neck.
Segmenta! Therapy in Cardiac Disorders 11
--------.-

S gmen ,Therapy Íf ardiac DisordeL

• Standard points o Points where reactions are frequently obtained


_ Segmental reacti ons pos s i b l e S eg mental r ea cti ons fr equ e nt

Fig.4

G n th e back, they extend to below th e shoulder blades. In this regi on hyperalgetic p o ints
,

can be located by palpation; they can be eliJnin at ed by quaddles ( p. 178) and d ee per in­
jections (t o the 'ollch' point), d own to the p e ri ost e u m if nec es s ary.
All scars i n t he s egln ent must be tr e at ed at the same ti1ne ( p. 190). Th e most p owerful
weapon that can be used in s egm e n t al th erapy f or t he h e art is the i njec ti on to t he stelIate
ga n gl í o n (p. 40-49).
12 Segmental Therapy

Segm n .:al Thera. y in Disorder . of e lungs

• Standard points o Points where reactions are frequently obtained


_ Segmental reactions frequent

Fig.5

Basic treatment for all pulmonary disorders: intravenous ínj ections alternately left and
right (p. 1 88).
Four to six quaddles (p. 1 84, 185) by the side of the sternum, further quaddles over the
s houlder area and bilaterally adjacent to the lateral processes of the thoracic vertebrae.
In acupuncture, the recornmended p o i n t s are: lung o1eridian point 1 Oil the anterior para­
axillary line, slightly l aterally of the mid-clavicular lin e at the level of the third i nterc o stal
space ; and lung point 2, which lies in the next intercostal space above the former (second
i ntercostal sp ace).
Segmental The rapy in Dísorders of the Lungs 13

Segmental herapy i n i''' o rders of the lun s

• Standard po int s o Points where reactions are frequent]y obtained


_ Seg men tal reactions frequent

Fig. 6

Eliminate any hyperalgetic points in the pulmonary regíon and treat aH s cars (p. 190) in
the seglnent at the same tinle. The injection to the stel1ate ganglion (p. 40-49) has a power­
fuI regulating effect on the neurovegetatjve supply to the as s ocia te d upper quad rant of
the body.
14 Segmenta! Therapy

Segmen ',a T· e ra y in Disorders ol the IJver and Gallbladder

• Standard points o Points where reactions are frequently obtained


_ Segmental reactio n s po ssi b l e _ Segm en tal reactíons frequent

Fíg.7

The basic treat ment in disorder s of the liver and gallbladder co nsists of: an intr avenous
procaine or lidocaine inj ec t i on (p. 188); quaddles (p. 178) over, or an injectíon into, the
epigast rium (p. 114); qua d dles over the region of the gallbladder or the pancreas; quad­
dles in the assoclated Head's zones (p. 3-5) on the back and sh ou I d ers ; an injection to
the ri gh t supraorbital nerve (p. 66); and injections to Vogler's points on the periosteum
(p. 116).
Segmenta! Therapy in Disorders of the Liver and Gallbladder 15

Segrr ental Therapy i ¡sorde "S ot" the liver and Gallbladder

• Standard points o Points where reactions are frequently obtained


_ Segmenta! reactíons poss ible _ Segmental reactions frequent

Fig.8

For p atients suffering from gallbladder cohc, paravertebral injections to the right inter­
costal nerves (p. 80) T9-T11 are recommended; for post-operative pain after abdominal
s u rgery, the treatment cons1sts of paravertebral injections to the intercostal nerves T5-
Tl1.
Within the segment, all hyperalgetic poin ts, muscle spasm, and scars (p. 190) must be
treated at the same time. Injections to the sYlnpathetic chain ( p. 90-93) have proved
extren1ely effective in the trea tment of abdOlninal disorders.
16 Segmenta] Therapy

Segm e nta The rapy in Gastric D'so ders

•Standard points o Points where reactions are frequently obtained


_ Segn1ental reactions possible _ Segmental reactions frequent

Fig.9

The basic treatment in gastric disorders consists of: intravenous procaine or lidocaine
injections (p. 188); injections into the epigastrium (p. 114); and to the left supraorbital
nerve (p. 66). For patients suffering from gastric colíe. paravertebral anesthesia of the
intercostal nerves (p. 80) T6-T8 on the left is recommended.
Any hyperalgetic points, scars (p. 190), and fibrositic nodules in the segment must be
treated at the same time.
Segmenta} Therapy in Gastric Disorders 17
_...
===-�= ------_ ._.,...��----�,

Segmen" al T 'lera y I Gas Tic Disorde s

• Standard points o Points where reactions are frequently obtained


_ Seglnental reactions possible _ Segmental reactions freq uen t

Fig. 1 0

Injections to the abdominal sympathetic chain (p. 90-93), i n conjunction with those into
the epigastriUl11 (p. 1 1 4) and to Vogler's points on the periosteum (p. 116) or the xiphoid
(p. 1 1 8 ) form a useful and effective combinaban for treating abdominal and gastríc
disorders.
18 Segmental Therapy

Sum ary of t e "ncipa Injectlon olnts on . he Hoa


( ,
� .. riar " spect)

Temporal bone
Supraorbítal nerve
Eye quaddles
Infraorbital nerve
Ciliary ganglion
Gasserian ganglion
Lower alveolar (mental) nerve
Surnmary of the Príncipallnjectíon Points on the Head (Anterior Aspect) 19
------

::.-­
Cili"''Y gangli

Gasserian gangrion"

Fig. 1 1
20 Segmental Therapy

Summary of t e ri .leí allnjectiol1 Poil1ts on . he He"


(lateral Aspect·

Headache points over the temporal and parietal bones


Supraorbital nerve
Eye quaddle
Sphenopalatine ganglion
Ciliary ganglion
Gasserian ganglion
Infraorbital nerve
�astoid process
Summary of the Principal Injection Points on the Head (Lateral Aspect) 21

, �, .

Headache points over


the temporal and parietal.bohe� , '

�ye qoadctf'e
�inglioÍ1 �

' Ciliar\' �;ari91i6n

T
Gass8[ían ganglion

Mastoid proQ'ess

Fig.12
22 Segmen tal Therapy
._---�.

Freq e ntly Used I njection Poi nts on the Back of th e ' ead ,
on eck a d Shoulders
Frequently Used Injection Points on the Back of the Heacl, 00 Neck and Shoulclers 23

Fig . 1 3
25
-------�._-,

The Light ing .' eac jo I a n the s ' a rCll . or a n


- terfere c e "'ield
26 T ll e Lightning Reaction and the Sea rc h for an l n terference Field
----------------------.
.-

In 1 940, Ferdinand Hl1neke observed his first líghtning reaetíon. This led hirn to the ther­
apeutieally important eonc1usion that a state of neural irritation or an 'interference field'
can cause and keep in being élny kind of disorder outside tbe segment. He had diseovered
a way to eliminate pathogenic interference fiel ds and thus to cure patients sufferíng from
therapy-resistant disorders. We therefore use the term 'Huneke phenomenon' to describe
such a lightning reaction.
The conditions for a J ightning reaction are :
1 . When a nel1ra1-therapeutic substanee is injected i n to the interference field responsi ble
for a disorder, all remote disturbances controlled b y the interferen ce field must dis­
appear comple tely at the mom ent of the injeetion, as far as this is anatomieally sti11
possíble.
2. The patient must ren1ain com pl ete1y symptom-free for at least 20 hours (8 hours in
the case of teeth).
3. If the sympton1s reCltr, the injection must be repeated at the same síte ; the patient
m ust then remain completely symptom-free for at least as long and preferab ly l onger
than on the previous occasion.
Any of the following lTIay act as interference fields:
Dental foei, Le., infected . displaced , devitalized teeth, etc., (p. 1 93 ); tonsils ( p. 74-77),
sinuses ; any skin, deeper-tissue, and bone scars; foreign bodies, chronicalIy ínfl alned
organs; residual conditions after inflalTImatory disorders of the liver, gallbladder,
stomach, intestines, appendix, prostate ( p. 1 24 - 1 2 7 ). ovari es, or tubes.
A detailed clínical history can often provide useful pointers.
If an inj ection into a suspected interference field does not produce the expected reaction,
fu rther injections to the sa me site are pointl ess; in such cases, other possible interference
fields should be sought.
In practice. 0 . 5 - 2% procaine ( novocaine) and lidocaine ( xy locaine ) solutions have proved
effective for use in ne ural therapy. Other substances used in neural tbe rapy inelude neuro
2
L90\ Sensiotin cum procai n , and Xyloneural .
3
The maxim u m dose for adults is about 25m1 of 2% procaine given intramuscularly or 2 0ml
of 1 % lidocaine solution. The quantities stated in the text are maxima and must on no
account be exce eded. The practiced n eural therapist can usually manage with much small­
er doses, generally no more than a few milliliters. Th e quantity i njected is far less impor­
tant than the correct site of the ínj ection.
The use of procaine or lidocaine solutions ¡s contraindicated in the fol lowing disorders:
Arteriovenous (AV) block, bradycardia, severe conduction disturbances, severe hypo­
tonia, and card iac decompensation.
Lidocaine should be used for patients with hypersensitivity or allergy to procaine ; to date
no reports have been published d escri bing allergic 01" hypersensitivity reactions to lido­
carne.
Obviously, a thorough anatomical knowledge and strict observance of sterile p rocedures
are essential for any physician practicing neural therapy. In the photographic material
for this atlas I have intentionally omitted covers. su rgical gloves, references to skin dis­
infection, etc., in ord er to show the techniques as clearly as possible. Drawings are pro­
vided where necessary for greater clarity.
Injections where there lTIay be sorne risk of compl ications are marked by a note following
the word CA UTlON.
(ntra-arteri al ínjections into a vessel leading to the brain or i nto the subarachnoíd space
can have serious consequences; always protect you r patient and yourself by prior aspi­
ration to ensure that the needle is correctly positioned.
27

Tec n" u �
28 Technique

j--t of I _ie�tions

Head, N eck
Inje cti on to and i nto : Temporal artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
to : Upper cervical g a n glio n a n d ret r o s tyl oi d re gio n . . . . . . . . . 32
C i li ary gan l i on g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4

Mandibular nerve near G a sser ia n gangl io n . . . . . . . . . . . . . . 36


Sphenopalatin e ganglion a n d maxillary nerve . . . . . . . . . . . 38
Stell ate ga n glion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Ste ll ate ga ngl i on ( a ccord ing to Herget) . . . . . . . . . . . . . . . . . . 42
S te ll ate ga n gl i on ( according to Leri che a n d Fontaine,
lTIo dified by P O o sc 11 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Ste l l a te ga nglion ( a ccording to Rei schauer) . . . . . . . . . . . . . . 46


under: Scalp . . . . .. . . .. . .. . . . .
. . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
to : Mastoi d p rocess . . . . . .. . .. . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . 52
Glos sop haryngeal n e rv e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
I nfraorb ita l nerve . . . . . . . .. . . . .. .. . . . . . . . . . . . . . . . . . . . . . . 56
Superior l aryngea I nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Mental nerve . . .. . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Occipital nerves . . .. . .
. . .. . . . . .
. . . . . . . .
. . . . . . . . . . . . . . . . . 62
Phre n i c n erve C3 -C5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
La t e ra l su pra orbi tal nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Deep cerv i cal p l ex u s C2 -C4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
S uperficial c erv i c a l plexus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
into : Th yr o i d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
to : Palati ne to nsil . . . . . . . .. . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 74
int o : Ad eno i d s ( ph a ry n ge a l tons il ) and pharyngeal hypophysis 76
Test i nj e ctio ns t o the teeth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Chest, Back, Abdomen, Pelvis


I njection to : I ntercos tal n e rves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
E p i d u ral a n es th e s ia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Injecti on ¡ nto : Posterior sa cra l foramina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
to : Ab d o m inal syn1pathetic chain (acco rding to V ís h n ev s ki ) . 90
Lu mbar sympathetic cha in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
i n to : R e gío n of the root of the sciatic nerve L3 -L5 . . . . . . . . . . . . 98
to and into : Sacral p l exus . . . . . . . . .
. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . 1 02
Presacral infiltrati on ( a ccording to Pend l ) . . " . . . . . . . . . . . . . . . . . . . . . . . . . " . . . . . . . . .
. 1 06
Inj e ction into : Sacroi liac joint . . . . . . . . . . . . . ... .. . . . . . . . . . . . . . . . . . . . . . . 1 08
to : Franke nháuser's ganglia ( uterovaginal plexus) . . . . . . . . . . 1 10
into : Pelvic regí on . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 12
Ep i ga s triu m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 14
to : Vogler's points . . . . . . . . . . . . .. . .. . .. . . . . . . . . . . . . . . . . . . . . 116
Injection to : Xip hoid . " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 118
Pudenda l nerve . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 20
¡nto : Prostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 24
Prostate ( s u p ra p u b i c injection a cc o r di n g to Hopfe r ) . . . . . 1 2 6
List of Injecti ons 29

Extrem ities: Arms, Legs


Inj e c ti on to a n d i nto : BrachiaJ artery . . . . . . . . . . . . . . . . 1 28
. . . . . . . . . . . . . . . . . . . . . . .

to: Subcl avian ar te ry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3 0


into : E l bow j oint _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 32
Wrist j oint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 34
Shoulder joi nt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 36
to : M e d i a n nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3 8
Ra d i a l nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Ulnar ne rve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 44
Ring-block anesthesia of fi n ge rs and toes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 46
l nj ection to : Brachia l p lexus (5 -T1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 48
to and into: Femoral a r tery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 52
Pos terior tibial artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 54
i nto : Hip j o int . . . . . . . . _ . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 56
Knee joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 60
Anide j o í n t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 62
]oints of fingers and toe s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 64
to : Lateral cut aneous feInoral nerve . . . . . . . . . . . . . . . . . . . . . . 1 66
to and into : Femoral nerve . . . . . . . . . _ . _ . . . . _ . . . _ . _ . . . . . . _ . . . . . _ _ . . _ 1 68
to : Fi b u ] a r nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 70
O bturator n erve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 72
Ti bi a l nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 74
Trochanter luajor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 76
Quaddle t he ra py . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 78
I ntramuscular i n filt rati a n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 7 9
Qu a d d le s in the : Regíon of t h e knee j oínt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 80
S acroilia c regíon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 82
Parasternal regia n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 84
Pelvic region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 86
Intravenaus i nj e c tian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 88
Inj ection s inta scars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 90
30 Head, Neck

He d. ec

I jection to and ¡nto t e Temporal Arte y

Indications : Temporal arteritis, migraine, temporal head aches.

Materials : Size 12 need le, 1 mI procaíne o r lidocaine.

Technique : The temporal artery runs from the external ear to


Po int of insertion:
the temple where its pul se is visible and palpable.
Injection to and i nto the Te mporal Arte ry 31

Fig . 1 4 : I njection t o a n d ¡ nto the te m p oral a rte ry


34 Head, Neck

I nj �ctio to the Ci iary Ganglion

Indications: Al l acute a nd ínflam matory eye dis ord ers, e.g., keratitis, iri d o cycli ti s .
gl au c Olna ; a n d certain typ es o f headache.

Materia1s: 40 mm long need l e , 2 mI procai n e or hd o caine.


- -

Technique : The p at i ent s head is finnly s upporte d ; the eyes are held open, looking
'

up and mediaUy. With the tip of the forefi nge r of the free hand gently
force the eyeb a ll upward a nd toward th e nos e .

Point of insertion: For th e righ t eye at seven o c l oc k for the l eft eye a t
' ,

fi v e o ' c lock.

Direction of needle: Back u n der l oo s e bone co nta c t with the l owe r o r­


bital wall, then up and in.

lnjection depth: At a d e p th of 30 m m and no m o re tha n 35 mm, the


nee d le hes close to the ciliary ga nglion .

CA UTlON: Asp i rate before i nj ecti o n !


I nj ection to the ciliary ga ngl ion 35

Fig s . 1 7 , 1 8 : l njectio n t o t h e ci l i a ry g a ng l i o n
36 Head , Neck

I njecti n t the Mandibu a N e rve Nea r the Gassen a n G n g Uon

Indications: Trigeminal neu ralgia, trismus; also worth trying with headaehes of un­
certain origin ; pain due to lnal ignancy in the afea supp [ied by thí s
nerve.

Materials: 0.8-rnm-diarneter x 60-rnrn-long need le, 1-2 mI procai ne or l idocaine.

Technique: Point of insertion:The patient s its with the mouth sl igh tly open; the
mandibu l ar notch can be p a l pated about 30 mm in front of the tragus,
directly below the center of the zygomatic arch.

Direction of needle: Transvers e ly along the base of the sku ll toward s


the middle.

Injection dep th: At ad epth of about 40 mm, the need l e strikes the ptery­
goi d process. Withdraw the needle slightly, tben advance d o rs a l ly
5 - 1 0 mm ; it is now close to the foramen ovale.

CAunON: Aspirate before injection ! The p atient's pain reaction s hows


that the n e ed l e is in the correet position.
I nj e ction to th e M and ibular Nerve n ear the Gas serian Ganglion 37

Figs. 1 9-2 1 : l njectio n to the m a n d i b u l a r n e rve near the Gasseria n g a n glion


38 Head, N eck

In "ection to the Spheno. ala e Gan g l lon and the Maxil lary Ne . l/e

Indications: Hay fever, vasomotor rh i nit i s , neuralgia of the second branch of the tri­
geminal nerve, sinusiti s ; also worth trying in therapy-resistant headaches
and for m axi l l a ry pain in the absence of p ath o l ogical d e ntal findings.

Materials: O . 8 - m m -d i a lneter x 60 - n11n -Iong needle, 1-2 mI p r oca i n e or lidocaíne.

Tech nique: Point of insertíol1: At th e upper edge of the zygOInatíc arch, m id way between
the external ear and the o rbital rimo

Direction of needle: When the need l e is p osi t i oned correctly, it wil l point
towar d the zygom atic bone on the other side of the s kul l ( formín g obt u se
an gle s to front and below).

Injection dep th: At a dep th of about 50-60 mm, the needle reach es the
p telygopalatíne fos sa.

CAUTION: Aspi rate !


Inj ection to t h e Sp henopala tine Ga ngl ion and t h e Maxillary N e rve 39
-------

Fi gs. 2 2 , 23 : I njection to the s p h enopa latine ( pte rygo pa l ati ne) ga n g l io n a n d the maxi l l a ry nerve
40 Head. Neck

I njection to the Stellate Ganglion

Indications: Head: Pre- and post-apoplectic syndrom es ce rebral edelna, íntracranial


.

vascu lar s p a sms. po st-concuss ional synd ro m e . tra u ma tic e pile p sy.
paresis of the facial nerve, persistent facial e d e m a after erysípelas; cer­
tain types of headache a nd mi gra ine .

Eyes: Glaucoma . op h th almic herpes zoster, occlusion of the central ret­


inal arte ry. thrombosis of the central vein. dis eases of the choroíd. de­
generative dísorde rs of the macula. etc.

Ears: Méniere's disease , chroníc otitis media, sudden deafness , otic


zoster, ínner -ear d eafn ess, tinnitus. frostbite, allergic disorders, etc.

Nose: Vasomotor rhi nitis, chronic sinusitis, etc.

Throat and neck: Hyperthyroidisffi, ne u ralgia, cervical syndrome. sept ic


tonsíl l itis, cervical migraine, etc.

Sho u lder: Shoulder/a r m synd ron1 e sca lene syndrome , arth ros is defor­
,

mans, capsular a rthriti s, po st-traumatic s tiffeni ng of the j o i nts, etc .

Ann: BrachaIgia, causalgia, brachiaI-pl exus n e uralgia., phanton1- l i m b


p a i n s , post-traumatic o steop or o s is epico ndylitis, te ndinosis. l ymph
, ­

edelna following mastectomy. circula tory d isturbances, etc.

Lung: Bronchial a s t hm a. puhnona. ry tuberculosis, p ne umon i a. pleurisy,


herpes zoster, p ul m on ary embolism , pu hnonary ede m a etc. .

Heart: Angina pectoris, conditi on s foI l ow in g myocard ial infarction.


fibrillation, p aroxysmal tachycardia.
Injection to the SteIlate Ganglion______________c______________________�______________�
41

Fig . 24: Auxi l i a ry l i n es fo r l oca­


ti n g t h e
entry point for the i n ­
jection to the ste l l ate ga n g li­
on acc ord i n g to Herget:
a : Divi de t h e l ength o f t h e
stern omasto i d m uscle i nto
three equal p a rts. The e ntry
p o i nt l ies on t h e a n te r i o r ed g e
of t h e m uscl e at t h e tra ns iti on
from t h e ca u d a l t o t h e m i d d l e
th ird
b: At the a nterior edge of
th e ste rnomasto i d m u sc l e at a
l evel m i d wa y betwee n th e
first ri ng of the trachea a n d
th e u p p e r b o rd e r o f t h e st er­
num

Fig. 25: I n j ecti o n t o t h e st e l l a -t e ga n g l i o n a cc o r d i n g t o Leri che, as m od ified b y P Dosch


42 Head, Neck

I njectio n t the "te " l - t Gan g " .on (Accordi n t o Herget)

Materials: S O-rom-l ong needle, 2 -5 mI p ro ca i ne or lid oc ain e .

Technique: ( Herget's metho d ) :


The patie nt lies supine, with a fi rm pad u nd er the shoulders, s o that
the head is bent back and the cervical s pine hyperexte n d e d .

Poin t of insertion: A t t h e po int o f transition fro m the lower t o t h e m i d ­


d I e third , on
an a ux i l i a ry h ne be twee n masto id and s te r n o cl a vi c u l ar
j oint on the m edia l e dge of the ste rnomastoid lTIuscle, about 20-3 0 mm
l aterally from the mid li n e .

Direction of n eedle: Pe r p en di c u lar to ski n.

Injectíon depth: At a de p t h of 60-70 mm, th e p o in t of the n e e d l e reac h e s


the head of the first rib : withdraw needle 2 n1ffi a n d infi ltrate.

CAUTION: Aspira te !
If t h e needle is in the correct position, th e p ati e n t d ev el o ps a hOlno­
lateral H o r n e r s syndrOlne with ptosis, my o s is and en o p h t h a lm o s Fur­
' , .

ther signs are i ncreased circu l ation in chee ks, face, a n d nec k : the con­
j u nctiva a n d scle ra becOlne n o t i ce a b ly i njecte d ; anhidrosis of fa ce and
n eck; l acri m ation.
Injection to the Ste l late Gangl ion (Accord ing to Herget) 43

Fi g . 26: Herget's method

Fi rst r i b

. Ste llate gan glion--1�"T-�_�

••
Trt:1chea ••••
-
....

Fig . 27 : An atomy a n d pos iti o n of n e e d l e in the i njecti o n a ccord i n g to H e rg et


44 Head, Neck

I n,iection O 'he Ste late G ng ' ¡on f Accord i 'c to ler� ( e ''': ''
F, nta in �, a Mod"fied
� yP osct '

MateriaJs: 40-lnm-Iong need l e, 4-5 ml procaine or l i d ocaine.

Technique: (according to Leriche and Fontaine, as modifie d by P Dosch ) :


POÍnt of ínsertion: T h e h e a d o f the s eated patient is bent back and tu rned
away from the s i d e of the inj ection. At the poin t of transitio n fron1 the
lower to the middle third of the s terno masto i d muscle, place two
finge rti ps of the free hand on the outer e d ge of the sternomasto id to
push the ves s e l s o u t of th e way in a medial and the pleura in a caudal
d i rection. The head of the first rib s h o u ld now be palpable. The ently
point is immediate ly abov e the cranial fingerti p.

Direction DI needle: Toward the spino u s processes of the sixth or sev­


enth ce rvi cal ve rtebra.

lnjection depth: Practica lly subcutaneously when the h e a d of the first


fib is rea d í ly palpable ; to a lnaxi m u m of 20 mm in adipose pati ents.

CA UTlON: Aspirate to check for the presence o f liquor, bl ood, Of air !


" "
-
Sternocleidbrhastoid mÚsde

Fig . 28: Anato my a n d positi o n of n e e d l e i n the i nj e cti on acco rd i ng to Le riche a n d Fo nta i n e , as


m o d ified by P Dosch
I nj e c tion to the S tellate Ga nglion ( Leriche anc1 Fonta i ne, as Modified by P D o sch) 45

Fig . 29: M ethod a cco rd i n g to Leriche a n d Fo nta i n e , as m o d ified by P Dosch


46 Head, Neck

Injection to t . S ' e l l ate Ga n g lio n ( " ccordíng to Reischauer)

Method: 80-1 00-mn1-long needle, 1 0 mI p ro ca i ne 01' h d o c a i n e .

Technique: ( Reischauer' s metho d ) :


Point oI insertion: The pa t ien t sits astríde the c hair, p r es e n t i n g t h e back
to the physician, wi th the chin pressed ag a i n s t the chest to allow the
spino us process o f the seventh cervical vertebra to proj ect as far as pos­
sible. Insert the needle perpendicular to the skin and parallel to the
median plane, 40 m m laterally from the n1idline be tw ee n (6 and (7.

lnjection depth: At a d ep t h of 30-35 111m, the needle meets the lateral


p o rtion of the cervical vertebra l arches. It ís now turned at an angle of
45° i n a cranial and 45° in a lateral d i rectí on and advanced carefu l Iy
alo ng the bone. After losing bone con tact, advance the needle another
1 0 mm in a ventral direction, and inj ect. The patient signaJs the co rrect
position of needle by a typical pain in the s houlder blade.

CAUTlON: Aspirate !

-
-

. ..
.,

Ste l l ate gang l i on ��a...,....=---t

. ' . Carotid a rtery

Jugular vein .

Fig . 3 0 : An atomy and positio n of n ee d l e in the i njectio n a ccord i n g to Reis c h a uer


l njection to the Ste l I ate Ganglion (Accord i ng to Re ischauer) 47

Fig. 3 1 : Reisch auer's method


48 Head, Neck

Sternocleidomastoid m uscle

F i g . 32 : M et h od acco rd i n g to Leriche and Fo nta i n e , a s m odified by P Dosch


Injecti on to the S tellate Gangl ion ( According to Reischaue r ) 49
------

Sterno.cleidomast0id muscle

Fi g . 33 : H e rget's m ethod
50 H e ad , Neck

Inj ecti n u de (he Scalp

Indications: H ead ache, vertigo, p o s t-concussio n synd rome, tra umatic epilepsy,
cereb ral va sospasti c disturb a nces, pre- and post-apoplectic states, in­
sOlnnia.

Materials: Size 1 2 ne e d l e 0.5-1 mi procaine or l i d ocaine to each side.


,

Technique: Point of insertion: Over temporal o r pari e tal bone at level of te mp les.

Direction of needle: Pe rpen d icular to s kin.

Tnjecti on dep th: Down to or u nder the periosteum.


Injection u nd er the Scalp 51
--------�-

F i g . 34: I njection u llder the sca l p


52 Head, Neck

njection t the Mastoid Process

Indications: a: S e gln enta l the ra py : Acute or chronic otiti s med i a , otitis externa,
¡nner-ear deafn e s s , tinnÍtus , vestib ular vertigo, pares i s of the fac i a l
nerve, facial tic.
b: In terfereoce -fi eld se arch : As a te st i nj ection if the patient's hi s tory
suggests dísorders of the ear.

Materials: Size 1 2 needle, 0.5 m l p rocaíne or l i docaine.

Technique: Turo up the ear lo b e o

Po ínt oI insertion: An terior edge of the nlastoid process.

lnjection depth: As fa r a s contact with the pe riosteum, then d istr i bute


a few tenths of a ln i lliliter ventrally and do rsally of the ln astoid, in
orde r to inelude the greater auricular and lesser occipita l nerves.
Inj ection to the Mas toid Process 53

Fi g s. 3 5 , 36: I njectio n to the masto id process


S4 Head, Neck

In,ject!'on o the Glossopha ryngeal Nerve

Indications: AH disorders within the area supplied by this n e rve, sLlch as glosso­
pharyngeal neuralgia, a typi c aI tri geminal neuralgia, dysphagia ,
dí sord ers o f the tongue.

Materials: 60-mln-Iong needle, 2-3 Inl procaine or lidocaine.

Technique: Po int 01 ÍnsertÍon: Midway between the tip of the n1a stoid and the angle
of the mandible.

DÍrectÍon 01 needle: Perpendicular to s kin.

Injection dep th : Bone contact with the styloid process at a depth of


3 0-40 Inn1, t h e n i nfiltrate o nly o n a nterior s í d e .

CAUTION: Aspirate !

Fi g. 3 7 : Anato my a n d pos itio n of needle for the i njection to the g l ossop h a ryngeal nerve
I nj e cti o n to the Glossophalyngeal Nerve 55

Fi g . 3 8 : I njecti o n t o the g l osso p h a ry n g ea l n e rve


56 H e a d , Neck

In.i ection .. O
' t e I nfraorb¡' al Nerve

Indications: Trigemina l neu ra lgia, supramaxil l ary p a i n in the absence of patho­


logical dental fi n di n gs ; d isorders affecting the m axillary sinuses, facial
p a in
.

Materials: Size 12 needle, 0.5 mI p rocaine or lidocaine.

Technique: Poin t oI insertion : There is a palpable r o ug hn e s s s l i g htly Inedially of


the center of the infra orbital ri dge ; the infraorbital foramen is abou r
8 n1m below this. Insert the needle just b elow this point.

Dírection oI needle: Obliquely in a cranial and medial d i rection.

Injection depth: U ntil bone contact ís made a n d paresthesia is produced.


Injection to the Infraorbital Nerve 57
-------

Figs. 39, 40: I nj ectio n to the infraorbita l n e rve


58 H e a d , N eck

Injectiol O to th ,� Superio la r ngea l Nerve.0<

Indications: Neura l g i a pa in and dysphagia of the larynx.


, ,

Materials: 60-mm-long n eed le, 5 mI proca i n e or lídocaine.

Technique : The s u pe rior laryngeal nerve divi d e s a t tbe leve l of the hy oid bone i nto
an external and an internal branc h.

Point of insertion: Th r o ug h a q u a d d l e set in the center above the thyro i d


n otch .

Direction of needle: Pass the nee d l e t h ro u g h


tbe quaddle, going s ub­
cutaneously under control of the free fore fing e r in an oblique lateral
and cranial d i rection toward the grea ter horn of the hy o id b o n e.

Injection depth: 5tay subcutaneous until the p a t ie n t signals paresthe s i a .

Fig . 4 1 : I njecti o n to t h e su peri o r l a ryngeal n e rve: p o i n t of entry a nd d i rectio n of need l e


lnjection to the S uperior Laryngeal Nerve 59
-=�-------�--

Fi g . 4 2 : I njection to t h e superi o r l a ryng e a l n e rve


60 Head, Neck

Inje .: j Jin th ental �Jerve

Indications: Trige minal n e u ral g i a fa ci a l p a i n p ain i n c h in and lower lip.


, ,

Materials: Size 12 n e e d le, 0 . 5 mI procaine or lidocai ne.

Technique: Point of insertion: The me ntal fo r a m e n lies below the lower premolars,
m idway between the a l veolar rid ge and the lower e dge of the j aw ; it
ca n be readiIy pa l p ated .

Direction of needle: Perpendicu lar to skin as far as the mental foramen,


then a few míl l imeters i n a cranial and m ed i a l d irection.

lnjection depth: Unti l bone contact is obtained and p a r es th e s i a occurs.


Injection to the Mental Nerve 61

Fi g s. 43 , 44: I nje cti on t o t h e m e nta l n e rve


62 Head, Neck

I n1"_,tloo to the Occipital Nerve

Indications: O c c i p i t a l neura lgia , c ervi c a l syndrome, headac he ; all di sord ers wi thi n
the a fea supplied by t h i s nerve ( sk i o u p to the pari e ta l regi on, l a t e ral ly
as f ar as the temporal r eg i o o p os t e ri o r p art of ear).
,

Materials: S i ze 1 2 needle, 0.5 - 1 mI p roc a i ne o r lidocaine.

Technique: Po int of insertion: The ne rve Hes i n a med i al d i rection i rnmed iate ly a d ­
j a ce nt to the readi ly pa l pa b l e o cc i p i t a l artery, abo u t 2 0-40 m m frOlll
the mi dl ine, a n d i s palpable b e twe en the bony attachme n ts of the tra­
pe zi u s and s e mi s p inal i s capítis mu scles.

Direction of needle: P e rp e n d i c u l a r to skin, u nti l p a re sth es i a Dccurs.


l njection to the Occipital Nerve 63
_��H_
*_
__
________________�____________________�_________________

Fig. 45: I njectio n to the occi pital n erve


64 Head, Neck

e5

Indications: Stubborn hi cc o ugh s . p a in ra d i a t i n g to neck and s h ould ers i n o rganic


abdOIninal a n d thoracic d isorders .

Materials: 40-mm-Iong n ee d l e , 2 - 5 mI p ro ca in e or lidocaine.

Technique: The patient turns the head away fron1 the side of the inj ect i o n and in­
el i n e s it toward the i njection. in o r d er to relax the s te rn o m as to i d n1U S ­
ele.

Point 01 insertion : 011 the l ateral edge of the muscle. directly above i t s
p o int of a ttachment to th e clavicle.

Dírectíon 01 needle: Almost p arallel to the clavicle, o b l i qu ely in a medial


d irecti oll.

lnjection depth: At a depth of abo ut 3 0 mm, the needle enters the sca­
lene notch.

CAUTION: As p i rate ! Because of th e risk of diaphragmatic p aralysis, i n­


ject only one side at a tiIne.

Fig . 46: An atomy and positi o n of n ee d l e fo r the i njecti on to the p h renic nerve
Injection to tbe Phre nic Nerve (3 -(5 65

Fíg. 47 : Injection to the phrenic nerve (3 -(5


66 Head, Neck
------

. njecc:on . O the late �al Suprao a l Nerve

Indications: Neuralgia of the first b ra n ch of the trigelninal n e rve, herpes zoster,


frontal head a che, stye, tarsa l cyst, frontal s i nusitis.

Materials: Size 12 n eed l e 0 . 5 mi p ro ca ine or lidocaine.


,

Technique: Point of insertion: By running the thumb along the supraorbítaI r i dg e,


we fí nd t h e sup raorbítal notch s l ig ht l y med i a l ly of the center of this
ridge.

Direction oI needle: Cr anialI y i n fro nt of the thumbnaiL

Injection depth: U nt i l bone contact is obtained and paresthes ia oecurs.


Inj ection to the Lateral S u pra orbital Nerve 67

--- ''' '-----

Fig s . 48 , 49: I njectí o n to the latera l s u p raorbita l nerve


68 Head, Neck

I jection to the Deep Cervical Plexus (2-.(4

Indications: Cervical syndrome, torti collis, neck pain.

Materials: 40-rnm-Iong needle, 2 mI procaine or líd ocaine.

Technique: The p atient hes supine. the neck s u pported on a roll cushion and the
head turned away from the side of the i nj e cti on.

Poin t oI insertion: With the fingers of the fre e h a nd force the sterno­
ma stoid rnuscle out of the way i n a ventral d irecti o n : insert the needle
at the p osteri o r e dge of this muscle at the level of the angle of the man­
d ibl e
.

Direction of needle: Perpendicular to skín.

lnjection depth: At a de pth of n o m o re than 1 0 m m there is bon e contact


with the posterior tuberosity of the t h i r d lateral process. Without al­
lowing the needle to penetrate further in, guide it a few ll1illin1eters
in a d o rsal and caudal d irection.

CA UTION: Aspirate to check for the presence of b lo o d or l i q uor. If the


n e e dle is correctly i n position, the patíent signaIs paresthesia i n the
shoulder region.
l nj e ction to the Deep Cervical Plexus C2-(4 69

Fi g . 50: Injection to the deep cervical plexus (2-C4


70 Head, Neck
--��=�
� ==�==
..=..
=. �
--------------------------------------------------

I njectio to the Superficia l ' e rvica l P. exus

Indications: N e ck and shoulder pain, torticollis, cervical syndrOlTIe.

Materials: 40-mln-Iong needle, 2 mI p roca í ne or l id ocaine.

Technique: The p a tíent lies s upine, the neck supported on a roIl cushion and the
head turned away from the side of the inj ection.

Point oI insertion: Midway between the lnastoid process and the clav­
¡ele, a t the posterior edge of the sternomastoid lTIuscle.

Direction oI needle: Perpendicular to s kin.

Injection depth: At a depth of 2 0-3 0 m m, bone contact is Inade with


the lateral process of the s eco nd or third cervical vertebra. Withdraw
the needle 5 - 1 0 mm, then i n filtrate an area of 30 m m x 1 5 mnl.

CAUTlON: Aspirate !

Lesser occipital nerve \

Spinal ganglion,

Fig. 5 1 : S e cti o n of the neck at the l eve l of the s u p e rfi ci a l ce rvi c a l p lexus
I nj ection to the S u p erfici a l Cervical Plexu s 71

Fi g . 5 2 : l njecti o n to the s u pe rficial cervica l plex u s


72 Head . Neck

n � e(ti on i Ito -he y Ol(

Indications: Hypothyroidisn1 and hyperthyroidi sm, go i ter thyrotoxicosis, B a s ed o w s


, '

d i s e a s e ; a sensation of p ress ure or a IUlnp i n the throa t ; anxiety,


p a lpi ta ti ons , menstrual d i s o rd e r s , hab itua l abortion; also t ry in alo­
pecia, tac hy c ar di a , a n d feve r of unknown c a u s e ; n eu r o d y s t o ni a , 'nerv­
O llS' abdominal and d igestive di sorders, i n creased nervousness and ex­
ci ta bi l i ty. In WOlne n, inj e cti ons s houl d be given at the same time to
Frankenhauser's g a n gl i a (p. 110).

Material s: S i z e 18 needl e , 0.5-1 mI pr o cai n e o r l i d ocaine fo r each lobe of the


gland.

Technique: Point of insertion : The pati ent s h ould be s u p ine or se ate d . Palpate the
position and síze of the thy r o i d while the p ati ent is swa llowing.

Direction DI needle: Perpend icular to s ldn.

lnjection depth : About 1 0-20 mm i n to the p a re nc hy m a o f the gland.

CA UTION: Aspirate ! I f bl oo d is a s p i ra t ed , c h a ng e p o sit i o n of needle.

Fi g . 53 : Injection i nto the thyroid


I nj ection i nto the Thyro id 73
--------�--��

Recurrent laryngeal

Fig . 54: Anatomy and positi o n of needle in the i njecti a n i nta the thyroid
74 Head, Neck

In�e(tio to t, e Palatine Tonsil

Indications: a: Segmental therapy : Chronic tonsillitis. recurrent sore throat.


b: Interfe rence-fíeld search : A s a tes t i njection in patíents whose clín­
ical history indicates frequent ol' s eve re sore th roats , scarlet fever,
diphthería, tonsilloto 111y, or tonsíllectomy.

Materials: O.8-mm-dialneter x 80-mm-Iong needle, 0.5 mI proeaine or lidocaÍ ne.

Technique: The patient's head sbould be fixed firrnly in posi tion, and the buccal
eavity well lit.

Above the to nsillar poles_ For the injeetion to the


Po Ínt of insertion:
lower poles, push the tongue in a s l igh tly medial direction and ins ert
the needle between the lower wisdom tooth and the root of the tongue.

Injection dep th: Sub mucously.

Inthe case of tonsil lectomy s cars, insert the needIe in the center of the
sear an d i nject direetly below the s urface of the scar tissue.

CAUTION: Aspirate ( proxímity of vessels Ieadíng to the brain)!


Injection t o the Palatine Tonsil 75

Fig . 55: I njection to the pa lati ne tonsil ( u pper pale)


76 Head, N e ck

I njee í n i n--,o -h · d noíds ( Pharyngeal Tonsi l ) and - -he


_. �

Ph r 11 eal - ypop ysis

Indications: Adenoidal proliferatíon, allergic rhinitís. disturbance of the sense of


smeIl or taste, angioneurotic edema, pluriglandular dysfunctions, bron­
chial asthma, trigeminal neuralgia, arthroses, rheuluatism.

Materials : O.8-mm-diameter x 80-mm-Iong needle, 0.5 - 1 mi proeaine or lido­


eaine.

Technique: In aceordance with Leger' s method, the needle is inserted above the
uvula imluediately next to the boundary between the hard a n d 5 0 ft
palate.

lnjection depth: Ad vanee the need)e u ntil bone eontact is obtaíned with
the posterior waIl of the pharynx. Bend the terminal 1 5 mm of the nee­
dIe at a slight angle to reach the pharyngeal hypophysis further cranÍ­
ally . against the anterior wall of the sphenoid sinus.

When bone eontaet is made. withdraw the needle abou t 1 mm and ¡n­
jeet after aspi ration (check for blood ! ).

CA UTION: Aspirate !

Sphenoid s ü i u s

Adenoids --ft=�-

Fig . 56: An atomy a n d positi on of the n eed l e in t h e i njectio n ¡ nto the adenoids
lnj ection i nto the Adenoids ( Pharyngea l Tonsil) and the Phalyngeal Hyp o phys i s 77
_-",",:.cr""m XJiMQro

''':'�
-
' > '�.' ' . ..
• ..,r . . .
'- ....!oI
•_ '
.
.: • •":

.} - < "

Fig . 57: I njection i nto th e adenoids


78 Head, Neck

Test Injecti t s o the Teeth

Indications: a: SegtnentaI therapy : In alI i ntl a mma to ry proeesses in the regíon of


the teeth, mo u t h , and upper and I ower jaws : a lveol itis , post-extraetio n
pain, paradontop athie e o nd iti ons slow-healíng wou n d s, etc
,

b: Interferenee-field seare h : Any of the fol low i ng may aet as interfer­


enee fields : devitalized, infe ete d, or displaced teeth ; r e s i d u al ro o ts, al­
veolar poekets. residual ostitis ; sears fol lowj ng root reseeti on and sur­
gery to the maxillary s inu s e s ; eys ts, parodontosis, ging ivit i s , st o m a ti tis.

Materials: Cartrid g e or loeking syringe. 0.2 -0.3 mI pro ea i ne or l i docaine per in­
j eet ion .

Technique: Ove r each dental root to be tes ted inj ect 0.2-0.3 mI, both buecally and
palatally.
Test lnj ections to the Te eth 79

Fi gs. 5 8 , 59: Test i njecti ons to the teeth


80 Chest, Sacie, Abdomen, Pelvis

e es , . 'a .k, b om ·n, elvis

1, j ' cti on to th _ I ntercostal Nerves

Indications: Interco sta l ne u ra l gi a , h e rp es zoster; to re lieve pain in fib fractures.

Materials: Size 1 2 n e e dl e, 0.5-1 m i procaine or lidoca i n e .

Technique: Point of insertion: D e p e nd in g


o n the site of the p a i n : in the a nt e rio r
sectí on a t th e lower edge o f the rib ; in t he posterior secti on further
toward the nliddle of the i n tercosta l s p ace.

Direction of needle: Until the needle reaches the nerve.

Injection depth: 5-1 0 mm. When the patient signals a pain reactio n, t he
needle is c o r re c tl y in position.
Injection to the i n tercostal nerves 81

Fig . 60: I njecti on to t h e i ntercosta l n e rve s


82 Ch est, Ba ck, Ab domen, Pelvi s

Epldura · Aneso_.hesia

Indications: Any di s o r de r s in the afea su p p l i e d by the sacral plexus ; i nfl ammati o n ,


pain, itc h i ng, sexual disturbances, hemorrhoids, s c i at i c a ; obstetrics.
The s ac ra l pl exus supplies the fol l owíng are a s :
Skin: Anus , perineum, scrotuln, p e n i s ,
Organs: Lower rectuln, vagina as far as the cervix of the uterus , ureter,
pelvi c fIoor, pro sta te , ana l s phincter.

Materials: 1 -mm-diameter x 60-mn1- long need le, 5 lnl proca ine ( 20 mI in obstet­
r í cs ).

Technique: The p atient stands h ard agai nst the exa minati o n couch, bent over fo r­
wa rd at a right a ngIe.

Po int of insertio n: About 20 mm above the cra n i al end of the na t a l cIeft,


the bony protuberances of the sacra l cornua can be re a dily p a lp a te d ;
between them líes t he res i l i ent obturator Inen1b rane th at closes the
sa Cl-al hi atus. In adipose p a tien t s , the entry p o i nt is 40-50 m m cra n i a l l y
from the tip of the coccyx.

Direction of nee dle, injection dep th: I n s e rt the n e ed l e steeply through


the u p p e r part of the membrane, then d e p r es s the haft and slíde the
needle 40-60 mm fu rther cran ially up the sacral canal. The d ural s a c
ends 6 0 - 9 0 mm b eyon d the point o f entry.

CA UTION: Aspirate to check fo r the pre sence of bIood or l iquo r !


Epidural Ane sthe sia 83

Fig . 61 : Epi d u ra l a nesthes ia


84 Ch est, Back. Abdomen, Pelvis

Fig . 62: Epid u ral (sa cra l) a n esthesia


Epidural Anes thesja 85

Obtu rator
membrane

Fig . 63 : Epid u ra l anesthes ia (topograp hy)


1 . Entry poi nt of the needle th rough the u ppe r pa rt of the mem brane
2 . The n eedle is d e p ressed a n d advanced 40-60 m m cra n i a l ly i nto the sacra l ca nal
86 (hest, Back, Abd omen, Pelvis
------

I njection ¡ nto . he Posterior Sacra Fora rn i na

Indications: Sciatica, u nilateral b ack ac h e p rostatic and rectal d istu rb ances, coccygo­
,

pain in c a rci n o m a of the p r os t a t e ; s phin et er spasm


d ynia ; sciatíea - l ike
of the b l a d der.

Materials: 60-mm-long need le, 2-5 ml pr o ea i n e or l idoeaine.

Technique: Point 01 insertiol1: The patíent may e ither stand. or hes fa c e down. The
U ne e o n n ee t i ng the two i liae erests inters eets the s pi nous p rocess of
the fou r th lumbar v e r te b ra Another two spinous processes further
.

caudalIy i s that o f the first sacral vertebra. The first foran1en l ies two
fingerbreadths late rally from the low er edge of this.

Injection depth: Insert th e needle to a de pt h of 1 0- 2 0 mm. The i njection


into the other foralnina is gíven a nal ogous ly .

CAUTION: Asp i ra t e to check for the p resence of l iqu or !


Inj ecti on i oto the Posteri o r Sa cra l Foram i n a 87
._---

Fig . 64: I njection i nto the posteri or sacra l fora m i n a


88 Chest, Back, Abdomen, Pelvis

o o
O O

Fig . 6 5 : lnjection i nto th e posterior sacra l fo ra m i n a


I nj ectio n i nto the Posteri o r Sacra l Foramina 89
------

Fi g . 66: I njection ¡ nta the fi rst posterior sa cra l foramen


90 Chest, Back, Abdomen, Pelvis

Injection O the Abdominal Sym pat. etic C h ai n


.

(.According o Vishnevski)

Indications: a : Seglnental therapy : In upp er a bdominal d isorders affecti n g the


storn ach, intestine, l i ver, gallbIadde r, pancreas, kidn eys.
b : I n terferen ce-fi e l d search : As a te s t ínjectio n , when an interfere nce
field is susp ected after upper abdomina l disorders.

Malerials: l - mm-díameter x 1 2 0-mm-long nee d l e , 2-5 m I p rocaine or lidocaine.

Technique: Po int of insertio n : The p atient s ta n d s bent forward against a table or


the head end of the examinatíon couch. Pal pate med i a l ly froID the pos­
terio r axil lary l ine alo ng the lowest palpa ble [i b unti ] the edge of the
l o ng exte nso r ¡n uscles o f the back can b e felt about three fi nger­
breadths froln the spino Ll s p roces s e s . The entry p o i n t i s here, between
the edge o f the rib and the e dge of the muscle b und le . Let the p a tient
breathe out ful ly and hold his/her breath, to ensure that the lower bor­
der of the lung moves up as far as pos sib le .

DÍrectiol1 01 needle: 3 0° med i ally and 60° cranially, i . e . , obli que ly up­
ward, a p p roximately in the d i rection of the no rmal ly s ituated contra­
l a tera l nip ple.

Injection depth: At a depth o f a b ou t 80- 1 00 lTIln, the needle s eems to


pe netrate into a void after overcOlníng the resistance o ffered by the
muscles and fascia . The abdo mina l sympa thetic chain l í es about 1 0 mm
further o n .

CA UTION: As pi rate !
Injection to the Abdominal Sympathetic Chain (Accordi ng to Vishnevski) . 91
,------

Fig. 67 : I njecti on to the abdom i n a l sym pat h eti c cha i n


92 Chest. Back, Abdomen, Pelvis

o
O
1 0
20
30
40
50

Fi g . 68: I njection to the a bd o m i n a l sym pathetic ch ai n (sh owi ng the a uxi liary l in e s to help i n 1 0-
cating the co rrect e nt ry poi nt)
Inj ecti on to the Abdominal Syrn p athetic Chain (Accord ing to Vishnevs kí ) 93

�-- Sympathetic chain

r---- Com m u n icati n g branches

----"'--
" - Spinal gan g l ion

Fig. 6 9 : To pog ra p hy a n d position of need le in the injection to the u p pe r ren a l p o l e a ccord i n g


t o Vish nevski

U pper renal pale

.___-----.�00P., -+--- Sympathetic chai n

r- Commu nícati ng branohes

-"-=�r- Spinál gan glion

Fig. 70: To pogra phy a nd position of n eedle in the injection d i rectly to the sym path etic c h a i n
94 Chest, Back, Abdomen, Pelvis
--------�--==�"

I njection to the lu mbar Sympathetic Chain

Indications: Ci rcu latory disturbances of the lower extre miti e s , burns, fros tbite, va r­
icose u l c e r s lo w- h e al i ng amp utati o n stumps, ph antom-l i mb pains,
,

post-traun1atie osteoporos i s .

Materials: 1 - m m-diameter x 1 20-mm-Iong need l e 2 - 5 mI p ro e a i n e or l i docaine.


,

Technique: Poin t 01 insertion: The patient stands b e nt forward or líes d own in a


s im il ar po sition. The t i ne con n e cti ng th e il i ae cr e s ts c ross e s t h e s p i n o us
process of the fo u r t h lum b ar vertebra. Fro m thi s refere nce point.
cho ose the app r o p ri at e level for t he inje ction; th is is ge n e ra l ly the s ec­
ond lumbar ganglíon. The point of entry is thr e e fingerbreadths la t e r­
ally from the s p i n o us process of th e second l u m b a r vertebra.

Directio n of needle: About 60° in a m e di a l diree t i o n .

Injection depth: At a d e pth of about 30 mm the nee dle reaches the l at­
eral p r oc e s s ; t o by p ass thi s , raise the point of the needle and tu rn it to
the sid e At 70 m m the needle re aches tlle lateral s urfa ce of the verte­
.

bral b ody Withdraw the needle and move it pas t this at a more oblíque
.

angle unti l bone contact with the convex su rface of th e vertebra is only
just lo st.

CAUTION: A s p i r a t e !
Inj ection to the Lu mbar Sym pathetic Chain 95

Fig . 7 1 : I njection to the l u m ba r sym patheti c chai n


96 Chest, Back, Abd omen. Pelvis

10
20
30
40
50

Fig . 7 2 : Injecti on to the l u m bar symp athetic cha i n


I njection to the Lumbar Sympathetic Chain 97

F i g . 73 : I njecti on t o the l u m ba r sy m p athetic c h a in


98 Chest , Bacl<, Abd o m e n , Pe l v i s

I njectio n ¡ nto e Reg·on of th oot o th Sciat· e Nerve l3 -l5

I ndicatio ns: S c i a t i c d d a m a ge t o a n i n te rv e r te b ra l d is k i n t h e l u m b a r reg i a n , n e u ­


,

ralgi a : c i rc u l a t o ry d i stu rba n ces a n d p a re s t h e s i a o f t h e l o w e r e x t re m i ­


ti es o

Materia ls: 1 - m m-d i a m e te r by 1 0 0 - 1 2 0 - m m - l o n g n e ecl te, 2 - 5 mi proca i ne or l i d o ­


came.

Techn i q u e : Tll e p a t i e n t s t a n d s dgai n s t a t a b l e 0 1' t h e h e a d e n d o f the exa rn i n a t i o n


couch.

Po i n t 01 insertio n : Pa l p a te d l ong rhe i li d e e re s t t o w a r d t h e verte b r a l eo l ­


u m n ro t h e p o i n t w h ere th e i l i u m , the l a te ral p r o e e s s of t h e fi fth l u m ba r
verte b ra J n d rhe b o d y o f t h e firs t s a c r a l vertebra fo r m a c l ea r l y p a l p a b l e
d e p r e ss l o n .

Di reeti o n 01 needle: Perp e nd i c u la r to the s k i n .

Injeeti o n d ep tl1: At a d e p th o f 5 0 - 8 0 m m , th e s e i a t i c r e fl e x i s o b ta í n e d .
I nj e c t i o n i n to t h e Re g i o n of t h e Roo t of t h e S c í a t i c N e rve L3 - LS 99
--�-----

Fíg . 7 4 : l njecti on i nto t h e re g í o n o f the root o f t h e sci a t i c n e rve L3 - L 5


1 00 C h es t, Sa c k, Abd omen. Pelvis
--------�

Fíg. 75: I njection i n to t h e reg ion of the root of the sciatic nerve L3 - L5
I nj e ction into the Regian af the Raot af the Sciatic N erve L3 -L5 101

Fig. 7 6 : I njection i nto th e reg ion of t h e root of t h e sci atic n e rve; entry poi n t to the c a n a I between
pelvis and fifth l u m b a r vertebra
1 02 Che st, Back, Abdomen, Pe lvis

I njection to and into the Sacral Plexus

Indications: Di sorders i n the regi on s u p p l i e d by this plexus :


1 . Pud e n d a l plexus and pud e n d a ] nerve
2. Inferior gluteal n e rves
3 . Posterior cuta ne o u s fe m oral nerve
4. 5ci atic nerve
5. 5 1 -54
6. Lu mbosacra l tru n k L4-L5

Materials: l - lnm-diameter x 1 2 0- 1 5 0- m m-Iong n e e d le, 5 mi pro ca i n e or lido­


caine.

Technique : Point of insernon: At the poi nt o f i n tersecti on of two auxi l ia ry l ines, a s


fol l o ws :
1 . A h o rizo n tal l i n e fro m the top of the n a tal c l e ft to the upper edge
of the troch anter m aj o r.
2. A verti cal l i ne fro m the u p per posteri or il iac spine to the o u te r edge
of the i5chial tubero s i ty.

Directio n of needle: Perp e n d i cular to the 5ki n.

lnjection dep th : lo bone co ntact. The nerve p I ate ís abo ut 3 5 n1m w i d e .


Pro b e with the p o i n t o f t h e n e e d I e a n d infil trate t h i s p l ate obliquely
up a nd outward . The correct position o f tIle needle is i n d ica ted by the
fo l lowi ng seq uence o f paresthesia note d by the pati e nt, fro m m e d i a l
t o lateral : testicles. p e n i s , p e rineum, t h i g h , buttock, calf, fo ot.
I njection to and into the Sacral PlexlIs 1 03

Fi g . 7 7 : I njecti o n to the sacra l p l exus


1 04 Chest, B a ck, Abdomen, Pelv i s

Fi g . 78: I njection to the sacra l p l exus: a uxiliary l i n es to help i n l ocati n g the plexus
I nj e cti o n to a n d i nto the S a cra l Plexu s 1 05

Tubercle of the

f
Lu m bosacraltt ru n k

Ischíal tuberosíty

.�
Fi g . 79: I njection to the sacral plexus
1 06 Chest, Back, A bdomen, Pelvis

Presacra l l n ll"i ltration According to Pen d l

Indications: D i sord ers i nvolving the following: Rectu m, anus, perinewn. b l a d d er .

ureth ra ; p ruritus of a n u s and vulva, dís orders of the p rostate, gyneco­


l ogical disord e rs ; sciatica ; ci rc u la to ry d i stu rb an ce s and oth e r dísorders
affe ctin g the lower extrem i ti e s .

Materials: 1 20 - rn m - l o ng n e e d l e , 5 n11 p r o c a i n e or lidocaine.

Technique : The p a t i e n t stands aga i nst a ta ble, bent forward at a r ight angl e .

Point oI insertion: One fingerbre a d th l a te rally fro m a n d be low t h e ti p


of the coccyx.

Direction of needle: Next to the coccyx. cra n i a l l y on the ve n tral s id e of


the sacru rn.

Injection depth: The uppermost sacra l fo ramen i s about 1 00- 1 20 lnm


from the p o i n t of ínsertion, the n ext one is 8 0 -90 mm away, ¡ . e . , nearer.
Advance the n e e d l e in loose bone contact w ith the s acrwn.

CAUTlON: Ri s k of p e rforatíon to the rectwn !

Fi g . 80: Presacra l i nfi ltrati on a cco rd i n g to Pen d l (topogra p hy)


Presa cral lnfi l tra tion According to Pendl 1 07

Fig . 8 1 : Presa cral i nfi ltrati o n accord i n g to Pe n d l


1 08 Chest, Back, Abdomen. Pelvis

I njection i n - o the Sa croiliac Joint

Indications: B ackache, IUlnbago, s ciatica.

Materials: 6 0 - 8 0 -m m - l o n g needle, 2 - 4 m I procaine or lid ocaine.

Technique: The p atí e n t s ta n d s agai nst a n exa m i nation couch, bent forwa rd.

Poín t of insertíon : Three fingerbre a d ths l atera l I y of t h e s p i no u s p rocess


of 5 1 .

DÍrection of needle: A t a n a ng l e of 4 5 ° to the skin i n a l a teral d i rection.

l nj ec t i o n depth: Abo u t 30-50 mm.

Fig . 82 : I nj ecti o n i n to the s a c ro i l ia c j o i nt ( a uxi l i a ry l i n e for o ri entatio n )


I nj e cti o n i n to the Sacroiliac Jo i n t 1 09

Fig . 8 3 : I njection i nto th e sacroíliac joint


1 10 Ch est, Back, Abdo m e n , Pelvi s

I njectio n to Fra n l<enha user's Ga n g l ia (Uterovaginal Plexus)

Indications: a: Seglnental therapy: Dys menorrhea, abnormal menstruatí o n , dys­


pareunia, endometritis and para metriti s , vaginal discharge, n e uritis of
the pe lvic floor, lower abd onlínal d isorders of i nd e tenn inate cause, fri­
gi d ity, steri l i ty; d isorde rs connected with the menstrual períod such
as headaches, m igrai ne, autonomic pelvic d isorders, e tc.
b: l n terference-field searc h : As a test i nj ecti on if the patie nt's h i s to ry
inel udes : vaginal diseharge, abortions, difficult labor, di lation and
curettage ( D & C), pelvic inflamma tory d isease, gonorrh e a ; any surgery
i nvolving the ge n i tals.

Co n tra in dica tíons: Duri ng the peri o d , avoi d any transvagí nal inte rven­
tion; use the injeetion from o utside the p elvic cavity (p. 1 1 2 ).

Materials: O.8-mm-diam eter x 1 2 0- m m-l ong need le, 2-4 mI procai n e or lido­
caine.

Technique: Before the inj ection, the patient should elnpty her bla d d er. She is
placed on a gyneeo l ogical eou c h and the uterine cervix is fixed in a
specu I Uln.

Through the m ucosal fold in the lateral forn ix beside


Point of insertion :
the eervix, Le., through the lateral vaginal vault. i n a pos itíon from
abo ut four to five o' clock, or seven to eíght o'e1oek.

Direction of needle: Slightly obl i q u e ly i n a lateral and d o rsal direction.


I nj ection depth : 1 0-20 mIll.

CA UTION: There is a risk of perforating the ureter or the uterin e artery


i f the needle is direeted parallel to the eervix !
I nj ecti o n to Fra nkenha user's Ga ngl i a ( U tero vagi nal Plex u s ) 111

Figs. 84, 8 5 : I njection to Fra n ke n h a user's ga n g l i a

-.
� --_._--"--� ��--'---
1 12 Chest, B a ck, Abdomen, Pelvis

I njection ¡ nto the Pelvic Reg ían

Indications: a: Segmental the rapy : Dysm e norrhea , pel v i c i n fl a m m a to ry d isease,


end ometritis a nd p a ra metrit i s meno rrhagía, lnetrorrhagia, n011-
,

s pe c i fi c vagi nal d is cha r g e , lower a bdominal p a i n and b a ckaehe . dys­


pareunia, m e ns tru ation-re l a te d di sorders, s t e ri l i ty, fr í g i d i t y .

b : l n terfe renee-fi e l d s e a r c h : As a test i nj eeti o n i f the p a ti e n t s h i s tory


'

¡nel u des gen ita l d istu rbances of any ki n d .

Materials: 60-80 - rn m-long n e e d l e , 2 x 2 mI proca í n e o r l ido c a i n e .

Technique: Befo re t h e i nj ect i o n , the p ati e n t s h o u l d e m p ty h er b l ad d e r. S h e t h e n


l í es s u p i ne on t h e exa ln inati on coueh.

Point of insertion : A b o ut fo ur fi nge r b re ad ths laterally from the symph ­


y s i s , i . e . , about two fingerbreadths m e d i a l l y o f t h e p u ls a ting feIDo ral
artery, in the regíon of the upper l i rn i ts of the p u b ic h a i l'. With two
fi ngers of the free h a n d p a l pate the upper edge o f the p u bi e ra m u s .

Direction of n eedle: Between t h e fingers p e rp e nd i c u l a r t o t h e ski n i n


.

the d irection o f t h e p u b i e r a m u s ( acupuncture point St2 9 ) , then with­


d raw n e e d le s l ightly and g u i d e i t cranial ly over the edge of the b o n e
i n a medioc a u d a l d i rection.

lnjection depth: 40-60 mnl, d epend ing o n the a d i po s i ty o f the pati e nt.

Fig. 86: I nj e cti o n i nto the pelvic reg ia n


I nj e cti o n i nto th e Pelvic Region 1 13

Figs. 8 7 , 88 : I njecti on i nto the pe lví c reg íon [stages 1 (a bove) and 2 ( be low)]
114 Chest, Back, Abdomen, Pelvis

I njection ¡ nto the Epigastri u m

Indications: AH abd Olninal d i so rders, e.g" gastric or duodena l u lcer, gastritis ; if in­
adeq u ate o n i ts own, conlbine wí th the i nj ection to the abdominal syln­
pathetic chain ( p . 90-9 3 ) .

M at e ria ls : Si ze 1 2 needle, 2 m I p rocaine o r lidocaíne.

Technique: The patient lies sup ine.

Point DI insertíon: O n the median l i ne, three R ngerbreadths below the


xiphoid p rocess.

Direction oi needle : Perpendicular to the skin.

Injection depth: 3 0 - 5 0 mm preperi toneal ly, d epend i ng o n the sub­


cuta neOLlS ad ipos ity.
I nj e cti on into the Epiga s tri um 1 15

Fi g . 8 9 : I njection i nto the e p i g a stri u m


1 16 (hest, Back, Abd omen. Pelvi s

I nj ectio n to Vog ler's Poi nts

Indications : In the p res ence o f stOln ac h or gal lb l a d d e r d isease, these p o i n t s on the


costal m a rgin a re p ressure-sens itive.

Materials: S i ze 1 2 n e e d l e , 2 mI proca ine or l i d o c a i n e for each point.

Technique : Poin t of ínsertion : Find the ten der spots on the p e rioste u m o f the costal
m a rgi n , a pp roxi m a te ly in the nipple lineo

Direction of needle, injection depth : Perpend i c u Ia r to the 5kin su rface


a nd down to t ll e periosteu m .
l nject i o n to Vogler's Points 1 17

Fi g . 9 0 : I nj e cti o n to Vog l e r ' s p o i nts


1 18 Chest, Back, Abdomen, Pelvis

I njection to the Xiphoid

Indications: Nervous gastric d i s o rders ; in ad diti o n to i nj ecti o ns to the a b d O ln i n a I


sympathetic cha in ( p. 90-93 ) and into t h e e pÍgastriu m ( p . 1 1 4 ) .

Materials: S i ze 1 2 nee d l e , 1 mI procai n e o r l i d o caine.

Technique: Point of insertion : hnlnediately be low the t i p of t h e xi p ho i d .

Direction 01 needle: Perpend i c u lar t o the skin.

Injectíon depth: Up to 10 mm, depend i ng on a d i p o s i ty.


.

I nje ction to the X'lp 110ld 1 19

, 1
/ '
Fíg. 9 1 : I nj e ct i o n t o t h e Xl. p h o .l d
120 Che s!, Back, Ab d o m e n, Pelvis

I njection to the Pudenda l Nerve

lndications: Pud e n d a ! neuralgia, p ruritus of a nu s and vu lva ; d i sord ers affect i ng the
s crotu ffi, penis, vu lva, perineum. I n o bstetri cs this inj e ction is used to
rel ieve pai n duri ng the second stage of labor, i n e p i s iotomy, and peri­
neal s u ture.

Materials: 1 -mm-dia meter x 1 2 0-lnln-Iong needle or PP needle, 5 - 1 0 mI p rocaine


o r lidocai ne.

Technique: a : On the stand i ng patient, bent over fo rward :

Three to fo u r fí ngerbre ad ths below the po i nt of entry


Poi n t of i nsertio n :
fo r the i nj ection to the saCl-al plexus ( p. 1 02 - 1 0 5 ).

Proceed in the direction of the sym­


Direction of need le, Í l1jection dep th :
physis u ntí l paresthes i a i s prod uced i n the g e nita l region.

b : Pe r ine a l method: The patient i s placed on a gynecologica I couch i n


t h e lith oto my pos i tion. Pa lpate the i schial tube rosity fro m the vagina
o r rectu m.

Point of i nse rtí o n : Adj acent to the vagina or rectu m.

Contro lled by the inserted fi ngers,


Direction of needle, injection dep th:
guide the needle transcutaneously to the ischial tu berosity.
I njection to the Pudendal Nerve 121

Fig . 9 2 : I njection to the p u d e n d a l nerve, method (a)


Fig . 93 : I njection to th e p u d e n d a l n e rve, peri n e a l method ( b )

' .¿
1 22 Chest, Back, Ab d o m e n , Pelvis

c: Tra nsvagin a l m etho d : The p a ti e n t ís p l aced 00 a gyo e co l ogí c a l


couch a s fo r method ( b ). Fo r th i s techniq ue , a P P needl e is need ed ( i. e .,
with a pro tective sleeve ). Contro lled by the i ns e rted fi ngers, guic1e the
p rotective s l e ev e d i re ctly to the i sc h i a l tuberosity.
I nj e ction to the Pudendal Nerve 1 23

Fig. 94: I nj e cti o n to the p u d e n d a l ne rve. tra n sva g i n a l method (e)

Fig . 95: I njection to t h e puden d a l nerve : d i a g ra m of perinea l a n d tra nsvag i n a l m ethods


1 24 Chest, Back, Abdo men, Pelvis

I njection ¡ nto the Prostate

Ind ications: a : Seglnental therapy: Acute or chro n i c prosta titi s , hyp ertrop hy of the
prostate, d i sorders of m ícturiti on, impotence.
b: fnterfere nce-field searc h : As a tes t í njection, if the patient's hi story
i neludes prostati ti s, gonorr hea, non-specific urethri tis, noctu rÍ a.

MateriaIs : 80-mlu- l o ng need le, 1 mi p rocaine or l i d ocaine per lobeo

Technique : The p ati ent i s placed on a gynecological exa mi natíon couch . He holds
up the scrotum. Pass the gl oved forefinger of th e free hand i nto tlle
rectUlTI to palpate the p rostate.

Point 01 ínsertio n : About 1 0 lTIn1 [ate rally of the m i d line.

Directi o n01 n eedle: Under control of the fi nger in the rectu m , guide the
needle i n to the prostate.

CA UTION: Avo id perforatio n of the rectum.

The patient should be warned before this treatment that urine and
seminal fluid may be bloodstained a fter t hi s i njection.
I nj e cti o n into tbe P rostate 1 25

Fig . 96: l njection ¡ nto the p rostate

Fi g . 97: l njecti on í nto the p rostate: the need le is g u ided fro m the perineum d í rectly into t h e
p rostate , u n d e r d i g ita l co ntrol fro m t h e rectu m
1 26 Chest, Ba ck. Abd omen. Pelvis

I njection ¡ nto the Prostate


(Su pra pubic I jection Accord ing to Hopfer)

Indications : a: Seglnental the rapy: Acute or chronic prosta titis, p rostatic hyp er­
tro phy, d i s turbances of m ic t u r i t io n i m p o te n ce, male climacte ri c,
,

orc h i ti s , epid idYln i ti s .


b : I nte rfe rence-fi e ld s earch : A s a te st inj e ction, if tb e pat i e n t's history
¡ n c l u d e s pro s ta ti tis go no rrhea, non-specific u reth ritis, no ctu ria.
.

Materia ls: 8 0 - m m-long n e e d l e , 1 m i p roca i ne o r lí doca i n e pel" l o b e.

Technique: The pati e n t empties his bladder and i s placed o n the examinatí o n
couch.

Po in t of insertio n : Ab o u t four fingerbre adths l a te ra ll y from the syln p h ­


ysi s , a b o u t t w o finge rbre a d ths medía l1y o f t h e p u I s a ti ng femora l arte ry .

Directiol1 o[ n eedle: Pe rp e n d icular to the skin t o t il e upper edge o f t h e


p u b i c ra m u s , t h e n i n a m e d i o c a ud a l di rection to ward t h e a n us.

Injection depth : Depen d i ng on a d i pos ity. down i n to the tis s u es o f the


prostate gla n d ; til e p a ti e nt re p o rts a typ ícal pai n r a d i a ti ng to the glans
penis.
I ojectjon i o to the Prostate ( S u prapubic Injecti oo Accord i ng to Hopfe r ) 127
------

Fig . 98: S u p rapubic injecti on i nto the prostate


1 28 Extre m i ties: a rms, J egs

E tremit-es. a rms, leg -

I njection to and i nto the Brachia Artery

Indications: Circu l atory d isturbances, causalgia, post-traumatíc osteo porosis of the


upper extremity.

Materials: S ize 2 need le, 1 mI procaine or l idocai ne.

Technique: Point DI insertio n :


a: Palpate the artery a httle above the antecubital fossa and inject
intra- and para-arterially.
b : The artery can also be read i ly pa l pated in the axil la, w here it i ssues
from beneath the greater pectoral muscle and runs along the medial
biceps gro ove .

Fig . 99: I njection to a n d ¡ nto the b rach i a l artery


lnjection to and into the Brachial Artery 1 29

F i g . 1 00 : I njection to the brachial artery in the axi l l a


1 30 Extre m i ties: arms, l egs

I njec ion to he Su bclavi a n Artery

Indjcati ons: Circu latory di sorders, celluli tis, abscesses, frostbite, burns to th e upper
extren1ity.

Materials: 40-mm- l o ng needle, 2 tnl procaíne or l i doca ine.

Technique: Point 01 insertion: The p u lsating a rte r y can be palpated 1 0 mm above


the mid-po int o f the clavicle.

CA UTlON: To avo i d the ri si< of perfora ting the ple ura] apex, d o n ot iDsert
the needle fu rther than 1 5 m Ino

First thoracic vertebra

Fig. 1 0 1 : A n ato m y a n d posítion of n eed le in t h e injection to t h e s u bclavian a rtery


lnjecti on to the Subclavian Artery 131

Fig . 1 0 2 : I njection t o t h e subclavian artery


132 Extrem iti es : arms, l egs

I njection ¡nto the El bow Joint

Indications: AH d i s orders in the region of the j oi nt.

M aterials: Size 1 2 needle, 2 mI procaine or l i docai neo

Techni que: The patient lays the fo rearm 0 0 a ta ble to fo rm a pp roxi mately a right
angle between the forearm and upper armo

Point of ínsertion: Midway between o le cranon a nd l ate ra l epicondyle.

Direction of needle: Toward the antecubita l fossa.

lnjectíon depth: Approximately 1 0- 2 0 lnm .


I njection into the Elbow Joint 1 33

Fi g . 1 0 3 : I nj ecti o n i nto t h e elbow joi nt


1 34 Extremities : arms, l egs

I njection ¡ nto the Wrist Joint

Indications: Arthro s í s , arthritis, post-traumatic joint d i sorders.

Materials: S i ze 1 2 nee d l e, 1 Inl pr oc a i n e or lidocaine.

Technique: Po i n t of i nsertiol1: Mi d way b e tween the e n d o f the u ) na a n d t h e s tyloi d


proces s .

Dírection oI needle: Perpendicu l a r to t h e sl<in.

lnjectio n dep t!1 : 5 - 1 0 mm.


Inj ection into the Wrist Joint 1 35

Fi g . 1 04 : I njecti on i nto the wrist joint


1 36 Ex trem i ti e s : arms, l egs

I njection ¡nto the Shoulder Joint

Indications: Arthrosis defonnans, hume roscapular perí arthritis, s ubacromial b urs i­


tis ; conditions following contusion of the sho ul der.

MateriaJs: 40-mm- long need l e , 2-5 mI p roca ine or lid ocaine.

Technique: Inj e ction from the fro nt:

The patieflt I ets the arm hang down, paIm to the


Poi n t of inserti o n :
front; medially froID the head of the humerus, the joint l i ne can be pal­
pa ted. The need l e s hould e nter j us t below the clavicle.

Directi o n DI n eedle: Just below the acrOlnion i n an outward d i rection.

After overcoming the resistance fro ID the l iga ments,


Injectio n dep th :
the needle s l ídes easily into th e joint.
lnj ection into the S h O ll l d e r J o i n t 1 37

Fi g . 1 0 5 : Injection into the shoulder joi nt


1 38 Extre m i t i es : arm s, l egs

I njection to the Median N erve

Indications: For d i sorde rs of the hand in the area supplied by this nerve ; carpal tun­
nel synd rome.

Materials: Size 1 2 needle, 1 - 2 mI procai ne or l i doca ine.

Te chn i que : a: I n the antecubital fossa, the median nerve l ies o n the u l n a r side o f
the pal pable brachial artery.

b : Above the wri st.

Po i n t of insertion: About three fí ngerb read ths above the l i n e of the wri s t
j o i nt the nerve líes i n a rad i a l d irecti o n from the te n d o n o f the pal maris
,

l o ngus muscle and is clearly visible i n vo lar flexion o f the hand.

Directi o n of n eedle, injection depth: Perpendicular to the skin until the


patient repo rts pa restbes i a i n the regí on s u pp l ied by this nerve.
Inj ection to the Median Nerve 139

Fig . 1 06: I njection t o the m e d i a n n erve i n the a ntecu b ita l fossa

Fig. 1 07 : I njecti on to the m e d ia n n e rve a b ove the wrist j o i nt


1 40 Ex tremi ties : a r m s , l egs

I njection to the Radia l e rve

Ind ications : Disorders of the hand in the area su ppliecl by the rad ial nerve.

Materi als : Size 1 2 needle. 1-2 m I procaine o r l i docaine.

Techn i que: a : Th e rad ia l nerve is access ible a bove the elbow.

Poin t of insertion: Abo ut fo ur fingerbread ths above the l ateral epi­


condyle.

Direction of n eedLe: Perpe ndicular to the s ld n.

lnjection dep th: If the needle's position is correct, the pa tient reports
e lectrifyi ng pai n in the thu mb and the back of the hand.
I njection to the Rad ial Nerve 141

Fig . 1 0 8 : I njection t o t h e rad i a l n e rve a t the e l b ow ( a )


1 42 Extrem ities: arms, l egs

b : In the r eg i on of the wrist, feel for the p u ls e of the rad i a l a rtery a b out
three fingerbread ths ab o y e the j o int l ineo

Poin t oJ insertion: Radially fro m the radial a rtery .

lnjection depth : Until the p atient report s p a r e s the s ia .

c : Dis tri buti on of a l o c a l anesthetic in the dorsoradjal regio n of the


w r i s t at snuffbox l evel blocks the b ranches of the s up er fici a l radial
nerve.

Direction of needle, injection depth: Perpendicular to the s ki n, s u b c u t a ­

n eo u s
.
l nje ction to the Rad ia l Nerve 1 43
------

Fig . 1 0 9 : I nj ecti o n to the ra d i a l n e rve at the wrist j o i nt ( b)

Fig . 1 1 0 : I nj ection to th e ra d i a l nerve at the wrist (sn uffbox: e)


1 44 Extremities: arms, legs

I njection to the U l na r Nerve

Indications: D i s o r d e r s affecting the area supplied by this ne rv e e.g., p a i n , vaso­


,

spasm.

Materials: S i z e 12 n e e d le 2
, m I procaine 0 1' lidocai ne.

Technique: a : Point of insertion: The u lnar s u lcus is palpable between t h e medial


humeral epicondyle and the o lecranon.

Direction of need le: Pe r p e n d i c u la r to t h e skin.

Injectio n dep th : D e p e n di n g on the adiposity of the pati e n t the nerve


,

lies 1 0- 2 0 mm b e J ow t be s u rfa ce before i t d ivides i n to i ts p a lmar and


d o rsal branches.

b : Point of insertion : The p a lmar bra n ch of the u l nar nerve l íes a bo u t


t h ree fingerbread ths a boye t h e wrist, bétween t h e u l n a r a rtery and the
tendon of the flexor carpí u l naris, on the u l n ar síde of the artery.
I njecti on to the U l n a r Nerve 1 45

Fig . 1 1 1 : I nj ectio n to the u l n a r n e rve at the e l b ow j o i nt

F i g . 1 1 2 : Injecti on to the ulnar n e rve nea r the wrist j o i nt


1 46 Extre m i ties: a rms , legs
-------

Ring- b lock Anesthesia of Fi ge s a n d Toes

Ind ications: D i so rders affe cting the j oi n ts and other parts of the fí ngers and toe s ;
paronychia.

Materials: Size 12 n e ed le 2 n11 procai ne or l id ocaine.


,

Technique: Point of insertion: At b oth s i d es of the base of the fi nger.

Direction of needle: D i s tribu te l 1nl each 011 th e extensor and flexor as­
pects. F o r t h e toes, the procedure is anal ogo us.
Ri ng-block Anes thesia of Fi nge rs a n d Toes 1 47

Fig. 1 1 3 : R i n g -b lock a n esthesia of the fi ngers


1 48 Ex tremities : arms, legs

I njection to the Brachia l Plexus C5 -Tl

I ndications : Pl exu s neuralgia b rachialgi a , paresthesia of the ann, circulatory d is­


,

turbances, post-tr a u ma tic osreoporo s i s , frostbite, b urns ; red u ction of


a di slocated s houl d er.

Materials: 40-mm-I ong needle, 2 mI proca i ne or lidocaine.

Technique: a: Supraclavicular p l exus anesthesia


The patient i s seated wíth rhe head fixed on a neck s u p po rt, tu rn e d
away from t h e s i d e of tbe injection, a n d s lightly i nclíned fo rward . Be­
fore the needle enrers, th e patient must be warned to expect pare sthe­
sia, to avo i d d e fen sive lnove me nts .

1 0 mIn aboye the lniddle of rhe clavicle, j us t l atera l ly


Poí n t 01 i nserti o n :
from the p ulsati ng subcl avian a rrery.

D irection of needle: Approximately toward rhe spinous p rocess of the


thi rd thoracic vertebra.

Injection dep th : At a d epth of about 1 0 n1 m rhe s u p raclavicular plexus


,
.
passes subfascial ly over rhe firsr rib The paresthe s i a reported by rhe
o

pati e n r i n d icates rhe pos ition of t he needle and co rres pon d s to t h e are a
s u p pl i e d .

CA UTION: Take care n ot r o pe rforate t h e ple ura !


Injection to the Brachial Plexus (5-11 1 49

Fig . 1 1 4: I nj ecti o n to th e b ré1 c h i a l p l exus (su pra c l avi c u l a r p l ex u s a n esthes i a )

Fi rst thorac i c artery

Fi g . 1 1 5 : Anatomy and position of need le in th e s u bclavian injection to t h e bra c h i a l plexus


1 50 Extre m i t i e s : arms, l e gs

b : Axillary plextls a n es th esia


A long the u p per arm palpate the brachial artery toward the axilla to
the point where the p ulse is stí l l just p e rce pt i b l e. fnsert the need l e at
this point and advance it u ntil the p atient reports p aresthesia in the
area s u pplied by the n e rve.

F i rst thoracic artery

Fig . 1 1 6 : Anatomy a n d position of nee d l e in the axi l l a ry i njection to t h e b ra c h i a l p l exus


Inj ectíon to the Brach i a l Pl exus (5 -T1 1 51

Fig. 1 1 7 : I njection to the bra ch i a l p l exus (axi l l a ry p l ex u s a n esthes i a )


1 52 Extre m i t i e s : arm s . legs

I njectio n to a n d ¡ nto the Femora l Artery

Indications: AH forms of c í r c u l ato ry disturbances affecting the J ower extremíties,


i nclud ing arterial occlusio n di sorders a n d varicose u lcers ; p hlebitis,
post-thrOluboti c conditions, angiospastic dysbasía.

Materials: S ize 1 n e e d l e , 2-3 m I p roca i n e or lidocaíne.

Technique: Poin t of insertíon: The femoral artery i s pal pable i rn rn e d iat e l y b e l ow


th e i ngui n a l l iga m e nt in the fossa ovalis. The femoral vejo l í es med i a l I y
fro m it; the nerve l a teral Iy.
a: When the arte ry is read i ly p a l p a b l e a lIow it to pu lsa te b e twe e o the
,

tips o f forefinger and rn i d d l e fi nger, and bri s kly i ns e rt the n e e d l e v e r­


ticaHy b e twee n them d i rectl y ioto the art e ry.
b : In a d i p o s e p atients, the artery can b e m o r e e a s i l y fo un d b y trací ng
its course wíth fo r e fi ng e r and m íd d l e finger, and inserting the need le
between the fi ngertips. When arteria l b lood pulsates into the syri nge,
brisldy inject 2 mI. After the i nj e cti o n keep the i nj e ct i o n site com­
,

p ressed for a few mi nutes.


lnjection to and into t h e Femoral Artery 1 53

Fig . 1 1 8 : l nje ct ion to and i nto the fem o ra l a rtery

Fig. 1 1 9 : I njecti on i nto the fe m ora l a rtery ( f ro m medial to latera l : ve i n , a rtery, nerve)
1 54 Extremíties: arms, l egs

I nj ectio n to a nd in o the Posterio r Tibia l Artery

Indications: (i rcula tory disturbances ; i n acupunctu re this inj e ction i s also reco m­
lnended in the treatment of disorders affecti ng the hip and knee joints,
the urogenita l syste m , and for menstrua l d i sturbances.

M at erials : Size 1 needle, 1 m i proca i ne or l i docaine.

Technique : Point ofinsertion: Below the calf on the i ns i d e of the tibia . If the needle
is i n the correct positio n , the patient feels a dull pain.
I nje ction to and í n to the Pos terior Tibial Artery 1 55

Fig . 1 2 0 : I njection to t h e poste ri o r ti bi a l a rte ry


1 56 Extre mitie s : arms, legs

I njectio n s ¡ nto the H i p Joint

Indications: Coxarth rosis, arthritis, p a i n d u e to stiffness of the joi nt.

Materials: 8 0- 1 00-mm-Iong need I e, 2 -4 mI p rocaine or lidocai ne.

Technique: a : Kibler's m ethod


The patient lies o n the side.

Po ínt of insertion: Three fingerb readths above the trochante r major,


past its upper edge.

Direction of n eedle: Perpendicular to the skin.

Injection depth: 10 bone c ontact.

Fig. 1 2 1 : l nj e ction i nto the h i p joint ( 2 )


I njection t o th e troc h a nter m aj o r (3)
Inj ections ioto the Hip Joi nt 157

I �

Fi g . 1 2 2 : Injection i nto the h i p joint acco rd i n g to K i b l er


1 58 Extremitie s : arms, legs

b : I njection fr o m the fron t


T h e patient l i es supine.

Poin t 01 insertion: I n s ert the need le two fingerbre a d ths l ateralIy from
the p u ls ating fe moral artery on the ¡ i n e c o n n e c t i n g the trochanter ma­
jor and the u p pe r bord er of t h e sYlnphysis.

Direction oI needle: Perpendicular t o the skin.

Injection dep th: To bo ne c o ntact o

o
O

Fi g . 1 23 : I njectio n i nto t h e h i p joint from t h e front. Point of i n se rti o n : Two fi ngerbreadth s la­
tera l l y from the fem o ra l a rte ry o n the l i n e f ro m the troc h a nter m aj o r to the u p p e r bord e r of
,

the s y m p h ys i s
Injections i n to the H i p Joint 1 59

:�

Fig. 1 24: I njection i n to the h i p joi nt fro m the front


1 60 Extremities : anTI S , legs

I njection i nto the Knee Joint

Indications: Arthrosis, a rthritis, post-tra u m a t i c disorders in the region of the knee.

M a terial s: 40-lnm-long need Ie, 2 mI procaíne or l idocaine.

Technique: The patient hes s up i ne and holds tlle knee s l ightly flexe d .

Po in t 01 insertion : O n t h e medial or l ateral edge of the lowe r t h i rd o f


t h e patella.

Direction 01 n eedle: Practically horizontal under the p atella .

Injection dep th: AboLlt 1 0-20 mm.

Fi g . 12 5 : l njection i nto the knee joi nt


I nj e ction into the I<nee Joint 1 61

Fi g . 1 2 6: I nj ection i nto the Imee joint


1 62 Extre m i t i e s : arms, l eg s

njection in o the AnIde Joint

Indications: Arthrosis, art h ritis, spo r ts inju ries, etc.

MateriaJs: Size 1 2 need le 1 -2 mi p ro c a í n e


, or l i do c ai ne.

Technique: a: From behind, o n the fi b ular síde of the up p e r part of the a nkle joint :

PoÍnt of i ns e r t ío n : About one fi ngerbreadth above the lat e r a l tubercle


of the calcaneU1l1, ím mediately behind th e fi bula r ma lleolus.

Direction of needle: H o rizontal an d vent ra lly .

InjectÍon dep th: 1 0 m m .

b: From the fro nt:

Po in t of Íl1sertion : Ap proxj mately o n the Hne connecting tIle two


m a lleoli and m e d i al l y
frOln t h e tendon of the exte nso r hallu ci s lo n g u s .

D i rec tio n of n eedle : S l i gh tl y i Ilward and down.

Inje ctio n dep th : About 1 0 mm.


lnjecti on i nto the AnJ<le J oint 1 63

Fig. 1 2 7 : I njection fro m be h i n d ¡ nto the a n id e joint

Fi g . 1 2 8 : I nj e ct i o n from the front i n to t h e a n id e j o i nt


1 64 Extremities : afms , legs

I njection ¡nto the Joi nts of Fi ngers a nd Toes

Indications: AH painfu l cond itions of the joints of the fi ngers a nd toes.

Materials: Size 1 6 needle or cartridge syringe with s hort needle, 0 . 5 mi procaine


or lidocai ne.

Technique: Poin t 01 insertio n: Inj ections i nto the small j oints are painfu l , hence al­
ways use yo u r free hand to fix the fi nger or toe joint to be treate d .
H o l d the j o int s lightly bent and i nj ect from a d orsal direction, but o c ­
casionally t h e i nj ection is a l s o given fron1 a lateral direction. I n t h e dor­
sal i nj ection, i l1sert the needl e i m mediately by the side o f the extensor
ten d o n.

Direction 01 needle: C uide the point of the need l e slightly fo rward and
d own over the head of the bone .
I nj e ction into the joints of Fi ngers a n d To es 1 65

Fig. 1 2 9: Injectio n ¡nta t h e fi n g e r joi nts

Fig . 1 3 0: Injecti on ¡nto t h e toe jai nts


1 66 Extre m i t i e s : arms, legs

I njection to . he latera l Cuta neous Fe mora l Nerve

Indications: Meralgi a.

Materials: S i ze 1 needle, 2-5 m i p ro c a í ne a r l i docaine.

Technique: Poin t of insertio n : 1 0 - 2 5 mm i n a lne d i a l and caudal d i re ction fro m the


anterior s u p e ri o r ¡ li a c s p i ne .

Direction of needLe, injection depth : Adva nce the n ee d l e i n t h e direction


infiltrate u nti i bone co n t a c t ís m ad e pro d u c i n g
of the i l ia c s p i n e a nd ,

a pain rea ction i n t h e afea suppli ed by the ne rve.


I nj e ction to the La teral Cutaneous Fem ora l N e rve 1 67

--..

Fig. 131 : I njectio n to the latera l c u ta n e o u s fe m ora l nerve


1 68 Extremi tie s : a rms. legs

I njection to and ¡nto the Femora l N rve

Indications: Di sorders in the a re a s u p p l ied by this nerve; neuralgia. causalgia. vas­


cular d isord ers , circulato ry disturbances.

Materials: Size 1 need l e. 2 - 5 mI procaine o r lidocai ne.

Technique: Point oI insertion :B elow t h e inguinal ligament. about 1 0-20 lUlTI la t­


erally fro m the fe moral artery.

Direction oI needle: Perpendic ular to the sIdn.

Injection dep th : If
the need l e i s i n the correct posítion, the patíent re­
ports par est hesia on the fro nt of the thi g h.
I njection to and i nto the Fem ora l N e rv e 1 69

F i g . 1 3 2 : I njection to a n d i nto the femora l nerve


1 70 Extrem ities : arms. legs

I njection to the Fibu -a r Nerve

Indications: Post-scíatic forms of pain in the leg, circula tory distu rbances.

Materials: Size 1 2 needle. 2 - 5 m i procai ne or l i docaine.

Technique: Poin t of ínsertion: The nerve is easiest to fi nd i m m e d i a te l y b e l ow tile


head of the f(bula.

Direction of ne edle, injection dep th : Perpend i c u l a r t o the s k i n , t h e n in­


filtrate down u nti l the pati ent rep orts p a i n reactí o n s .
l njection to the Fíbular Nerve 171

Fig . 1 33 : I nj ection t o the fi b u l a r nerve


1 72 Extre m i ti e s : arms, l egs

I njectio n to he Obtu rator Nerve

Indications: Add u c tor s p asm g ra c i l i s syn d r o me arthrosis of the h i p and knee.


, ,

Materials: 80-mm-long need J e, ab ou t 5 mJ p ro ca ine or lidocaíne.

Technique: T l1e p a t ient hes 0 (1 his/her back and rotates the thigh
Po i n t DI insertio n :
outward as fa r as possible . Palpate in a latera l directio n frOln the syrn ­
pbys is pubis i n ord e r to I acate the p u b i c tubercle. The pai nt of ent ry
is about a t b u m b s brea d t h caudally from this.
'

Perpendicular to the s kin at fj rst, u n til contact is


Directio n of needle:
mad e with the horizon tal por t i a n of the pubic bone.

Injection depth: Withd raw the needle sl í gh tl y, then advance it in a lat­


eral and caudal d ir e c tío n a l ong the l ower edge of the h orizontal ra m us
of the p ub i c bone and into the ob tu rat o r fo ra men. Paresthes ia in the
reg i o n suppl ied by this nerve indicates the co r rect p o s i ti o n of the nee­
dJe.

Fig. 1 3 4: I njecti on t o t h e obturato r n e rve


lnj ection to the O btura tor N e rve 1 73

Fig. 1 35 : I njecti on to the obtu rator nerve: anato m i ca l relationships a n d positi on of n eed l e
174 Extrem iti e s : a rms, legs

I njection to the Tibial Nerve

Indications: Paresthesía, pain, círcu lato ry d is tu rbances, i tchi ng, e c z e n1 a ; pos t­


traumatic disorders i n the are a supplíecl by this nerve.

Materials: Size 2 needle, 1 -3 Inl pr oc aine o r l i doca i n e .

Technique: The pa t ien t l ies face do w n .

PoÍnt 01 Ínsertion: At the l evel of the cranial end o f n1edíal malleolus,


the p o s t e ri or tibial artery can be pa l pated next to the A chil les t e n don .

Direction 01 n eedle: Set a quaddle ( p. 1 78 ) over the p o int of entry, and


pass through thi s a t right a ngles to t h e s ldn to b r i ng the poi n t of tl1 e
needle a djacent to and l ate rally of the a r t ery If the need l e is cor r ectl y
.

s i ted, the p a t i e nt wiJ l report pai n reactions.


I nj ection to the Tibial N e rve 1 75

Fi g . 1 3 6 : I nj ecti o n to the ti bi a l neNe


176 Extremítíes : arms, l egs

I njection to the Trochan er M ajor

Indications: Hypertrophic arthriti s of the hip joint, coxitis , coxalgia, ankyIosi ng


s pondyl i tis ( B echterew's d is ease).

Materials: Size 1 needle, 2 mI procaine or l id ocaine.

Techn ique: The t r och a n te r is gen e r al l y readily visible or palpable, whether the pa­
tient i s standing u p o r lying down.

Direction of needle: Perpendicular to the skin.

Injection dep th: Down to the períosteum.


Inj ection to the Trochanter Maj o r 1 77

Fig. 1 3 7 : I njection to the trocha nter major [also: pp. 1 5 6- 1 5 9 ( h i p joi nt)]
1 78 Extre m i ti e s : a r m s , l egs

Quaddle Thera py

Th e intracutan e o u s quad d J e is an i nj e cti o n u s e d freq uently i n ne u ra l thera py. It is of u s e


only when given i n t o d i sturbed t i s s u e i de ntified b y informatíon fro m th e p a t ient, exaIn­
inati on , and p a l p atío n . The mech a nisln by which i t a cts i s p rov i d ed by th e c utaneovisce ral
reflex channe [s . N o n-se lective q uad d l i ng has nothing in common with neuraJ therapy a n d
is t o b e d ep recated. Qua d d Ies m u s t be strictly intracutane o u s . Fo r c h í l d re n a n d over­
a nxio u s patients, the D e nnoj e t has p roved usefu l ; w i th this, a q uadcl l e is set in the sIdn
at s u p e rs o n i c speed witho ut the u s e of a need le.

M aterials: S i ze 20 need l e , 0.2 -0A Inl procai n e or l i d o ca i ne .

Fig . 1 3 8 : I nt racuta n eous qua d d l e


I ntramuscular lnfi l tra tion 1 79

I ntra muscular I nfi ltrat" o n

Ind ications: Mya l gia. fibros i ti c nodules n1uscle spasm, cervica l syn d r o me, muscle
,

contractu res, pulled muscle, s prains ; all segmental m u s c l e - reflex


symptoms.

Materials: The size of needle d e p ends on the d e p th at which the process occurs.
whil s t the quantity is measured in tenths of a m illil ite r on ly and de­
pen d s upon the extent of the tissue changes .

Technique: Set a quadd l e over the pai nful a fea ind icate d by the
Poin t of insertíon :
pati ent or fo und by pal p ation.

Direction of needle: Pass the needle thro ugh the quad d le to pro be deep­
er, i n filtrating as yo u p roceed
.

lnjection dep th : To the 'ouch poi nt' i ndicated by the p atient i n to the
,

fi bros itic nod ule a nd pai nfu l tissue. to the periosteum, to ligaments.
and lígalnentous attachments .
1 80 Extremities : arms, l egs

Quadd les i n the Reg ion of the Knee J oi nt

Indications: Arthrosis or a rthríti s of the knee, post -trau ll1atic disorde rs.

Materials: S i ze 2 0 need le, 0.5 mI procaine or l i d ocaine per q uaddle.

Technique: Poin tDI ins ertion : Latera U y : one quaddIe a t the leve] of the joint l ineo
MedialIy: one qu addle each ove r the head of the ti bia, the joí n t l i ne,
a nd the head of the fell1ur; and another in the mid d l e of the popl iteal
fO SSJ.
Qua d d l e s in the Region of the Kl1ee joí nt 1 81

Fig. 1 3 9 : Quaddles i n the region of the Imee joint


1 82 Extrem ities : arro s, l egs

Quaddles in the Sacroiliac Region

Ind ications: D i s orde rs of the u rogenital system.

Materials : Size 20 nee d l e , 0.5 mi p roca ine or li docaine p e r q u a d d l e .

Technique: Point DI insertion: 5ix q u a d d les i n t h e d o r s a l segme nts ( H ead's zon e s )


of the pelvic region. The l1ighest pai r l í e s over t h e latera l dinlples o f
t h e Michaelis rho mboid, t h e two l owe r p a i rs are near t h e u pper e n d
o f the nata l cle ft, a b o u t 2 0 lTI1TI apart. The four upper q u a d d J e s cover
the a rea i n n e rvated by tlle hypog a s tri c plexu s, a nd the lowest p a í r
a ffects the externa l a n a l a nd vagi nal zone 54-S S .
Quaddles in the Sacroiliac Regjo n 1 83

Fi g . 1 40 : Q u a d d les i n the sacroiliac region


1 84 Extremiti e s : a rm s . I egs

Quadd les i n h e Pa rasterna l Reg ion

Indications: In cardi ac and pulmona ry disorders ( p. 1 0 fO.

Materials: S ize 2 0 need le, 0 . 2 - 0 . 5 m I pr o c a i n e or l i docai ne.

Technique: Point of Ínsertíon: FO ll r to six q uaddles b i latera l l y over the i ntercostal


s p aces close to the sternum. Add i tiona lly, intravenous i nject i o n s : in
cardiac d i sorders, o n the left ; in pulmonary d i sorders, a lterna tely left
and right.
Qu addles in the Parasterna l Reg i o n 1 85

Fig. 1 41 : Q u a d dl e s in the p a ra ste rn a l reg io n


1 86 Extre m i ti e s : arms, l egs

Quadd l es to the Pelvic Reg ion

I ndications: Gynecol ogi cal d i sord ers, e.g. , dYS lnenorrhea, endometritis a nd para­
metritis, pelvic inflarnrna tory d isease, rnenorrhagia and metrorrhagia ;
urogenital d i sorders, such as i ntlalnln atory and dystro p h i c dísease of
b l a d d er, prostate, and renal pe lvis Combi ne with quad d Ies i n sacroi liac
.

regí on ( p. 1 82 ), poss i b ly a lso with í nj ec t io n s to Frankenhauser's ganglia


or to the p elvic regíon (p. 1 1 0- 1 1 3 ).

Materials: S í ze 2 0 nee d le, 0 . 2 Inl procaine or l ído c a i ne per quaddle .

Technique: Four to s ix quad d les dist ri b u ted aJong the u pper border of t he p u b ic
bone.
Qu addles to the Pelvic Region 1 87

Fig . 1 42 : Q u addles to the pe lvic reg ion


188 E xtre m i ties : arms, legs

I ntravenous I njection

Indications: Thi s inj ectíon is u s ed as the bas ic treatlnent for all disord ers in the re­
gion of the head, neck, and tho rax. Proca ine or lidocaine rel i eves pain,
acts as a vas o d i lator, red u ces va scu lar permeab i l i ty, regul a tes the ci r­
c u l a b o n, acts as an anti-al l e rgic, red uces i nfla lnmati o n, and acts as a
d i uretic. Procaine given i ntravenously has an e ffec t o n the heart siInilar
to that of s parteine and quinine. Procaine suppresses the ci rculatory
col lapse induce d experi mentally by Veratrin ( Bezold-j arisch reflex),
and the same a pplies to anaphyl acti c serum shock and necro s i s for­
mation in tlle S hwartzman-Sa na relli phenomenon.

Materials: Size 12 or 2 needle; NEVER USE MORE THAN 1 111 1 p rocaíne o r lido­
caine !

Technique: In the usual man ner; befo re withd rawing the needl e con1pletely, inj e ct
a no ther 0 . 5 mI paravenously .
Intrave nous Inj ection 189

Fig. 143: I ntrave n o u s i njectio n of proca ine o r l i d oca i n e


1 90 Extre m i ti e s : arms , l egs

I njections ¡nto Sca rs

Indications: a : Segme n t al therapy: AH s e a rs i n the segment und e r trea tment must


be i njected in the same sessíon ; sy m p to ma t i c scars, kelo ids, post­
opera tive eomplain ts. etc.
b: r n terference-field seareh : Any sear may aet as an in t e rfere n e e field ,
i rrespective of kind, size, or age of s ear.

Materials: S i ze 1 2 need l e, q uantity of proea ine or lid oca i ne a ecord i n g to the size
of the scar.

Technique: I nj ect s uperfi ci a l ly i n to the se a r so that someth ing l i ke a confluent weal


is formed. In the case of l ong. narrow sears, set q uad d l es at in terva l s
of about 1 0-20 mm. D e e p s cars m u s t be treated i n d epth.
I nj e ctioos ioto Scars 191

Fig . 1 44 : I njection into a sear


1 93

I nterference Fields in the Teet and Jaws

Diseased teeth place a load on the body's cybernetic i n forma tí on and regula to ry syste m s
a nd can b l oc k these systeITIs. W e are i n t erested n o t on l y i n apical foci of infectio n , but
also in teeth that are d evita I ízed, dis p lace d , etc. An asym p tOInatic d enervated tooth can
a lso becon1e an i nterfe r e n ce fie l d even i n the abse nce of a visible gra nu l o m a The prote i n
.

i n the d enti n d i s i ntegra te s afte r devital i zation. I t s brea kdown products, such as mer ­

captan, can aet as ehronic i rritants to the bas i c auto n omic system ( Pi s ch i nger) a n d become
a source of er r oneous i nformatíon and regu l atory dysfu nction The de ntin canaIs contain
.

all the ele ments of the basie autonomic system such as term i nal nerve fibers. capilIaries ,
and lYlnph vessel s . All i n tl a m mations occur in this basic ti s s ue, a n d i t is here that i n ter­
ferenee fields are gene r ated. The devita l i z ed tooth is not isolated : i t i s l i nked to the res t
o f the body via the dentin canals, a n d in thi s sense i t i s not dead fro m a bio l ogic a l s ta n d ­
p o i n t . A s o urce of fa l s e i n for m a tÍ on this permanent i rritati on c a n a c t spec ifically on i n­
,

h erite d or aequi red weak po i nts and a l low d i sease to occur th ere.
Every p hysician and de ntist s h ould be fami l i a r with these modern scient i fic fu ndamenta l s
of matrix research ( H H e i n e ) . However, t h e l i teratu re a bout t h e effects of interferenee
fi e l d s in the tee t h and j aws often fails to give s u fficient consideratí o n to these new fin d­
mgs.
We know that the active i n terference fields in the teeth can re nder aH attempts at treat­
ment ineffective. Pro d uctive coope rati on between physician and d e n ti s t wo u l d expan d
o u r diagno stic a n d therapeutic o p portu n í ties a n d $uccesses. W e are opposed t o re rnoval
of teeth as a rnatter of eourse. However, we also feel th a t the attempt to save teeth at
any cost often forces pati e n ts to pay that p rice with their h ea l th .
1. Apica ! Pe r i o d o n t i ti s 1 95

1. Apica I Periodontitis

Too th 24, the pre mola r i n the Ieft u pp e r j aw,


ex h i bi ts a s h arply d elna rcated radio l uce nt
area. Bone d es tructi o n a ro u n d the tip of the
root d u e to c h ro ni c infl a m m ation a pp e a rs a s
o i nc re a s e d ra d i o l ucency at t h i s s i te . To oth 24
(f)
y h a s an a m a l gam fi l l i ng ove r the occl u s a l a n d
distal s urfa c e s . I rritation o f the p ll l p d ll e to
a d eep d e fect in the crown has led to de­
vital izatíon. Chronic ba cteri a l i n fi l tratíon i nto
the p u l p h a s p rod uced the c l í nica} p ictllre o f
chro n i c apica l periodontitis ( gra n u l oma ) .
I n sp e c t i o n of t h e tooth re veals gray d iscol­
o ra ti o n in a d d i ti o n to the l a rge a m algam fil l -
i ng. T h e vitaJ i ty te s t i s negative .
1 96 I n terfe rence Fíel d s in the Te eth and Jaw5

2. Apica l Broadenong o f t h e Periodonta l Space

Too th 1 4, the fi rst premolar i n the ríght up­


p e r j aw exhibits widening of the periodon­
,

tal s p a ce i n the a pical third of both roots ( th e


fi rst prelTIolar usually h a s a buccal and a pal­
atine roo t). This is a s ign of inflam mati o n
that m ay be interpreted as a s e q u e l a of in­
fla ln ln a to ry irri tatio n of the pulpo Inflamma­
tion of the period o n ta l l igament beyond tbe
apex o ccurs with typical pain associated
with axial motion of the too th. The extre me­
ly large amalgam filling is indíca tive of a
very deep p revious cari ous defect. Ba cteria l
irri tation of the pulp res u lts in th e spread o f
inflamm ation beyo nd the a pex into t h e SU1'­
roun d ing apical portion o f the periodontal lígalnent. The p a ti e n t o ften experie nces this
as a sensation of a n extended o r raí s ed tooth with painfu l early contact d uring occlus ion.
In diagnos ing the dis orde r, one s hould n ote tha t the tooth may still be vital or already
be devital í ze d , but it will usua l ly be painful when tapped.
3. Chro n i c Ap ical Periodontitis 1 97

3. Chronic Apica l Periodon itis

Tooth 3 5 , the second premolar in the l eft


l ower j aw, i s a tooth tllat has u n dergone
previous roo t canal treatlnent. After remov­
al of the p u l p , the p u l p cavity was fi lled. The
ra di opaque fill ing material proj ects a few
n1i l limeters past the apex a n d h a s caused in­
flarnrnation i n the jaw around t h e tip of the
root. Visible i n t h e i mage as a r a d ioluce n cy ,
this i n fl a mm.1 tory p rocess has spread i nfe­
riorly to the cancellous bone a ro u nd the
a pex of tlle root a nd into the a picaJ portion
of the periodonta l liga ment. He re, the perio­
dontal s p a ce i n the .1p ic.1l thi rd of the root
ap pears widened . The body has res p o nded
to the s l ow spread of infl an11nation with reactive scIerosis of the cance l lous bone around
the i n flalned area. (l i n í c.11 symp torns may i nelude tend erness to pal p a t i o n in the a pica l
regíon or pai n upon app lication o f axia l l oads.
1 98 Interference Fi elds in the Teeth and Jaw5

4. Ch ron ic Apical Periodontitis

Tooth 3 6, th e first mol ar in t he Jeft J ower


j aw, exhi bits partial fil l i ng of the d istal root
canal with a few millimeters of radio paque
lnateri a l. The n1esi a l roo t has a rad iopaque
filling with a continuo us radiode nse metal
shadow extending 3 lTIlTI beyon d the típ of
the root. Ihi s i s d ue to the root fil e used to
ream the canal. Ihe infer i or margin o f the
apical rad íolucency i s d efined by root fil l i ng
material tha t was pressed beyo n d the can a l .
The tooth i s clinical ly a sympto ma tic with­
out any p athological findings. However,
acute exacerbation may occur at any time as
a res ult of p athogen s spread ing to the can­
cellous bone v i a the a pical fo ra me n and the highly infectio us reaming i nstrument l eft in
s itu.
5. Deep I nflammatory Periodontal Disease 1 99

50 Deep I nfla rnmatory Periodonta l Disease

To oth 4 1 , the m i d d le right i n cisor i n the


l owe r j aw , exhi b its c o m p l e te d e struction of
the bone structure around the e ntire root.
rhe d i s i ntegration of the cortex of the a lve­
olar p rocess exte n d s l a tera l ly and has al­
ready destroyed the ínterde ntal s e ptum

�;, bordering o n tile adj acent teeth. T h i s d i ffu s e


inflammati on exte n d s i n feriorly i n to d e eper
layers of ca ncel l o us bone a n d has obl i terat­
ed the periodontal l i gament of tooth 4 1 . The
to oth i s very loose and is su pported only by
gra n u l arí on tis s u e . Where ne urovascu l a r
sup p l y through the a p ical fo ralnen i s in tact,
the vita l i ty test wiU be positive. However,
d ue to the l a c k of bony su pport, the s l i ghtest l oad wi l l be s uffi c i e n t to d i s l o dge the to oth.
200 Inte rference Fields in the Teeth and jaws

6. Local Deep I nfl a m matory Periodonta l Disease

Tooth 46, the first m o lar in the right lower


jaw, exhibits a n interrad i cular rad i o l u cent
a re a in the bifu rc atí on (where the root d i ­
vides into mesial a n d d i s tal roots). The slight
díffu se rad iolucency of the cancellou s bone
of the a l veolar p ro cess along the mesial a s ­
p e c t of t h e tooth is attríbutable t o c h ro n i c
infl a m mation due t o t h e proj e cting margin
of the c[own. Ihis pocket of food debrí s pro­
mote s b acteria l infe s ta tion and local inflam­
mation of the gingival pap i l l a, whích in turn
leads to inflanlDla tion of the i nterdental
se ptum. A d i s t a l red ucti on i n the hei ght of
the bone is apparent where infl a m matory
d i s i n tegration o f the cortex o f the a lveolar process h as occu rred.
7. Radicular Cys t 201

7 e Rad icu l a r Cyst


Tooth 33, a s o l i ta ry canine in the left lowe r
j aw, exh ibits a round, s harply delnarcated
radiolucent a rea with a rad iopaq ue margino
The radicu l ar cyst deve loped a fte r devi ta l í ­
zati o n o f the tooth. Chronic apical periodon­
titis deve loped, which then p rogressed to
central liq uefaction. Active transport of
tissue fluids i nto the central l umen contribut­
ed to the expansive growth of the cyst.
which has d isplaced the sur ro u n d i n g bone.
Cysts usually expand a l o ng the path of least
resistance. Successful elilni nati o n requires
removal of the entire cys tic sac with its e p i­
thelial linin g.
2 02 Inte rfe rence Fields in the Teeth a n d Jaw5

8. Radicu l a r Cysts Adjacent to a Retrog rade Ama lga m Fil l i ng


after Resection

Tooth 1 2 , a l a t eral incisor i n the right u pper j aw, ex­


hib its a ro und a p ical rad io lucent area meas uring abo u t
5 mm i n dialnete r bord e re d by a rad iopaque halo. The
devitali z e d tooth fitted with an artificia l crown even­
tuaUy l ed to d evelopln e n t o f a rad icu lar cyst. Adj acen t
tooth 1 3 , the right ca n i n e i n the u pp e r jaw, i s also fitted
with a crown. It exhibits a radio paque root filling with
a continuous rad iod ense meta l s h a d ow in the u pper
and middle thirds of the root from a p rosthe ti c metal
root p i n o The sharply d e ln a rca te d s h o rtened roo t ex­
,

h i b its a central sp hericaJ rad iodense metal s hadow.


Too t h 1 3 has u ndergo ne root canal treatment and been
fi tted with a lnetal roo t pin to receive a gold crown.
T ll e tip o f t h e root was resected d ue to c hro nic a p i ca J
periodontitis. The root filling was n o t i mpervious a nd
re quired retrograde s e a l ing to preve n t additional bac­
teria ! invasion of the root cana l . This was d o ne u sing
amalgaln (a five-Inetal a l l oy of lnercury. s i lver. zinc,
tino and copper ) .
9. Hypercem entosis 203

9. Hypercementosis

Tooth 46, the first m o l a r in the right lower


j aw, exhi bits normal mesiaI root configura­
tion . Tile d istal root i s tilicke ned a t i ts apex,
a n d the peria dontal spa ce i s widened at the
apex a n d along the nlesial su rfa ce of the ra at
as far as the b i fu rcation. The i nte rd ental sep­
tum mesial to tooth 45 exh i b i ts d estruction
of the cortex o f the alveolar p rocess and d i s­
tal bone resorption. rhe crown of the tooth
has a rad io d e nse metal filli ng with a radio­
l u cent are a a t i ts base that communicates
with the horn of the p ulpo A spheri cal shad­
ow from a d e nti cle i s d iscernib l e at th e base
of the pu l p o
Secondary caries beneath the n a n i m pervious amalgam fi U i ng has l ed to chro nic i nflam­
ma tÍon of the pulp from bacte rial i rritati a n . The res ponse to c hronic i rr i tatíon has been
excessive pro d u ction o f ce l l u lar celnent, which is wrapped a ro u n d the a p i ca l region o f
t h e r o o t l i ke tree b a rle
2 04 I nte rfere nce Fi e l d s in the Teeth a n d Jaws

1 0 . Residua l Ostitis Fol lowing Heln isection

Tooth 3 7 , the second molar i n t h e l e ft l ower


(j ,
jaw, shows the partial1y fi l l ed mesial root of
C) the tooth. rile roo t canal is not comp letely
discernible. The b í furcation is exposed, and
the a m p utation stump of the dis ta l root
projects d istally ioto an irregular rad io­
l ucency. A s hadow from a foreign body is
present sligh tly su perior to tbe lnandibular
canal, a t t h e l evel of wh at wa s onc e the a p ex
of the distal root. A hemi section o f tooth 37
was pe rformed fol l owing the root canal
tre atlnent. When this was done , the surge o n
did not divide the tooth exactly in rile center,
but l e ft a portion o f th e di stal root in tbe j aw.
80th the inadequate surgical techn ique and the foreign body i n situ led to chronic in­
fl alTIl11ation at the s u rgical site.
1 1 . Re s i d u a l Ostiti s Fo l l owing Extraction and S u perfi ci a l Wound H e a l i ng 205

1 1 . Resid u a l Ostitis Fol lowin g Extr . ction and Supe rficial Wound
Hea l i n g

Region 46, the regi on of the fi rst mola r i n the


right lower j aw, exhibits a rad i oJucent a rea
corres pond ing to the a lveo l u s o f tooth 46
with radiod ense b ranch i ng calcifications
around m u ltipJe vacuoles. Traces of the
margi n of the a lveol a r process are visible i n
a t h i n rad i od ense covering of bone a djoining
the gingiva. Tooth 47 has a root filling; the
d i sta l roo t was fill ed eOlnpletel y and the
n1esial root o nly partialIy. The apex of the
mes ial root is eharacterized by a na rrow
radiolu cency, indica tive of apica l period onti ­
tis. After tooth 46 was extracted, the wo und
he aled slowly from the peri ph ery with pain
after extra ction. Th e gu m cIosed to fo rm a eo ntinuous e p i theli uID. The good regen eration
res u l ted in d eve lopment of bone trabecu lae. whieh form e d a superior corti ca l margin cov­
ering over the wound. The afeas of residual ostitis in the extra etion wound are demarcated
and relnain a s chronic infl a m m a tion. Too th 47 exhibits severe co ro n a l d estruction.
206 I n terference Fi e l d s i n t h e Teeth a nd J aw5

12 I mpacted a n d Displaced Wisdom Toot

Tooth 3 8 , t he wisdom tooth in the left lower


j aw, 1 S ti l ted 9 0° mesia l ly Ín the radíogra p h
w ith fu lly d e v e l o ped roots. I t s o ccl u s a l s u r­
face 1 S in contact with the d is tal coronal s u r­
face and dista l root of the rnesial s econd
molar, extending a s far ínferiorly as the m i d ­
d I e third o f the root. The tooth cavity exhi bits
a slíght radi olucency at i ts base while the
too th is appare n t)y not covered by any gin­
gi v a l bone. The roots, which extend dors all y
i nto the a ngle of the mandible, exhi bit grea t
curvature. Th e e ryt h e ma and swe J ling o f the
g i ngi v a d istal to tooth 37 sugge s t s a dis-
p laced im pac t e d wisdon1 tooth. Wh e n p re s ­
s u r e i s app l i ed t o t h e edematous m ucosa , large quantities of pu rulent secretion escape
from the gingival lna rgin d i s ta l to tooth 3 7. The i nf]a mm ation around the i m pac t ed crown
of tooth 38 can spre a d to the s urro u n d i ng fascial compartments and lead to a s evere
abscess syndrome.
1 3. lmpacted and DispJ a ced Tooth 1 1 207

1 3 . I m p a ct ed a nd Disp laced Tooth 11

A radiodense calcifi catíon sh adow s ugge s ti ng a dis­


placed a nd i mpacted tooth 1 1 ( mi d d le i n cisor in the
right upper j aw) i s visible to the righ t of the midline
of the maxilla. The d i sp l acelnent of the tooth in­
el ud es an axial deviation. Therefore, it is not visible
in its e ntire length. The roentgen ray beam is ro ugh­
ly para l l el to the longitu d inal axis of the tooth so
that its cross section is i mage d . It is not a pparent
where the crown of the tooth is. Its exact position
ca n only be d etermined i n a seco nd í maging p l a neo
The slí gbtly wid ened dental fo lliele a round the
crown of the ímpacted tooth s u ggests c h ronic in­
fIammation. The displa cement of the d en tin may be
due to pri mary deve lopmental a nomaly of the den­
ta l lamina o r seconda ry tra u m atic displacement.
Tooth 22 exhib its i nc01nplete root fi l l i ng with a p i ca l
radiolucency ( in d i ca tive o f c hronic apical períodon­
titis ).
208 Inte rference Fields in the Teeth and Jaws

1 4. Roo't Fra g m ent i n the Region of the First Molar i n the Left
lower Jaw

Regíon 3 6 exhibits a radi o l u eent a re a in the


eanee l l o u s bone eorrespond ing to the
former alveolus of too th 36. In the mid dle
of the bas e o f th i 5 area, a [ound rad i odense
bony shadow lneasuring a pproximately
3 lUlD may be seen. The radi o l u eent area i s
more sharply d e fí ned s uperiorly a n d í s b or­
d ered on the margin of the alveolar p roeess
by a fi rm bony b ridge. The tip of the root
fraetured d u ring extra etí o n of the tooth and
was left in s i tu and re mained unnoticed in
the healing wound. The b ony bridge c over­
í ng the de mareated area, the diffuse trans i-
tio n fro m normal b o ne to rad i o luee ney at
the base of the demarcated a rea, and the mesial tilt of molar 37 into that area fro m pos­
teri or suggest an extraetion that was performed lua ny years ago. Des pite th1S, the i nter­
fe renee factor posed by the root fragment has resu lted i n incomplete reossifieation of the
alveolus. The radiol ucen cy is rad iographic evi denee of ehronie ostitis superior to the root
fragluent left i n s itu.
1 5 . R o ot Fragment of the First Mojar i n the Left M axi l l a ry S i n u s 209

1 5 . Root Fra g m e nt af the Fi rst Molar i n the left Maxi l l a ry Sinus

Regío n 2 6 exh i b its a comp letely reossified


a lveolus with a sligh t loss of height i n its
cortical margino The inferior m a rgin of the
lnaxi l l a ry sinus líes s uperior to the root tip s
of teeth 1 3 , 1 4, 1 5 , a n d 1 7. An i rregul a r, ova l
shadow i s vis ible s uperior to the former al­
veolus of tooth 2 6 . Thi s i s a fraglnent of the
root of tooth 26 that has migrated into the
m axi l lary sinus. The tooth fractu red d uring
extraction. During the a ttempt to recover
the root fragme n t, it d i s placed and migra ted
through a perfo raríon into the maxi llary s i ­
nu s. B acte ria t h a t have entered the s i n u s
with t h e fragment often cause recu rrent s i ­
nus iti s . Too th 2 5 s hows measllring i nstru ments i n both root cana l s. I nc i d ental fi ndi ngs
in the rad iograph p rovided an explanatíon for tIl e cIl ronic recurre nt s i nusitis.
21 1

I ndex

b l adder, 1 0 6
intl am m a to ry d i sease, 1 8 6
o
abd o m e n , i nj ect i o n s l i sted, 2 8 re lated segm ents, 6 ears, and s t e l l ate ganglion i nj ect io n s ,
a b d o m inal s y mpa th et i c cha i n , s phi n c t e r spasm, 86 40
Vi s h ne v s k i i nj ect i o n , 90-93 brach i a l a r tery, 1 2 8 - 1 29 ecze m a , legs, 1 74
to po g ra p h y, 93 brac hialgia, 40, 1 48 edema, angi o n e u rotic, 76
a bscesses, 1 3 0 b rac h ia l plexus, 1 48 - 1 5 1 e l bow, 1 3 2 - 1 3 3
a d d u c t o r s pa s m , 1 7 2 n e u ra lgia, 40, 1 48 u l n a r nerve i nj ection, 1 44- 1 4 5
a d e noidal p ro l i fera tí o n , 76 bro nchi. re l a ted se gm e n t s, 6 e n d o m etritis. 1 1 0, 1 1 2, 1 86
a d e no i d s , 7 6 - 7 7 b ro n c h i al asthma, 40, 76 e pi d i dy m i s , re lated s egm ents , 6
allergic d ia th esis, 3 0 b u rns, 94, 1 3 0, 1 4 8 epididymitis, 1 24
a lveo l i t i s , 7 8 b u rs i tis, s u bacro m i a l , 1 3 6 e p i d u ra l a nesthesia, 82-85
a m p u ta rí o n stu m ps , 94 to pogra p h y , 85
a nal s phi ncter, 8 2 e piga s tri u m, 1 1 4- 1 1 5
a ngi n a pe c t o ri s , 40 ep i l e psy, traumatic, 4 0 , 5 0
an g i o s p a st ic dys b a s i a , 1 52 esop hagus , rel ated segme nts, 6
a nide j o i o t , 1 62 - 1 63 card iac d i sorders ext re m i tie s, see a rms ; legs
a n kyl o s i ng spondyl i tis, 1 76 para sternal q u a d d J es, 1 84 eye
a n t ec u b i ta l fos s a , m e d i an n e rve i n - seg m e n t a l th e ra py , 1 0- 1 1 i n fl a m m a tory di sorders, 3 4
j ect i on , ] 38 - 1 3 9 carpal tu nnel syndrome, 1 3 8 and s te l late gangl i o n i nj ections,
anus causalgi a , 4 0 , 1 28 40
a n d e p i d u ral anes the s i a , 82 and fe m oral n e rve i nj e c tion, 1 68 s ty e , 6 6
pruri t us, 1 06, 1 2 0 cel l u l itis, 1 3 0
a p ical p eri odon r i t is , 1 9 5 , 1 9 7 , 1 98 cervical gangl ion, u p per, 3 2 - 33
apoplectic states, pre- and post-, 40,
50
cerv i ca l p lexus
deep, 68-69
o
a rms s u p e r fi c i a l , 70- 7 1 fac i a l nerve, pares i s, 5 2
inj ecti oos l is te d , 2 9 cervical segments, 4, 5 fac ial p a i o , 5 6, 6 0
paresth e s i a , 1 48 ce rv i ca l s ynd ro m e, 62, 6 8 , 70, 1 79 facial t i c , 5 2
po s t -t ra u m atic os te opo ro s is , c hest, i nj ec ti o ns U s te d , 28 fe m o ra l a r tery, 1 5 2 - 1 5 3
128 chin, pain, 60 fem o ra l nerve, 1 68-1 69
a n d ste l l a te ga ng l i o n i nj ec t i o n s , c i l i a ry ga n g l i o n , 34-35 lateral cutaneous, 1 66- 1 67
40 ci rc u l a to ry d i s tu rb an c e s p oste ri o r cuta ne o u s , 1 02
a r t er i [Í s , te m pora l , 3 0 arm, 1 4 8 fi b ro s i tic nod u l e s , 1 79
arthritis, 1 34, 1 56 brachial artery i nj ect ioo, 1 2 8 fib u lar nerve, 1 70 - 1 7 1
ankle, 1 62 legs, 1 52 , 1 54, 1 68 , 1 7 0, 1 74 fi n gers
hypertro p h i c , b i p, 1 76 s u bclavian artery i nj e ctiol 1, j o i n t i nj ect i o n , 1 64 - 1 65
Imee, 1 8 0 130 ri n g-b l oc k a n e s t h e s i a, 1 46- 1 47
arthrosis, 76, 1 34 c l i m a c reric, m a l e , 1 24 Frankenhau ser's gangl i a , 7 2 , 1 1 0-
a n Ide, 1 62 co cc ygo d y n i a , 86 1 1 1 , 1 86
h i p , 1 72 colon, r e l a te d segments, 6 frigi d i ty, 1 1 0 , 1 1 2
knee, 1 6� 1 7 2 , 1 8 0 coxalgia, ) 7 6 frostbi te, 94, 1 30 , ] 48
a rthrosis deformans, sh o u l d e r, coxarthrosis, 1 5 6
1 36 coxit i s , 1 7 6
as thma, bronchial, 40, 76 cyst, ra d i cular, 2 0 1 , 202
axil l a ry p l exll s a n esthe s i a ,
1 5 0- 1 5 ] ga l l b l a d der
i nj ec ti o n p o i nts , 9
re lated segmen ts, 6
deafness , i n n e r-ea r, 5 2 segmenta l the ra p y, 1 4- 1 5
d i sk, i n tervertebra l , l u m b a r , 98 a n d Ll p p e r abd omi na l d isorders,
back, inj ections listed, 28 dysbasia, angi o spastic, 1 52 90
backache, 86, 1 08 , 1 1 2 dysmenorrhea, 1 1 0 , 1 1 2, 1 8 6 and Vogl e r's points i nj ecti on, 1 1 6
B a sedow's d i sease, 72 dyspa reu n i a , 1 1 O, 1 1 2 Gasserian gangl ion, 3 6 - 3 7
B ech rerew's d i s e a s e , 1 76 d y spha g i a, 54, 5 8 g a s t r i c d isord e rs, segme n ta l therapy,
Bezo l d-jarisch re flex, 1 8 8 1 6-1 7
2 12 Index

g a s tritis, 1 1 4 i n fra orb i ta l nerve, 56-57 q ua d d les, 1 8 0- 1 8 1


g l a ucoma., 34, 40 i nj ection poi nts
glos sopharyngeal nerve, 54- S S card iae d i so rd e rs. 1 0 - 1 1
gal lbladder. 1 4- 1 5
g luteal n e rves, i n fe r i or, 1 02
gai tero 72 gastr i c d i s o rders, 1 6 - 1 7
IJ
graci lis syndro m e , 1 72 h ea d . 1 8-1 9 . 20-2 1 . 2 3 l a ryngea l nerve, s u peri o r. 58 -59
gy n ecologi cal d is o rd e rs. 1 06 . 1 86 l ive r. 1 4 - 1 5 l a rynx. ne ura l g i a . 5 8
l u ng d i sord e rs. 1 2 - 1 3 legs
n e c k, 2 3 c i rc u l atory d istu rbances. 94. 98.
for segmental d isord e rs, 9
Cl s h o u l ders. 2 3
1 06
inj ections l i s t e d , 29
h a n d , d i sorders , 1 3 8. 1 40 i nj ections paio, 1 74
hay fever, 3 8 i n t raven otl s. 1 8 8 - 1 89 paresthesia. 98
head l i s ted , 2 8 - 2 9 post-sciatic pa i n . 1 70
i nj ect i on p o i nts , 1 8 - 2 1 i n s o rn n i a . 5 0 Leri c h e- Fonta i n e - Doseh i njection,
i nj ecti oll s listed. 2 8 i n t e rcostal n erves. 80-8 1 ste l l ate gangl í o n . 40-45. 4 1 ,
a n d i n trav en o u s injection. -1 88 i n te rcostal neuralgi a . 8 0 48
and s tel l a te ganglion í nj e c t i o lls. i n terference fie l ds , 3 . 2 6 l i d oca í n e
40 jaws, 1 9 3 i n trave nous i nj eeti o n , 1 88
t e m p o r a l artery i nj ee t i o n . 30-3 ) tee t h , 1 93 uses and i nd i cations, 2 6
h ea daehe i n terfere nce-field s e a rch l i g htn ing r e a c t i o n , 26
c i l i a ry ga n g l i o n injeeti o n . 34 an d a bd o mi na l s ym pat hetic c h a i n I i p . pai n , 6 0
fro n tal. and lateral s u p raorbital i nj ectio n , 9 0 l ive r
ne rve inj ec t ion , 66 Franl<eohauser's ga n g l i a i njection. inj e c t i o n po i n t s , 9
m a n d i bu l ar nerve i njection. 36 1 10 rela ted s e gm en ts. 6
menstrual, 1 1 0 m a s t o i d process inj e c t i on . 5 2 segme ntal therapy, 1 4-1 5
a nd occi p i tal nerve injection, 62 paJ ati ne to n s i l i nj e ction, 7 4 and u p per a b dom i n a l d i sorders,
and sca l p i njec t i o n , 50 p e l vi c region i njection. 1 1 2 90
te m p o ra l arte ry i njection. 30 () n d p rostate i nj ecti on , 1 24 . 1 26 l u m bago , 1 0 8
m axi l lary n e rve injecti o n . 38 a n d scar i njection. 1 90 l u m b a r s egments. 4, 5
s phenopa l a ti n e g a ngl ion i njec- test i njections to teeth, 7 8 l u mb a r sympathet ic c h a i n. 94-97
t í o n, 38 i n ternal org a n s , r e l ated segm e n t s . 6 . l u m bosacral trunk, 1 02
H ead's zones. 3 , 4. 5 7 l u n gs
heart í nte rve rtebral d isk. lu mba r. 98 d i s o rd ers , segm e nta l thera py, 1 2-
i nj ectíon points. 9 i ntestine 13
re la ted segm ents, 6 small. re l a red segmen t s , 6 injecti on pai nts , 9
a n d s te J l a te gangl i o n i nje ctions. a n d u p per a bd o m i nal d isorders, re lated se gm en ts , 6
40 90 a nd s t el l a te ga n g l i o n i nject io ns.
see also ca rdíac i n tracutaneaus q u a d d le. 1 7 8 40
H erget i njection. s teJ l a te ga ngl ion, i ntra musc u l a r i n fil tra tío n . 1 7 9 sec also p u l m o n a ry
4 1 . 42 -43 í n trave n o u s inj ectio n . 1 88- 1 8 9
h erpes zoster. 66. 80 i ri d ocycli t i s , 34
op h t h al m ic , 40 i tching. l egs, 1 74
h i cco ugh. 64
hip mandibu lar ne rve. 36-37
a rthrosis. 1 72 masto i d process, 52-53
hype rtrop h i c a rth r i t i s . 1 7 6 max i l l ary n e rve . 3 8 - 3 9
h i p j oi n t. 1 5 6- 1 5 9 j aws, in terference fi e l d s , 1 9 3 maxi l lary si nu s es , 5 6
i njec tion from fron t, 1 5 8 - 1 5 9 j oint s ti ffne ss . h i po 1 5 6 med i a n nerve, 1 3 8 - 1 3 8
K í ble r's m e t hod , 1 56- 1 5 7 M é n i e re ' s d i s ea s e . 40
Hopfer su pra pubic prosta te i njec- m e n o rrhagia. 1 1 2 , 1 86
t i o n . 1 26 - 1 27
humeros capula r p e r i a rrh riti s . 1 36
13 me ns tru a rion, a b norma l, 1 1 0,
112
H u n eke, Fe r d í na n d . 1 , 3. 26 kerari r i s . 34 m enta l n e rve. 60-6 1
hy perce me n tos i s, 2 03 Ki bler's metho d . hip j oi o t injection. m e ra l gia . 1 66
hype rthyroi d i sm, 40. 72 1 5 6- 1 5 7 metro r rhagia. 1 1 2 . 1 8 6
hy p o p h y s í s . p h a ryngea l, 7 6 - 7 7 Id d n e y s m i c t u ri tion d is o rde rs . 1 24 . 1 26
h ypothy roi d is m, 72 re lated segments. 6 mi g ra i ne . 30
and u p pe r abdom inal d íso rde rs. muscle con tractu res. 1 79
90 muscle spasm . 1 79
Imee, 1 60- 1 6 1 mya lgia. 1 79
arthri tis. 1 80 myoca rd i a l i n fa rc ti o n , 40
i m po tence. 1 24. 1 2 6 arthro sis, 1 7 2. 1 80
Index 213

p ar a s te rn a l regi o n, q u a d d les, 1 84 -
m 1 85
p e l v i c reg í o n, 1 8 6-1 8 7
sacro i l i ac regi a o , 1 82 - 1 8 3
n e c l< p a resthesia, l eg s , 1 74
i nj e c t i o n poi nts, 2 3 pa ro n y c h i a . 1 46
i nj ections lis ted, 2 8 p e l v i c fl oo r, 8 2
and i n trave nous í nj ecti o n , 1 8 8 neuritis, 1 1 0
p a i n , 64, 6 8 , 70 pelvic i n fl a rn matory d i sease, 1 1 2 , rad ial nerve, 1 40 - 1 43
a n d s te l l a t e ga ng U o n inj e e tí o n s , 1 86 e l bo w i njec t io n . 1 40- 1 41
40 p e l v i c regi o n, 1 1 2- 1 1 3 s n u ftbox l evel i nj e c t i o n , 1 42 - 1 43
temporal a rtery í njection, 3 0 - 3 1 quaddles. 1 86- 1 87 w rist joint i nj ecti o n , 1 42 - 1 4 3
n e u ra lg i a , 98 pelv i s , i njectio n s U s ted, 28 ra d icu l a r cyst, 2 0 1 , 2 02
b ra c h i a l plexu s , 40 P e nd l p res a c ra l infi l tra ti o n . 1 06 - 1 07 reactive segme n ts , 6
and fe m oral nerve inj ecti on, 1 68 p e n i s, 8 2 , 1 20 re ct u m. 8 2 . 1 06
g lossopha rynge a l. 54 pe riarthri tis. humeros eap u l a r , 1 36 d is t u rba nce s, 86
occi p i t a l . 62 peri n e u m , 8 2 , 1 06 , 1 20 re lated segments , 6
pudendal, 1 20 peri a d o n ta l d i sease , d eep i n fl a rn m a ­ Re i scha u e r i nj ectí a n , ste l la te g a ngl i ­
trige m i n a ! . see t rige m i n al n e u r a l ­ to ry , 1 99 . 200 o n , 4 6 -47
gia peri o d o n ta l s pace. a p ica l broad en­ re n a l pe lv i s , i nfla mmatory d isease,
see also pa i n i ng . 1 9 6 1 86
neur� t he rapy , 3, 1 7 8 p e r i o d on t i ti s , a p i c a l . 1 95 re s i d u a l ostítis. 2 04 , 205
nose, a n d stel Jate ga nglion i nj ec­ c h ro nic, 1 97 , 1 98 re ti na l artery, occl us i o n . 40
tioos, 40 p h a n tom - l i m b p a í n s , 40, 94 retrosty l o i d re g í on , 3 2 - 3 3
ph a lyngea l hypophys is. 76-77 rheu mati s m . 7 6
pha ryn gea l tons i l . 7 6 - 7 7 r h i n i ti s
ph l e bi t i s , J 5 2 a l le rgi c, 76
p h renic n e rve, C3-C5. 64-65 vaso motor, 3 8 , 40
obstetrics, a n d p u d e n d a l nerve i nj ec- post-concuss i o n sy n d rom e, 40. 50 rib fractures. pa i n. 80
tio n, 1 2 0 pos t -scia tic pa in. 1 70 ri ng-blocl< a n e s th e si a . 1 46-1 47
obtura to r n e rve , 1 7 2 - 1 73 post-traumatic d i so rders roo t fr agm en ts , teeth, 208, 2 09
occ i p i ta l nerve, 62-63 Imee, 1 60 , 1 80
o cc i p i ta l neura lgia , 62 osteoporos i s , 94, 1 2 8 , 1 48
o r c h i ti s , 1 24 and ti b i a l n e rve i nj e cti o n. 1 74
organs. inte rn a l , re l a ted segm e n ts, 6, pr es a c ral i n fi ltration, Pendl. 1 06 - 1 07
o
7 p roca i ne sacra! anesthesia. 8 4
osteopo r o s í s , p ost- trau m a tic, 94, i n t ravenous i nj ectio n , 1 8 8 sacra! fora m i na, p o s te ri o r, 8 6-89
1 28 , 1 48 u se s a n d i n d i cations, 2 6 sacral p l e x u s , 82, 1 0 2 - 1 0 5
osti tis. res i d u a l , 204, 205 pro sta te , 8 2 , 1 25 - 1 27 sacra ! seg m e nts , 4 , 5
otitis exte rn a , 52 c a rci n om a . 86 sac roi l i a c j oin t . 1 0 8 - 1 0 9
oti t i s m e d i a d i s o ( d e rs , 1 06 sacro i l i ac regi o n , quadd les, 1 82 - 1 83
a cute, 5 2 d isturbances, 8 6 sca l p , i nj ection u n d e r, 5 0- 5 1
c hroni c , 40, 5 2 hyp e rtrop h y , 1 24 , 1 2 6 s ca rs , i nj ec t i o ns ioto, 1 9 0- 1 9 1
ova r i e s , related segments, 6 i n flammatory d i s ease , 1 86 s c i a t ica , 8 6 , 9 8 , 1 0 6, 1 08
s u p ra p u bi c, 1 2 6- 1 2 7 scia t i c n e rve, 9 8 - 1 0 1 , 1 02
pro s t ati t i s , 1 24, 1 26 scrotum. 8 2 , 1 20
pr u ri t u s segmental t he ra py , 3
anus, 1 06, 1 2 0 and ca rd i ae d i so rd e rs , 1 0- 1 1
p a in v u l va. 1 06, 1 2 0 ga l l bl a d d e r, 1 4- 1 5
chin, 60 pudendal n e rve . 1 02 , 1 20-1 23 ga stri c d isord e rs . 1 6- 1 7
fac i a l , 5 6, 60 pe r i n e a l methad, 1 20, 1 2 1 , hea d , i njec ti o n p o i n t s , 1 8- 2 1
legs, 1 70 , 1 74 1 23 l ive r, 1 4- 1 5
I ips, 60 tra n sva gi n al method, 1 2 2 - 1 2 3 l u ng d i sord e r s. 1 2- 1 3
neck, 64, 6 8 , 70 p ud e nda l n e u ra lgia. 1 2 0 sca r inj ecti o n. 1 90 - 1 9 1
p h a n to m - l i m b , 4 0 , 94 pud e n d a l plexus . 1 0 2 segme n ts
r i b fractures. 80 pu lmonary d i sorders I í s te d . 4
s h o u l d e r, 64 , 70 i nj ection points, 1 2 - 1 3 reactive, 6
s u pra maxi l l a ry, 56 parasternal quad d l es , 1 84 related organs. 6, 7
see a/so neu ra l gi a s hou l d e r , 1 3 6- 1 3 7
palatine tonsil. 74-75 contusion, 1 3 6
pa ncreas d í s located, 1 48
rel a ted segm ents, 6 inj e cti o n po i n ts , 23
a nd u p per abdom i na l d i s o rd ers , quad d l e therapy, 1 78 p a i n , 64, 70
90 kn ee j o i n t, 1 80- 1 8 1 and stel l ate ganglion inj ections,
p a ram e t r i t i s , 1 1 0, 1 1 2 , 1 8 6 pa r a sternal regio n , 1 84-1 8 5 40
214 I n d ex

Shwartzm a n -Sa narel l i p he n ome -


non, 1 88
teeth
1 1 . i mpaeted and d i s p l aced,
I!I
s i n uses, max i l l a ry. 5 6 207 ul cer
s i nus itis, 3 8 , 40, 6 6 i n terference fields, 1 93 d u o denal . 1 1 4
s m a l l intes tine, rela ted s egme n ts. 6 tes t i njeeti o n s, 78-79 gas tri c, 1 1 4
s m e l l , s e n se o f, 76 radicular eysts, 201 , 2 0 2 varicose , 94
s !1 u ftbox l eve l i njecti o n , rad ial nerve, r o o t fragments, 208, 2 09 u l na r n e rv e , 1 44- 1 45
1 42- 1 43 wisd om. i mpacted a n d d i s p l a ced , u reter, 82
s p he n o p a l a tine ga n g l i o n , 38 -39 206 re la ted segments. 6
s pleen, rel a te d seg m e n t s , 6 see a/so hype ree m e n tos i s ; perio- u rethra. 1 06
ste l l a te ganglion, 40-41 d ont- uroge n i ta l d i so rd ers , 1 8 6
Herget i njection, 4 1 , 42-43 , 49 temporal artery i njectio n , 3 0 - 3 1 u roge n i tal syste m , 1 82
Leriche-Fo n ta i n e-Dosch i njee­ tes tes. re lated seg m e n ts. 6 uterovaginal plexus, 1 1 0- 1 1 1
tion. 4 0 -45 . 4 1 thoracic segments, 4, 5 ute rus, re l a ted segments. 6
Re isehauer i nj ecti on. 4 6-47 thorax, and i n trave nous inj e c t i o n ,
s te ri l i ty, 1 1 0, 1 1 2 1 88
s to m a ch t h roat
i njeetion poi nts, 9 sore. 74
n ervous d i sorders, 1 1 8 and s te l l a te ga n g l i o n i njecti o n s , vag i n a . 82
rela ted s egm e n ts, 6 40 vagi n a l d i scharge, 1 1 0, 1 1 2
and segme n ta l thera py, 1 6 - 1 7 t hyroi d , 72-73 vascul a r d i s o rd ers , a n d fe m ora l
and u pper abdom i n a l d i s ord ers. t h yrotoxicosis, 72 nerve i njeetion, 1 68
90 t i b i a l a rtery, p o ste r ior. 1 54-1 5 5 veratrioe, 1 88
and Vogle r's po i n ts i njeeti o n , ti b i a l n e rve , 1 74- 1 75 ve rtigo, 5 0, 52
116 tic, faci a l . 5 2 Vishnevski i njection, a b d o m i n a l
sec also gastric; gastri t i s tinnitus. 5 2 sympathetic e h a í n , 90-93
s tye, 6 6 toes Vogl er's poi n ts. 1 1 5 - 1 1 7
s u baeromíal b u rs i tis, 1 3 6 inj ection ioto joints . 1 64- 1 65 vulva, pru ritus, 1 06, 1 2 0
s u bclavian a rtery. 1 3 0- 1 3 ) ri ng-bl o c l< a nesth e s i a . 1 46
su pra clavicu l a r p l exus a n e s t h e s i a, to ngue, d i so rd e rs , 54
1 48 - 1 49 to nsil
s u p ramaxi l l ary p a i n , 56 palatine, 74-7 5
s u p ra o rbital nerve, l a teral. 6 6 - 6 7 p h a ryn geal. 76-77 wisdom tooth , i mpacted and d i s-
sympathetic cha i n to n s i l l i ti s , 74 placed . 2 06
a b d o m i n a l , V i s h nevs ki i nj ection. to rtico l l i s , 68. 70 wrist, uJ nar n e rve i nj ecti o n , 1 44- 1 45
9 0 - 93 tr i ge mi n a l neuralgia, 36, 3 8 , 54, 5 6 wrist j o i nt, 1 34-1 3 5
l umbar, 94-97 and ade n o i d i njecti o n , 7 6 rad ial nerve inj ectio n , 1 42 - 1 43
a n d l a te ra l slI p ra orbi tal nerve i n ­
j e ction, 66

D and menta l n erve i nj ectíon, 60


tri s m u s. 3 6
El
tac hycard i a, paroxys m a 1 . 4 0 trochanter major, 1 76 - 1 7 7 xi p h o í d , 1 1 8 - 1 1 9
tarsal eyst. 6 6
ta s te , sense of, 7 6