This exhibit depicts a stellate ganglion block procedure from an anterior view. The stellate ganglion is a sympathetic ganglion (cluster of sympathetic nerve cell bodies) located anterior to the transverse process of the C7 vertebra. It is formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion in the sympathetic chain. The sympathetic chain is part of the sympathetic division of the autonomic nervous system responsible for the body’s involuntary "fight or flight" responses. A stellate ganglion block is an injection of local anesthetic into the neck as a means to block sympathetic nerve impulses in the upper extremity and/or face. This is often done as a treatment for sympathetically maintained pain due to Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) or Herpes Zoster (shingles). The procedure is performed by manually retracting the sternocledomastoid muscle, carotid artery, jugular vein, and vagus nerve. The doctor can then palpate the anterior tubercle of the C6 transverse process (Chassaignac’s tubercle) and use it as a landmark to advance the needle. Once the needle is in place, local anesthetic can be injected into the area of the sympathetic chain. The anesthetic then travels inferiorly by gravity toward the stellate ganglion to inhibit sympathetic nerve impulses.