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Eby SF, Teramoto M, Lider J, Lash M, Caragea M, Cushman DM. Sonographic peripheral nerve cross-sectional area in adults, excluding median and ulnar nerves: A systematic review and meta-analysis. Muscle Nerve 2023; 68:20-28. [PMID: 36583383 DOI: 10.1002/mus.27783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/AIMS Although electromyography remains the "gold standard" for assessing and diagnosing peripheral nerve disorders, ultrasound has emerged as a useful adjunct, providing valuable anatomic information. The objective of this study was to conduct a systematic review and meta-analysis evaluating the normative sonographic values for adult peripheral nerve cross-sectional area (CSA). METHODS Medline and Cochrane Library databases were systematically searched for healthy adult peripheral nerve CSA, excluding the median and ulnar nerves. Data were meta-analyzed, using a random-effects model, to calculate the mean nerve CSA and its 95% confidence interval (CI) for each nerve at a specific anatomical location (= group). RESULTS Thirty groups were identified and meta-analyzed, which comprised 16 from the upper extremity and 15 from the lower extremity. The tibial nerve (n = 2916 nerves) was reported most commonly, followed by the common fibular nerve (n = 2580 nerves) and the radial nerve (n = 2326 nerves). Means and 95% confidence interval (CIs) of nerve CSA for the largest number of combined nerves were: radial nerve assessed at the spiral groove (n = 1810; mean, 5.14 mm2 ; 95% CI, 4.33 to 5.96); common fibular nerve assessed at the fibular head (n = 1460; mean, 10.18 mm2 ; 95% CI, 8.91 to 11.45); and common fibular nerve assessed at the popliteal fossa (n = 1120; mean, 12.90 mm2 ; 95% CI, 9.12 to 16.68). Publication bias was suspected, but its influence on the results was minimal. DISCUSSION Two hundred thirty mean CSAs from 15 857 adult nerves are included in the meta-analysis. These are further categorized into 30 groups, based on anatomical location, providing a comprehensive reference for the clinician and researcher investigating adult peripheral nerve anatomy.
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Affiliation(s)
- Sarah F Eby
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Lider
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Madison Lash
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marc Caragea
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel M Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Agarwal A, Chandra A, Jaipal U, Saini N. Imaging in the diagnosis of ulnar nerve pathologies-a neoteric approach. Insights Imaging 2019; 10:37. [PMID: 30895491 PMCID: PMC6426899 DOI: 10.1186/s13244-019-0714-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
The ulnar nerve is a branch of the C8 and T1 nerve roots and arises from the medial cord of the brachial plexus. It supplies the intrinsic muscles of the hand and assists the median nerve in functioning of the flexors. Also known as the musician’s nerve, it is the second most common nerve involved in compressive neuropathy following the median nerve. Common sites of entrapment include cubital tunnel at the elbow, the ulnar groove in the humerus and the Guyon’s canal at the wrist. Patients present with altered sensation in the ulnar fourth and the fifth digit and the medial side of arm with loss of function of intrinsic muscles of the hand, the flexor carpi ulnaris and ulnar fibres of flexor digitorum superficialis in more severe cases. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus, or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of ulnar neuropathies as seen on ultrasound and MRI and emphasises upon the importance of imaging modalities in the diagnosis of neuropathies.
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Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India. .,, A 235, Shivanand Marg, Malviya Nagar, Jaipur, India.
| | - Abhishek Chandra
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
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Agarwal A, Chandra A, Jaipal U, Saini N. A panorama of radial nerve pathologies- an imaging diagnosis: a step ahead. Insights Imaging 2018; 9:1021-1034. [PMID: 30397879 PMCID: PMC6269333 DOI: 10.1007/s13244-018-0662-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 12/23/2022] Open
Abstract
Abstract The radial nerve has a long and tortuous course in the upper limb. Injury to the nerve can occur due to a multitude of causes at many potential sites along its course. The most common site of involvement is in the proximal forearm affecting the posterior interosseous branch while the main branch of the radial nerve is injured in fractures of the humeral shaft. Signs and symptoms of radial neuropathy depend upon the site of injury. Injury to the nerve distal to innervation of triceps brachii results in loss of extensor function with sparing of function of the triceps resulting in the characteristic ‘wrist drop’. Injury in the mid-arm is associated with loss of sensation in the dorsolateral aspect of the hand, the dorsal aspect of the radial three-and-a-half digits and in the first web space. Involvement of only the posterior interosseous nerve (PIN) results in weakness of the wrist and digit extensors. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of the exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft-tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of radial neuropathy and emphasises the importance of imaging modalities in diagnosis of neuropathies. Teaching Points • Radial nerve injuries are assessed by clinical examination and diagnosed using electrodiagnostic and imaging studies. • Knowledge of anatomical relations and course of the nerve is necessary to identify the nerve at pre-determined anatomical locations. • Altered echogenicity and signal intensity, discontinuity of the nerve, focal thickening and cause of compression can be assessed by imaging modalities. • MR imaging helps in confirmation of the ultrasound findings, differentiating similar appearing lesions and provides additional soft-tissue details.
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Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis and Modern Imaging, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India.
| | - Abhishek Chandra
- Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiodiagnosis and Modern Imaging, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
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Matsumoto ME, Berry J, Yung H, Matsumoto M, Munin MC. Comparing Electrical Stimulation With and Without Ultrasound Guidance for Phenol Neurolysis to the Musculocutaneous Nerve. PM R 2017; 10:357-364. [PMID: 28919499 DOI: 10.1016/j.pmrj.2017.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ultrasound guidance is increasingly being used for neurolytic procedures that have traditionally been done with electrical stimulation (e-stim) guidance alone. Ultrasound visualization with e-stim-guided neurolysis can potentially allow adjustments in injection protocols that will reduce the volume of neurolytic agent needed to achieve clinical improvement. OBJECTIVE This study compared e-stim only to e-stim with ultrasound guidance in phenol neurolysis of the musculocutaneous nerve (MCN) for elbow flexor spasticity. We also evaluated the ultrasound appearance of the MCN in this population. DESIGN Retrospective review. SETTING University hospital outpatient clinic. PARTICIPANTS Adults (N = 167) receiving phenol neurolysis to the MCN for treatment of elbow flexor spasticity between 1997 and 2014 and adult control subjects. METHODS For each phenol injection of the MCN, the method of guidance, volume of phenol injected, technical success, improved range of motion at the elbow postinjection, adverse effects, reason for termination of injections, and details of concomitant botulinum toxin injection were recorded. The ultrasound appearance of the MCN, including nerve cross-sectional area and shape, were recorded and compared between groups. MAIN OUTCOME MEASURES The volume of phenol injected and MCN cross-sectional area and shape as demonstrated by ultrasound. RESULTS The addition of ultrasound to e-stim-guided phenol neurolysis was associated with lower doses of phenol when compared to e-stim guidance alone (2.31 mL versus 3.69 mL, P < .001). With subsequent injections, the dose of phenol increased with e-stim guidance (P < .001), but not with e-stim and ultrasound guidance (P = .95). Both methods of guidance had high technical success, improved ROM at elbow postinjection, and low rates of adverse events. In comparing the ultrasound appearance of the MCN in patients with spasticity to that of normal controls, there was no difference in the cross-sectional area of the nerve, but there was more variability in shape. CONCLUSIONS Combined e-stim and ultrasound guidance during phenol neurolysis to the MCN allows a smaller volume of phenol to be used for equal effect, both at initial and repeat injection. The MCN shape was more variable in individuals with spasticity; this should be recognized so as to successfully locate the nerve to perform neurolysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mary E Matsumoto
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Jessica Berry
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Herbie Yung
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Martha Matsumoto
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Kaufmann Medical Building, Ste 201, 3471 Fifth Ave, Pittsburgh, PA 15213
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Molin CJ, Widenfalk J, Punga AR. High-resistance strength training does not affect nerve cross sectional area - An ultrasound study. Clin Neurophysiol Pract 2017; 2:163-169. [PMID: 30214991 PMCID: PMC6123855 DOI: 10.1016/j.cnp.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/21/2017] [Accepted: 07/29/2017] [Indexed: 11/17/2022] Open
Abstract
Trained individuals did not have larger cross-sectional area of peripheral nerves than untrained individuals. Trained individuals had thicker biceps muscles. Nerve CSA of the median nerve in the forearm correlated with participants’ height, and was larger in men than women.
Objective The aim was to study the effect of high-resistance strength training on peripheral nerve morphology, by examining properties of peripheral nerves as well as distal and proximal muscle thickness with ultrasound, comparing healthy individuals who perform and do not perform high-resistance strength training. Methods Neuromuscular ultrasound was used to examine cross sectional area (CSA) of the median and musculocutaneous nerves, and muscle thickness of the abductor pollicis brevis muscle, biceps brachii muscle, quadriceps muscle and extensor digitorum brevis muscle, in 44 healthy individuals, of whom 22 performed regular high-resistance strength training. Results No difference in nerve CSA was found between trained and untrained individuals although trained individuals had thicker biceps brachii muscles. The CSA of the median nerve in the forearm correlated with participants’ height and was significantly larger in men than women. Conclusions In this cohort, CSA of the median and musculocutaneous nerves was not affected by strength training, whereas gender had a prominent effect both on CSA and muscle thickness. Significance This is the first study to examine the effect of high-resistance strength training on peripheral nerves with neuromuscular ultrasound.
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Affiliation(s)
- Carl Johan Molin
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Johan Widenfalk
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Anna Rostedt Punga
- Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
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Stav A. Author's Reply to "A Few Suggestions for Preventing Failure of Ultrasound-Guided Blocks for Below the Shoulder Surgery". Rambam Maimonides Med J 2017; 8:RMMJ.10287. [PMID: 28178442 PMCID: PMC5298373 DOI: 10.5041/rmmj.10287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nair A. Letter to the Editor: A Few Suggestions for Preventing Failure of Ultrasound-Guided Blocks for Below the Shoulder Surgery. Rambam Maimonides Med J 2017; 8:RMMJ.10286. [PMID: 28178438 PMCID: PMC5298372 DOI: 10.5041/rmmj.10286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ultrasound-guided anterior axilla musculocutaneous nerve block. Radiol Med 2013; 119:135-41. [PMID: 24297578 DOI: 10.1007/s11547-013-0322-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/28/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE This paper presents a technique of ultrasound-guided localisation and block of the musculocutaneous nerve through the anterior wall of the axilla. MATERIALS AND METHODS Twenty patients (7 males and 13 females; mean age, 35 years) had axillary nerve block for upper extremity trauma. With the arm adducted, the ultrasound probe was positioned on the anterior axillary wall; the axillary artery, coracobrachialis and pectoralis major muscles and lateral cord of brachial plexus were visualised in cross section. With continuous imaging of the axillary artery in cross section, the ultrasound probe was slowly moved towards the biceps muscle until the musculocutaneous nerve appeared crossing the coracobrachialis muscle. After ultrasound localisation of the musculocutaneous nerve, the arm was abducted and externally rotated, and the nerve was identified with nerve stimulation and blocked. The quality of sensory and motor nerve block, as well as of ultrasound imaging were evaluated. RESULTS Ultrasound-guided block of the musculocutaneous nerve was excellent and complete in 18 of the 20 patients. In two patients, the musculocutaneous nerve was fused with the median nerve and the nerve block was repeated successfully with the same technique. The quality of ultrasound imaging was excellent in all patients. No patient experienced pain or tourniquet discomfort during surgery, or any other nerve block-related complication. CONCLUSION The anterior axillary ultrasound view provides for complete nerve block and imaging of the entire course of the musculocutaneous nerve and its relations with adjacent structures with excellent quality.
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Won SJ, Kim BJ, Park KS, Yoon JS, Choi H. Reference values for nerve ultrasonography in the upper extremity. Muscle Nerve 2013; 47:864-71. [DOI: 10.1002/mus.23691] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 12/24/2022]
Affiliation(s)
- Sun Jae Won
- Department of Rehabilitation Medicine; Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Seoul; South Korea
| | - Byung-Jo Kim
- Department of Neurology; Korea University College of Medicine; Seoul; South Korea
| | - Kyung Seok Park
- Department of Neurology; Seoul National University Bundang Hospital, Seoul National University, College of Medicine; Seoul; South Korea
| | - Joon Shik Yoon
- Department of Rehabilitation Medicine; Korea University College of Medicine; 80 Guro Gu, Guro Dong; Seoul; South Korea
| | - Hyuk Choi
- Department of Medical Sciences; Graduate School of Medicine, Korea University; Seoul; South Korea
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Cuvillon P. Bloc axillaire, « balance bénéfices/risques : quel est le bénéfice de l’abord sous échographie ? ». ACTA ACUST UNITED AC 2012; 31:e193-7. [DOI: 10.1016/j.annfar.2012.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Uzel AP, Bulla A, Steinmann G, LaurentJoye M, Caix P. [Absence of the musculocutaneous nerve and its distribution from median nerve: About two cases and literature review]. Morphologie 2011; 95:146-150. [PMID: 22079600 DOI: 10.1016/j.morpho.2011.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Musculocutaneous nerve arises mostly from the lateral cord of brachial plexus. Nevertheless, variations have been reported and, among them: the total absence of musculocutaneous nerve (from 1.4 to 15%), the absence of its passage through the coracobrachial muscle, its variable level of penetration as measured from the tip of the coracoid process, and its communicating branches with the median nerve. We report two cases of unilateral musculocutaneous nerve absence in a 66-year-old male and a 95-year-old female cadavers, on the right and the left side, respectively. The nerve fibers normally coming from musculocutaneous nerve emerged from the median nerve. The knowledge of this anatomical variation is important specially when performing plexus bloc or Latarjet's procedure.
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Affiliation(s)
- A-P Uzel
- Service d'orthopédie et traumatologie, CHRU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe. , maxuzel
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Ultrasound-guided regional anesthesia for procedures of the upper extremity. Anesthesiol Res Pract 2011; 2011:579824. [PMID: 21716734 PMCID: PMC3119462 DOI: 10.1155/2011/579824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 04/07/2011] [Indexed: 12/22/2022] Open
Abstract
Anesthesia options for upper extremity surgery include general and regional anesthesia. Brachial plexus blockade has several advantages including decreased hemodynamic instability, avoidance of airway instrumentation, and intra-, as well as post-operative analgesia. Prior to the availability of ultrasound the risks of complications and failure of regional anesthesia made general anesthesia a more desirable option for anesthesiologists inexperienced in the practice of regional anesthesia. Ultrasonography has revolutionized the practice of regional anesthesia. By visualizing needle entry throughout the procedure, the relationship between the anatomical structures and the needle can reduce the incidence of complications. In addition, direct visualization of the spread of local anesthesia around the nerves provides instant feedback regarding the likely success of the block. This review article outlines how ultrasound has improved the safety and success of brachial plexus blocks. The advantages that ultrasound guidance provides are only as good as the experience of the anesthesiologist performing the block. For example, in experienced hands, with real time needle visualization, a supraclavicular brachial plexus block has changed from an approach with the highest risk of pneumothorax to a block with minimal risks making it the ideal choice for most upper extremity surgeries.
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Apaydin N, Bozkurt M, Sen T, Loukas M, Tubbs RS, Ugurlu M, Tekdemir I, Elhan A. Effects of the adducted or abducted position of the arm on the course of the musculocutaneous nerve during anterior approaches to the shoulder. Surg Radiol Anat 2008; 30:355-60. [PMID: 18330488 DOI: 10.1007/s00276-008-0336-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 02/28/2008] [Indexed: 11/28/2022]
Abstract
Nerve injury is a common complication during anterior shoulder surgery. The purpose of the study was to evaluate the musculocutaneous nerve (MN) anatomically and to clarify the relationship of the MN to the glenoid labrum and coracoid process in different arm positions. The study was carried out on 40 shoulders of 20 adult cadavers fixed in 10% formaldehyde. The minimum distance of the MN at the entrance point of the nerve into the coracobrachialis to the anteromedial aspect of the coracoid tip and the distance between the MN and the top, middle, and inferior points of the glenoid labrum were measured. All measurements were performed with a digital caliper while the arm was in a neutral position, 45 degrees and 90 degrees of abduction, 90 degrees of abduction-internal rotation and 90 degrees of abduction-external rotation to evaluate whether arm position effects the results statistically or not. The results demonstrated that the position of the arm significantly changes the distance between the coracoid process (CP) and the MN or its cord. The change in distance between the glenoid labrum and the MN or its cord was also statistically significant. The distance between the CP and MN was greatest when the arm was abducted to 45 degrees (mean 3.4 cm) and least when the arm was positioned to 90 degrees of abduction-internal rotation (mean 2.0 cm). While the distance between the MN and the coracoid process was least at 90 degrees of abduction and internal rotation, the distance between the MN and glenoid labrum was lest with 90 degrees of abduction and external rotation. The distance between the glenoid labrum and MN was greatest with 45 degrees of abduction. The results of this study might be of use in avoiding the MN especially during Bristlow operations and certain rotator cuff procedures. Transferring the coracoid process during Bristow operations or placing arthroscopic portals when the arm is abducted to 45 degrees appears to be the safest position in terms of MN injury. Based on our results, when the arm needs to be abducted to 90 degrees during operation, externally rotating it may decrease the tension on the brachial plexus thus increasing the distance between the MN and the portals or retractors.
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Affiliation(s)
- Nihal Apaydin
- Department of Anatomy, School of Medicine, Ankara University, Ankara, Turkey
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Abstract
The benefits of regional anesthesia are well documented. The downsides of such techniques have been a significant failure rate and a potential for serious complications. Nearly, all regional blocks were first described as essentially 'blind' techniques. The development of high-resolution portable ultrasound (US) has made the use of US for regional anesthesia possible. Improved understanding of sonographic anatomy should lessen both the failure rate and the possibility of incurring serious complications. Natural caution has dictated that only a selection of blocks used in adults has been commonly used in pediatric practice, but with the aid of US, the repertoire of blocks for infants and children may be widened. The second part of this review will concentrate on the practice of both peripheral and central blocks.
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Affiliation(s)
- Steve Roberts
- Jackson Rees Department of Anaesthesia, Alder Hey Hospital, Royal Liverpool Children's NHS Trust, Liverpool, UK.
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