Surgical Anatomy of the Supraclavicular Brachial Plexus

Leung, Sophia; Zlotolow, Dan A.; Kozin, Scott H.; Abzug, Joshua M.

doi:10.2106/jbjs.n.00706

Cited by 13 publications

(6 citation statements)

References 14 publications

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“…Sonographically the nerve can be traced laterally in the posterior cervical triangle, deep to the omohyoid muscle, by tilting the probe incrementally steeper in the caudal direction. This ultrasonographic observation agrees with anatomical studies by Leung et al 20 . The local anesthetic was injected at the most lateral short-axis view of the nerve that we could obtain, with an in-plane technique, while advancing the needle from posterolateral to anteromedial.…”

Section: Suprascapular Nerve Blocksupporting

confidence: 93%

A novel combination of peripheral nerve blocks for arthroscopic shoulder surgery

Musso

Flohr-Madsen

Meknas

et al. 2017

Acta Anaesthesiol Scand

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Background: Interscalene brachial plexus block is currently the gold standard for intra-and postoperative pain management for patients undergoing arthroscopic shoulder surgery. However, it is associated with block related complications, of which effect on the phrenic nerve have been of most interest. Side effects caused by general anesthesia, when this is required, are also a concern. We hypothesized that the combination of superficial cervical plexus block, suprascapular nerve block and infraclavicular brachial plexus block would provide a good alternative to interscalene block and general anesthesia. Methods: Twenty adult patients scheduled for arthroscopic shoulder surgery received a combination of superficial cervical plexus block (5 ml ropivacaine 0.5%), suprascapular nerve block (4 ml ropivacaine 0.5%), and lateral sagittal infraclavicular block (31 ml ropivacaine 0.75%). The primary aim was to find the proportion of patients who could be operated under light propofol sedation, without the need for opioids or artificial airway. Secondary aims were patients' satisfaction and surgeons' judgement of the operating conditions. Results: Nineteen out of twenty patients (95%, CI 85-100) underwent arthroscopic shoulder surgery with light propofol sedation, but without opioids or artificial airway. The excluded patient was not comfortable in the beach chair position and therefore received general anesthesia. All patients were satisfied with the treatment on follow up interviews. The surgeons rated the operating conditions as good for all patients. Conclusion: The novel combination of a superficial cervical plexus block, a suprascapular nerve block, and an infraclavicular nerve block provides an alternative anesthetic modality for arthroscopic shoulder surgery.

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Section: Suprascapular Nerve Blocksupporting

confidence: 93%

A novel combination of peripheral nerve blocks for arthroscopic shoulder surgery

Musso

Flohr-Madsen

Meknas

et al. 2017

Acta Anaesthesiol Scand

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“…The exact origin of the suprascapular nerve (SSN) has been the subject of controversy for over 400 years (Vesalius, ). According to published studies, it emerges from the upper trunk of the brachial plexus (UTBP) (Kerr, ; Leung et al, ), the bifurcation point (e.g., equivalent trifurcation) (Hanna, ), or a branch of the posterior division of the UTBP (Arad et al, ). According to Hanna (), the configuration of the branches of the UTBP can be summarized by the acronym SPA: suprascapular nerve (S), posterior division of the upper trunk (P), and anterior division of the upper trunk (A).…”

Section: Introductionmentioning

confidence: 99%

Description and ultrasound targeting of the origin of the suprascapular nerve

Laumonerie

Lapègue

Chantalat³

et al. 2017

Clinical Anatomy

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Anatomical variations in the suprascapular nerve (SSN) and its depth in the suprascapular notch can make it difficult to target with ultrasonography (US). One alternative could be a proximal approach to the SSN, if US provides a reliable description of its origin (orSSN). The primary objective of this study was to demonstrate that US can reliably locate the orSSN. The secondary objective was to describe the features of the proximal SSN. Seventy brachial plexuses (BPs) from 30 healthy volunteers (60 BPs) and 5 cadavers (10 BPs) were included. There were two parts to this study: (1) description of the proximal SSN in healthy volunteers using US to determine the diameter, depth and location of the orSSN; (2) targeting of the orSSN with US in cadaver limbs to determine its distance from the needle, ink marking and locating the orSSN. In Part I, the diameter of the orSSN averaged 1.33 mm (1-9 mm) and its depth averaged 5.12 mm (2.7-10.6 mm). The orSSN was located in the upper trunk of the BP (53) or its posterior division (7). In Part II, the orSSN was successfully targeted in nine of the 10 specimens by US; the needle/orSSN distance averaged 3.8 mm (0-8 mm). The implanted needle was at the orSSN in two cases, proximal to it in seven and distal to it in one. US is a valid modality for describing and pinpointing the orSSN, irrespective of patient morphology. Clin. Anat. 30:747-752, 2017. © 2017Wiley Periodicals, Inc.

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“…Part of this confusion can be caused by the way we draw and teach anatomy, perhaps because of the convenience of always drawing or representing the brachial plexus in the same way as we see in most textbooks and papers. 6,11-26 This confusion probably dates from the time of Vesalius (1555), his illustration of the brachial plexus has the same anatomy as published in most books and articles to date. 27 There were differences in brachial plexus illustrations described by Wilfred Harris 4 and Uysal et al, 5 Kirik et al, 6 and Albertoni et al 7 However, it is essential to emphasize that while Wilfred Harris 4 dissected adult brachial plexuses; Uysal et al, 5 Kirik et al, 6 and Albertoni et al 7 dissected fetal brachial plexuses.…”

Section: Discussionmentioning

confidence: 99%

The 2-Dimensional and 3-Dimensional Anatomy of the Adult Brachial Plexus Divisions and Cords

Neto

Eiras

et al. 2020

Hand (New York, N,Y.)

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Background: The objective of this work was to perform a critical review of the 2-dimensional and 3-dimensional anatomy of the adult brachial plexus divisions and cords. Methods: Twelve adult brachial plexuses from fresh cadavers were dissected. All were male and aged between 30 and 50 years. Only corpses without brachial plexus injuries were selected. The purpose of the dissections was to identify the origin of the anterior and posterior divisions of the adult brachial plexus in their respective trunks, as well as the positioning of the posterior, lateral, and medial cords. Results: The posterior division of all trunks had a cranial and dorsal origin, while the anterior division of all trunks had a caudal and ventral origin. The posterior cord was the most cranial of all, the lateral cord was central, and the medial cord was the most caudal of all cords. The posterior division of the superior trunk was always between the suprascapular nerve and the anterior division. Conclusions: Brachial plexus diagrams in most textbooks and papers are different from what was found in our dissections. Contrary to the known diagram, the posterior divisions always had a cranial origin in the superior, middle, and inferior trunks.

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Surgical Anatomy of the Supraclavicular Brachial Plexus

Abstract: These findings differ from the standard illustrations and descriptions of the brachial plexus. A thorough understanding of the course of the upper trunk and its branches, such as the suprascapular nerve, is vital to performing nerve transfer surgery or neuroma excision and grafting.

Cited by 13 publications

References 14 publications

A novel combination of peripheral nerve blocks for arthroscopic shoulder surgery

A novel combination of peripheral nerve blocks for arthroscopic shoulder surgery

Description and ultrasound targeting of the origin of the suprascapular nerve

The 2-Dimensional and 3-Dimensional Anatomy of the Adult Brachial Plexus Divisions and Cords

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