Ultrasound guided therapeutic injections of the cervical spine and brachial plexus

Abstract

Introduction: Recent applications in ultrasound imaging include ultrasound assessment and ultrasound guided therapeutic injections of the spine and brachial plexus. Discussion: Ultrasound is an ideal modality for these regions as it allows accurate safe and quick injection of single or multiple sites. It has the added advantages of lack of ionising radiation, and can be done without requiring large expensive radiology equipment. Conclusion: Brachial plexus pathology may be present in patients presenting for shoulder symptoms where very little is found at imaging the shoulder. It is important to understand the anatomy and normal variants that may exist to be able to recognise when pathology is present. When pathology is demonstrated it is easy to do a trial of therapy with ultrasound guided injection of steroid around the nerve lesion. This review will outline the normal anatomy and variants and common pathology, which can be amenable to ultrasound guided injection of steroid.

Ultrasound-Guided Procedures in the Cervical Spine

“…Intra-articular facet joint injections have been used for diagnosis confirmation and facet joint-related pain treatment, although there is a lack of evidence as regards effective relief following these injections. Therefore, cervical medial branch block is still proposed as the standard diagnostic method for diagnosing/treating facet joint-related neck pain [ 7 ].…”

Compression neuropathy as a cause for painful shoulder

“…As the nerve roots merge to form trunks and then divisions, they resemble a ‘honeycomb’ appearance . These divisions subdivide into three cords, lateral, posterior and medial lying adjacent to the axillary artery, and emerge as three discrete hypoechoic fascicles of comparable size . Sonographically, the nerve roots are mono‐oligo fascicles, appearing hypoechoic, oval or round.…”

Brachial plexopathy: aberrant fifth cervical nerve root in conjunction with traction injury

“…2 More recently, it has been recognised that 'these variants of position can predispose to compression or stretching of the roots and these symptoms, do not necessarily cause a problem'. 6…”

“…The hypoechoic nerve roots merge forming three 'bunches of grapes' that gradually come together. 6 Scanning more distally, the connective tissue of the epineurium increases (increasing the echogenicity of the fascicular borders), as does the number of nerve fascicles visible. 4 The nerve appears to form a 'honeycomb' pattern ( Figure 4).…”

“…These divisions then morph into three cords; lateral, posterior and medial found lying adjacent to the axillary artery. 6 Normally, they should appear as three discrete hypoechoic fascicles of similar size, and when the patient abducts their arm, the cords should come together laterally.…”