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Paraskevas GK, Tzika M, Asouhidou I, Chrysanthou C, Apostolidi E, Galanis N, Karamitsou P, Poutoglidis A. A Cadaveric Case of an Accessory Cleido-Occipital Muscle Over the Common Trunk of the Supraclavicular Nerves. Cureus 2023; 15:e40982. [PMID: 37503504 PMCID: PMC10370505 DOI: 10.7759/cureus.40982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
The current study describes a case of an aberrant cleido-occipital muscle. In particular, this muscle was arising from the middle part of the clavicle, inserted into the medial part of the upper trapezius muscle, and crossed over the supraclavicular nerves with possible compression of them, especially during shoulder abduction. Knowledge of the muscular variability of the posterior cervical triangle is crucial for supraclavicular nerve entrapment syndrome diagnosis and treatment. The appearance of aberrant muscular fascicles may lead to misinterpretation of neck imaging, as well as difficulties during surgical procedures undertaken in the region.
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Affiliation(s)
- George K Paraskevas
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Tzika
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Irene Asouhidou
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Chrysanthos Chrysanthou
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Elpida Apostolidi
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Nectarios Galanis
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Paraskevi Karamitsou
- Department of Otorhinolaryngology - Head and Neck Surgery, "G. Papanikolaou" General Hospital, Thessaloniki, GRC
| | - Alexandros Poutoglidis
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Seror P. The supraclavicular nerve. Muscle Nerve 2022; 65:698-701. [PMID: 35366347 DOI: 10.1002/mus.27547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION/AIMS The aim of this study was to describe a new method for studying the supraclavicular nerve (SCN) conduction and to report four cases with SCN lesions. METHODS The SCN was antidromically recorded with a pair of self-adhesive electrodes located in the middle of the clavicle. Stimulation (<5 mA) was delivered 7 cm proximally with a bar electrode. To facilitate recording, it was explained to the participant that they would feel a very faint electrical sensation locally and an electrical tingle upward (ear) or downward (shoulder/clavicle). Each participant was asked to say when the tingling moved downward. RESULTS In normal subjects, median values were 16 μV (range: 9-33) for sensory nerve action potential (SNAP) amplitude; 1.2 ms (range: 1-1.5) for onset latency; and 1.25 (range: 1-1.7) for side-to-side amplitude ratio. In the four patients, the SCN SNAP was absent on the pathological side and normal on the healthy side. All four patients complained of unilateral neuropathic hypoesthesia on the anterior aspect of the neck, chest, and shoulder that occurred after radical neck surgery for thyroid or larynx cancer (x3) and first rib resection (x1). DISCUSSION A comparison with previous reports shows that this simple method provides similar or highest SNAP amplitudes. SCN lesions are rare, and rarely referred for electrodiagnosis, and often overlooked. However, the SCN conduction study, which causes very slight inconvenience (low-intensity stimulation), allows a better understanding of the origin of the complaints and permits the patient to benefit of more suitable treatment.
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Affiliation(s)
- Paul Seror
- Laboratoire d'électroneuromyographie, Paris, France.,Laboratoire d'électroneuromyographie, Hôpital de l'Est Parisien, Ramsay GS, Paris, France
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Stecco A, Pirri C, Stecco C. Fascial entrapment neuropathy. Clin Anat 2019; 32:883-890. [PMID: 31004463 DOI: 10.1002/ca.23388] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022]
Abstract
Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and "internal stretch lesion." The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat. 32:883-890, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Antonio Stecco
- RUSK Rehabilitation, New York University School of Medicine, New York, New York
| | - Carmelo Pirri
- Physical and Rehabilitation Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Carla Stecco
- Molecular Medicine Department, University of Padua, Padua, Italy
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Surgical Approach to Injuries of the Cervical Plexus and Its Peripheral Nerve Branches. Plast Reconstr Surg 2018; 141:1021-1025. [DOI: 10.1097/prs.0000000000004240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Giddie J, Fisher R, White A. A rare anatomical variant: transosseous supraclavicular nerve identified during clavicle fracture fixation. J Surg Case Rep 2017; 2017:rjx230. [PMID: 29218211 PMCID: PMC5710605 DOI: 10.1093/jscr/rjx230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/22/2017] [Accepted: 10/29/2017] [Indexed: 11/13/2022] Open
Abstract
We describe a rare case of an anatomical variant of the supraclavicular nerve in the intra-operative setting of clavicle fixation for a fracture. Intra-operatively it was noted that one of the supraclavicular nerves was passing through a foramen in the clavicle shaft. A 60-year-old gentleman presented with a displaced multifragmentary fracture of the left clavicle after a fall. Plate fixation with a pre-contoured locking plate was performed under general anaesthesia. The clavicle was exposed through an infraclavicular transverse incision. It was necessary to divide this transosseous nerve branch to permit appropriate plate positioning. Post-operatively the patient was left with some incisional chest numbness. Surgeons should aim to preserve the branches of the supraclavicular nerve although this may not always be possible as we have demonstrated. The patient should be warned about potential deficit.
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Affiliation(s)
| | | | - Andrew White
- Orthopaedic Consultant-FRCS Trauma and Orthopaedics, UK
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Viciano J, Urbani V, D'Anastasio R. Congenital Anatomical Variant of the Clavicle. Anat Rec (Hoboken) 2017; 300:1401-1408. [PMID: 28296289 DOI: 10.1002/ar.23596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/09/2016] [Accepted: 12/11/2016] [Indexed: 11/05/2022]
Abstract
The aim of this study is to present a rare abnormality of the clavicle (Code: SGS01) that was discovered in an ossuary in the Church of San Gaetano (Sulmona, central Italy; XVII-XIX centuries CE). In the middle third, the clavicle had three areas with losses of substance in the form of oval-shaped foramina with maximum diameters of 1-2 cm that were located in the anterior and superior surfaces of the diaphysis. The margins of these foramina were well defined and rounded, and the surfaces of the canal walls were smooth. Additionally, there were no zones of bony activity or reactive changes around the foramina. This new congenital anomaly of the clavicle and blood vessels is consistent with a variant that might have originated during fetal growth in which the subclavian vein or artery remained included during the process of ossification of the clavicle. Anat Rec, 300:1401-1408, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Joan Viciano
- University Museum, 'G. D'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | | | - Ruggero D'Anastasio
- University Museum, 'G. D'Annunzio' University of Chieti-Pescara, Chieti, Italy.,Department of Medicine and Ageing Sciences, 'G. D'Annunzio' University of Chieti-Pescara, Via dei Vestini, Chieti, Italy
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Natsis K, Totlis T, Chorti A, Karanassos M, Didagelos M, Lazaridis N. Tunnels and grooves for supraclavicular nerves within the clavicle: review of the literature and clinical impact. Surg Radiol Anat 2015; 38:687-91. [PMID: 26702936 DOI: 10.1007/s00276-015-1602-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/05/2015] [Indexed: 11/28/2022]
Abstract
Perforation of the clavicle by supraclavicular nerves is a common anatomical variation. This variation has been reported in several studies based on post-mortem, surgical and radiologic findings, with an overall frequency between 1 and 6.6 %. The penetrating branch passes either through a bony tunnel or a groove on the superior surface of the bone. Entrapment neuropathy of the perforating branch is a documented clinical entity reported in the literature. The intraosseous course of the supraclavicular nerves makes them vulnerable to injury in case of clavicular fractures or during surgical manipulations of these fractures. Furthermore, this variation should be taken into account during the interpretation of chest and shoulder radiographs. The purpose of the current study is to perform an extended review of the relevant literature, highlighting the clinical impact of this variation, as well as to incorporate our own findings into them.
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Affiliation(s)
- Konstantinos Natsis
- Laboratory of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P. O. Box 300, 54124, Macedonia, Greece.
| | - Trifon Totlis
- Laboratory of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P. O. Box 300, 54124, Macedonia, Greece
| | - Angeliki Chorti
- Laboratory of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P. O. Box 300, 54124, Macedonia, Greece
| | - Marinos Karanassos
- Laboratory of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P. O. Box 300, 54124, Macedonia, Greece
| | - Matthaios Didagelos
- Laboratory of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P. O. Box 300, 54124, Macedonia, Greece
| | - Nikolaos Lazaridis
- Laboratory of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, P. O. Box 300, 54124, Macedonia, Greece
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Silva A, Leandro I, Pereira D, Costa C, Valera A. Collective secondary cremation in a pit grave: A unique funerary context in Portuguese Chalcolithic burial practices. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2015; 66:1-14. [DOI: 10.1016/j.jchb.2014.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 10/06/2014] [Indexed: 11/29/2022]
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A novel variant of the cleidocervicalis muscle with clinical implications for nerve compression/entrapment. Surg Radiol Anat 2014; 37:697-9. [PMID: 25326903 DOI: 10.1007/s00276-014-1384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The cleidocervicalis muscle occurs in approximately 1-3 % of the population that may be confused with pathological neck masses. We describe a novel variant of the muscle and its clinical implications. METHODS This is a case report of a cleidocervicalis muscle variant identified during routine cadaveric dissection. RESULTS The muscle identified originated on the C5 vertebra and inserted on the clavicle medial to the trapezius muscle. Innervation was provided by a C6 spinal nerve branch. Notably, a branch of the supraclavicular nerve was closely associated with the muscle, raising the possibility of compression of this nerve. CONCLUSIONS Presence of a cleidocervicalis muscle should be considered in cases of shoulder pain consistent with supraclavicular nerve entrapment or compression.
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Labronici PJ, Segall FS, Martins BA, Franco JS, Labronici GJ, Silva BDA, Rocha LRD. Clavicle fractures - incidence of supraclavicular nerve injury. Rev Bras Ortop 2013; 48:317-321. [PMID: 31304127 PMCID: PMC6565904 DOI: 10.1016/j.rboe.2012.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/03/2012] [Indexed: 12/04/2022] Open
Abstract
Objective To analyze retrospectively 309 fractures in the clavicle and the relation with injury of the supraclavicular nerve after trauma. Methods It was analyzed 309 patients with 312 clavicle fractures. The Edinburgh classification was used. Four patients had fractures in the medial aspect of the clavicle, 33 in the lateral aspect and 272 in the diaphyseal aspect and three bilateral fractures. Results 255 patients were analyzed and five had paresthesia in the anterior aspect of the thorax. Four patients had type 2 B2 fracture and one type 2 B1 fracture. All patients showed spontaneous improvement, in the mean average of 3 months after the trauma. Conclusion Clavicle fractures and/or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve and cause alteration of sensibility in the anterior aspect of the thorax. Knowledge of the anatomy of the nerve branches helps avoid problems in this region.
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Affiliation(s)
- Pedro José Labronici
- PhD in Medicine from Escola Paulista de Medicina, Universidade Federal de São Paulo; Clinical Head of the “Prof. Dr. Donato D’Ângelo” Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
- Corresponding author. Av. Roberto Silveira, 187/601, Centro, Petrópolis, RJ, Brazil. CEP: 25685-040.
| | - Fabio Soares Segall
- Resident Physician in Orthopedics and Traumatology, “Prof. Dr. Donato D’Ângelo” Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Bernardo Augusto Martins
- Resident Physician in Orthopedics and Traumatology, “Prof. Dr. Donato D’Ângelo” Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - José Sergio Franco
- PhD; Associate Professor and Head of the Department of Orthopedics and Traumatology, School of Medicine, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Gustavo José Labronici
- Physician responsible for the Shoulder and Elbow Group, “Prof. Dr. Donato D’Ângelo” Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil
| | - Bruno de Araújo Silva
- Physician responsible for the Hand Group, “Prof. Dr. Donato D’Ângelo” Orthopedics and Traumatology Service, Hospital Santa Teresa, Petrópolis, RJ, Brazil; Head of Hand Surgery, Hospital Estadual de Traumatologia e Ortopedia Dona Lindu, Paraíba do Sul, RJ, Brazil
| | - Leonardo Rosa da Rocha
- Head of the Orthopedic Trauma Group, Instituto Nacional de Ortopedia e Traumatologia, Rio de Janeiro, RJ, Brasil
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Labronici PJ, Segall FS, Martins BA, Franco JS, Labronici GJ, Silva BDA, Rocha ELRD. Fraturas da clavícula – incidência de lesão do nervo supraclavicular. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Douchamps F, Courtois AC, Bruyère PJ, Crielaard JM. Supraclavicular nerve entrapment syndrome. Joint Bone Spine 2011; 79:88-9. [PMID: 22088932 DOI: 10.1016/j.jbspin.2011.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2011] [Indexed: 10/15/2022]
Abstract
Supraclavicular nerve entrapment syndrome, although rare, should be considered among the causes of anterior shoulder girdle pain. This syndrome is usually related to anatomic variants (involving the bone structures, fibrous bands, or muscles and tendons). Computed tomography is the most useful investigation. Medications used to treat neuropathic pain may provide relief. Otherwise, a local glucocorticoid injection or even surgical decompression should be considered.
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Affiliation(s)
- Frédéric Douchamps
- Service de médecine physique et réadaptation, CHU du Sart Tilman, ULG, B35, Sart Tilman, 4000 Liège, Belgium.
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Nathe T, Tseng S, Yoo B. The anatomy of the supraclavicular nerve during surgical approach to the clavicular shaft. Clin Orthop Relat Res 2011; 469:890-4. [PMID: 20936387 PMCID: PMC3032870 DOI: 10.1007/s11999-010-1608-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 09/21/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgery for clavicular shaft fractures is becoming more common but incisional and chest wall numbness reportedly occurs in 10% to 29% of patients. This may be the result of iatrogenic injury to the supraclavicular nerve branches. QUESTIONS/PURPOSES We determined if there was a predictable branching pattern of the supraclavicular nerve at the anterior clavicular border and determined the distances to these nerves from clavicular landmarks. METHODS We performed an anatomic dissection along the anterior border of the long axis of the clavicle in 37 cadavers. The branches of the supraclavicular nerve were identified at the anterosuperior clavicular border and the distances from these nerves to palpable bony landmarks were measured. RESULTS Ninety-seven percent of specimens had a medial and a lateral branch of the supraclavicular nerve. Nearly half (49%) possessed an additional intermediate branch. No branch was found within 2.7 cm of the sternoclavicular joint or within 1.9 cm of the acromioclavicular joint. Between these two positions, there was wide variability in nerve branch location. CONCLUSIONS There were two or three branches of the supraclavicular nerve crossing the clavicle 97% of the time and a wide variability of the location of these branches outside the safe zones. CLINICAL RELEVANCE There are safe zones within 2.7 cm of the sternoclavicular joint and 1.9 cm of the acromioclavicular joint. Between these safe zones, the location of the nerve branches is variable and the surgeon must use meticulous dissection if he or she wishes to prevent transection.
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Affiliation(s)
- Tyler Nathe
- Department of Orthopaedic Surgery, University of California at Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817 USA
| | - Susan Tseng
- Department of Orthopaedic Surgery, University of California at Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817 USA
| | - Brad Yoo
- Department of Orthopaedic Surgery, University of California at Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817 USA
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Havet E, Duparc F, Tobenas-Dujardin AC, Muller JM, Fréger P. Morphometric study of the shoulder and subclavicular innervation by the intermediate and lateral branches of supraclavicular nerves. Surg Radiol Anat 2007; 29:605-10. [PMID: 17851634 DOI: 10.1007/s00276-007-0258-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 08/23/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The supraclavicular (intermediate) and supra-acromial (lateral) branches of supraclavicular nerves contribute to the innervation of the thorax, shoulder, and neck. Despite their clinical and surgical interest, they are not often considered for descriptive anatomy. The goal of this work was to clarify the morphometric knowledge of these two branches and to discuss the clinical relevance of the anatomical features. METHODS Intermediate and lateral branches of supraclavicular nerves of 14 necks (8 embalmed cadavers) were dissected using magnifying glasses. Macroscopic parameters were measured and nerve relationships were recorded. RESULTS In 12 cases, the intermediate and lateral branches arose from a common trunk behind the posterior border of the sternocleidomastoideus muscle, at a mean distance of 96 mm (70-137) from the sternal angle. The intermediate branch divided into two or three secondary rami. Its most internal ramus crossed the middle third of the clavicle and its most external ramus crossed the second lateral quarter of the bone. The distance between the two farthest nerve endings of this branch was at mean of 98 mm (85-125). The mean distance of the most distal nerve ending from the clavicle was 46 mm (30-63). The lateral branch divided into two or three rami in eight cases and did not divide in six cases. Its most anterior rami crossed the trapezius muscle at a mean distance from the clavicular insertion of 17 mm (12-24). In 13 cases, these rami ended posteriorly or at the level of the anterior border of the acromion process and in 12 cases, they ended laterally or at the level of the acromion process with a mean distance 10.4 mm (0-24). CONCLUSION In case of deficiency of these nerves, pain or sensitive deficit can occur without motor trouble. The factors of acute or chronic injury are direct compression, nerve stretching, repetitive stresses, and direct wound. Moreover, several neck or shoulder surgical approaches are dangerous for these nerves.
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Affiliation(s)
- Eric Havet
- Rouen University Hospital, Laboratory of Anatomy, Faculty of Medicine and Pharmacy, University of Rouen, 22 boulevard Gambetta, Rouen, France.
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