Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research

Abstract

Delineation of architecture of peripheral nerves can be successfully achieved by high-resolution ultrasound (US), which is essential for US-guided pain management. There are numerous musculoskeletal pain syndromes involving the trunk nerves necessitating US for evaluation and guided interventions. The most common peripheral nerve disorders at the trunk region include thoracic outlet syndrome (brachial plexus), scapular winging (long thoracic nerve), interscapular pain (dorsal scapular nerve), and lumbar facet joint syndrome (medial branches of spinal nerves). Until now, there is no single article systematically summarizing the anatomy, sonographic pictures, and video demonstration of scanning techniques regarding trunk nerves. In this review, the authors have incorporated serial figures of transducer placement, US images, and videos for scanning the nerves in the trunk region and hope this paper helps physicians familiarize themselves with nerve sonoanatomy and further apply this technique for US-guided pain medicine and research.

Sonographic measurements of normal C5‐C8 nerve roots in children

“…The union of the branches of the C5‐C7 nerve root anterior rami forms the long thoracic nerve. The upper trunk gives rise to the suprascapular nerve . 2) It was once thought that every hypoechoic structure was a single integrated nerve root at the interscalene level .…”

Sonoanatomy of the spine: a comprehensive scanning protocol from cervical to sacral region

“…Placing the transducer in the sagittal plane on the supraclavicular fossa at the junction between the neck and upper shoulder, the first rib is easily identified as a hyperechoic bony plane with acoustic shadowing. Once it is precisely located, other ribs can be recognized sequentially by relocating the transducer more caudally [24,25].…”

“…Since the laminae of the thoracic vertebrae are overlapping, it is not easy to differentiate the facet columns from the interlaminar spaces. Positioning the transducer more centrally, the tips of the SPs are seen linearly arranged and are linked by the supraspinous and interspinous ligaments (fig 6D) [24,25].…”

Thoracic outlet syndrome: clinical and diagnostic features

“…Сегодня активно обсужда-ется диагностическая значимость метода в исследова-нии нервных стволов, в том числе при нейрогенном TOS [22,46,47,51,52]. УЗИ плечевого сплетения с провокационными маневрами, которое показало свою эффективность в подтверждении нейрогенного TOS, подробно описано в работе S. M. Fried и соавт.…”