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Bruckmoser R, Antoniadis G, Katzensteiner M, Wutte C, Schlagheck J, Stuby FM, Strowitzki M, Leister I. High-resolution ultrasound of the supra- and infraclavicular levels of the brachial plexus including the axillary nerve: imaging anatomy based on multiplanar reconstructions and technical guide. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023. [PMID: 38151035 DOI: 10.1055/a-2191-1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
PURPOSE The diagnosis of peripheral nerve injuries remains challenging. Electromyography and nerve conduction studies do not allow precise localization of the lesion and differentiation between lesions in continuity and non-continuity in cases with complete axonotmesis. Improved ultrasound technology allows the examination of almost the entire peripheral nervous system. The complex sono-anatomy of the brachial plexus outside of the standard scanning planes makes it difficult to access this region. METHODS On the basis of the Visible Human Project of the National Institutes of Health (NIH), multiplanar reconstructions were created with the 3D Slicer open-source software in the various planes of the ultrasound cross-sections. The ultrasound examination itself and the guidance of the ultrasound probe in relation to the patient were recorded as video files and were synchronized through the audio channel. Subsequently, image matching was performed. RESULTS Multiplanar reconstructions facilitate visualization of anatomical regions which are challenging to access thereby enabling physicians to evaluate the course of the peripheral nerve of interest in dynamic conditions. Sonographically visible structures could be reproducibly identified in single-frame analysis. CONCLUSION With precise knowledge of the ultrasound anatomy, the nerve structures of the brachial plexus can also be dynamically assessed almost in their entire course. An instructional video on ultrasound of the brachial plexus supplements this manuscript and has been published on Vimeo.com.
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Affiliation(s)
| | | | | | | | | | - Fabian M Stuby
- Trauma and Orthopedic Surgery, BG Unfallklinik Murnau, Murnau, Germany
| | | | - Iris Leister
- ParaMove, SCI Research Unit, BG Unfallklinik Murnau, Murnau, Germany
- Spinal Cord Injury Center, Clinical Research Unit, BG Unfallklinik Murnau, Murnau, Germany
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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Campbell AS, Johnson CD, O'Connor S. Impact of Peripheral Nerve Block Technique on Incidence of Phrenic Nerve Palsy in Shoulder Surgery. Anesthesiol Res Pract 2023; 2023:9962595. [PMID: 37727810 PMCID: PMC10506885 DOI: 10.1155/2023/9962595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/19/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023] Open
Abstract
Peripheral nerve blocks are an increasingly common method of providing postoperative analgesia for shoulder surgeries. However, the standard technique, the interscalene block (ISB), inevitably causes hemidiaphragmatic paresis (HDP), secondary to phrenic nerve palsy. This can cause morbidity in patients with preexisting respiratory compromise, prompting investigation into alternative "phrenic-sparing" nerve blocks. The aim of this review was to give an overview of these blocks and critically evaluate the current literature to determine if any are suitable replacements for ISB. The incidence of HDP and analgesic efficacy were considered. We queried four electronic databases and one register. Twenty-eight original articles were selected for review. The use of ultrasound guidance, lower volumes of local anaesthetic (LA), and injection 4 mm outside the brachial plexus fascia reduced HDP incidence for the ISB; however, no single modification did so sufficiently. While the anterior suprascapular nerve block (SSNB) showed comparable analgesic effects to the ISB, HDP prevalence was also high. The posterior SSNB produced consistently low HDP incidences but also inferior analgesia to ISB, except when combined with an infraclavicular brachial plexus block. The superior trunk block (STB) provided equivalent analgesia to the ISB while reducing HDP incidence, but not significantly. Lower LA volumes consistently led to lower HDP incidence across all blocks, likely due to a reduced ability to spread to the phrenic nerve. Further investigation into the minimum effective volumes of the extrafascial ISB, anterior SSNB, STB, and combined posterior SSNB with infraclavicular block is warranted to determine if any of these blocks can successfully balance HDP prevention with analgesic efficacy.
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Affiliation(s)
- Aaron S. Campbell
- Centre for Biomedical Sciences Education, Queen's University, Belfast BT9 7AA, UK
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Jump CM, Waghmare A, Mati W, Malik RA, Charalambous CP. The Impact of Suprascapular Nerve Interventions in Patients with Frozen Shoulder: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 9:01874474-202112000-00005. [PMID: 34936584 DOI: 10.2106/jbjs.rvw.21.00042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Frozen shoulder is a common condition resulting in severe pain and restricted range of motion. An assessment of the effectiveness of interventions may provide an improved understanding of the development and management of frozen shoulder. METHODS A literature search was conducted using Embase, the Cumulative Index of Nursing and Allied Health (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), and National Center for Biotechnology Information PubMed using relevant terms. Studies were included if they assessed the outcomes of interventions on the suprascapular nerve that aim to improve the symptoms of frozen shoulder. RESULTS A database search returned 196 articles. After review, 9 articles met the inclusion criteria and were included in the analysis. Suprascapular nerve interventions (nerve block, pulsed radiofrequency lesioning) are associated with improvement in pain, motion, and function. Meta-analysis showed that pain (Hedges g, -3.084 [95% confidence interval (CI), -4.273 to -1.894]; p < 0.001) and range of motion (Hedges g, 2.204 [95% CI, 0.992 to 3.415]; p < 0.001) improved significantly following suprascapular nerve block (SSNB). CONCLUSIONS SSNB is associated with significant improvements in shoulder pain and range of motion in patients with frozen shoulder. Further randomized controlled trials comparing SSNB with intra-articular injection and other nonoperative treatments are required to fully define its role in the management of frozen shoulder. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher M Jump
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ashish Waghmare
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Wael Mati
- Department of Radiology, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | | | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom.,School of Medicine, University of Central Lancashire, Preston, United Kingdom
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Inoue J, Tawada K, Sugimoto K, Goto H, Tsuchiya A, Takenaga T, Takeuchi S, Takaba K, Murakami H, Yoshida M. Bilateral suprascapular notches are asymmetrically shaped in a third of the Asian population. Knee Surg Sports Traumatol Arthrosc 2021; 29:3989-3996. [PMID: 34417834 DOI: 10.1007/s00167-021-06679-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The side-to-side differences within an individual's suprascapular notch (SSN) and the clinical characteristics of an ossified superior transverse scapular ligament are unclear. Therefore, the morphological asymmetry of the SSN was investigated, and the factors associated with the ossification of the superior transverse scapular ligament were analyzed. METHODS Two hundred and seventy-six computed tomography images were retrospectively analyzed, which included those of both scapulae of Asian patients (mean age, 62.1 ± 19.1 years; males, 197) with high-energy injuries or respiratory diseases. Variations in the SSN were classified into six types based on Rengachary's classification using reconstructed three-dimensional computed tomography. The group with a type VI SSN (completely ossified superior transverse scapular ligament) in at least one scapula was compared with the other group for age, sex, and chronic comorbidities. RESULTS Among 276 patients, 95 (34.4%) had asymmetric SSNs and 15 (5.4%) had type VI SSNs. There were no significant differences in age, sex, or comorbidities between both the groups. However, on comparing age groups, the prevalence of type VI SSN was higher in patients aged > 70 years than in those aged < 70 years. Fifteen patients had type VI SSNs, which were unilateral in 10 patients. CONCLUSION Asymmetric SSNs were observed in a third of the Asian patients. There were variations in SSNs between individuals and also within an individual. In the cases with suprascapular nerve paralysis, the difference in SSN morphology compared to a healthy side should be considered. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jumpei Inoue
- Department of Orthopedic Surgery, Komaki City Hospital, Komaki, Japan.,Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Kaneaki Tawada
- Department of Orthopedic Surgery, Komaki City Hospital, Komaki, Japan.
| | | | - Hideyuki Goto
- Department of Sports and Fitness, Faculty of Wellness, Shigakkan University, Obu, Japan
| | - Atsushi Tsuchiya
- Arthroscopy & Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | - Keishi Takaba
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Masahito Yoshida
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
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Ultrasonographic anatomy of the long thoracic nerve: A reappraisal using high frequency (24-MHz) probe. Diagn Interv Imaging 2020; 102:241-245. [PMID: 33008783 DOI: 10.1016/j.diii.2020.08.003] [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: 07/10/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to analyze the potential of ultrasound with a high frequency probe (24-MHz) in the assessment of the long thoracic nerve (LTN) and describe ultrasonographic landmarks that can be used for standardization. MATERIAL AND METHODS Ultrasonography analysis of the LTN was done on 2 LTNs in a cadaver specimen and then on 30 LTNs in 15 healthy volunteers (12 men, 3 women; mean age, 28.8±3.8 [SD] years; age range: 24-39 years) by two independent radiologists (R1 and R2) using a 24-MHz probe. Interrater agreement was assessed using Kappa test (K) and intraclass correlation coefficient (ICC). RESULTS In the cadaver, dissection confirmed that the India ink was injected near the LTN in the middle scalene muscle. In volunteers, visibility of the LTN above the clavicle was highly reproducible for the branches arising from C5 (R1: 87% [26/30]; R2: 90% [27/30]; K=0.83) and from C6 (R1: 100% [30/30]; R2: 97% [29/30]; K=0.94). Where the nerve emerged from the middle scalene muscle, the mean diameter was 0.85±0.24 (SD) mm (range: 0.4-1.6mm) for R1 and 0.9±0.23 (SD) mm (range: 0.4-1.7mm) for R2 (ICC: 0.96; 95% CI: 0.92-0.98%). Along the thoracic wall, where LTN run along the lateral thoracic artery, the mean diameter was 0.83±0.19 (SD) mm (range: 0.5-1.27mm) for R1 and 0.89±0.21 (SD) mm (range: 0.6-1.2mm) for R2 (ICC: 0.86; 95% CI: 0.72-0.93%). CONCLUSION The LTN can be analyzed with ultrasound using high-frequency probe by using the C5 and C6 roots, the middle scalene muscle above the clavicle and the lateral thoracic artery on the chest wall as landmarks.
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Blasco L, Laumonerie P, Tibbo M, Fernandes O, Minville V, Lopez R, Mansat P, Ferre F. Ultrasound-Guided Proximal and Distal Suprascapular Nerve Blocks: A Comparative Cadaveric Study. PAIN MEDICINE 2019; 21:1240-1247. [DOI: 10.1093/pm/pnz157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
The primary aim of our study was to evaluate and compare the accuracy of ultrasound (US)-guided distal suprascapular nerve (dSSN) and proximal SSN (pSSN) blocks. Secondary aims were to compare the phrenic nerve involvement between groups and to describe the anatomical features of the sensory branches of the dSSN.
Methods
pSSN and dSSN blocks were performed in 14 cadavers (28 shoulders). Ten mL of 0.2% ropivacaine colored with methylene blue was injected under US guidance. Accuracy was determined using SSN staining and the distance between predefined anatomical landmarks and the targeted SSN. The phrenic nerve (PN) was judged to be colored or not. The distribution of the sensory branches that originate from the 14 dSSNs is described. Quantitative data are expressed as median (range).
Results
The pSSN was dyed more frequently than the dSSN (13 vs 11, P = 0.59). The targeted SSN was close to the suprascapular notch (1.3 [0–5.2] cm) and the origin of the SSN (1.4 [0.2–4.5] cm) for dSSN and pSSN blocks, respectively (P = 0.62). For dSSN blocks, the most frequent injection site was the supraspinous fossa. Three PNs were marked in pSSN blocks, compared with none in dSSN blocks (P = 0.22). Three sensory branches were identified for all 14 dSSNs: the medial subacromial branch, the lateral subacromial branch, and the posterior glenohumeral branch.
Conclusions
US-guided pSSN and dSSN blocks can be realized with accuracy. A distal approach to the SSN could be an alternative to interscalene brachial plexus block for the management of postoperative pain after shoulder surgery in high–respiratory risk patients.
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Affiliation(s)
- Laurent Blasco
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
| | - Pierre Laumonerie
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059 Toulouse, France
- Anatomy Laboratory, Faculty of Medicine, Toulouse 31062, France
| | - Meagan Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Olivier Fernandes
- Department of Anesthesiology, Centre Hospitalier Universitaire de Reims, 51092 Reims, France
| | - Vincent Minville
- Department of Anesthesiology, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059 Toulouse, France
| | - Raphael Lopez
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059 Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059 Toulouse, France
| | - Fabrice Ferre
- Department of Anesthesiology, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059 Toulouse, France
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Laumonerie P, Ferré F, Cances J, Tibbo ME, Roumiguié M, Mansat P, Minville V. Ultrasound-guided proximal suprascapular nerve block: A cadaveric study. Clin Anat 2018; 31:824-829. [DOI: 10.1002/ca.23199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/30/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Pierre Laumonerie
- Department of Orthopedics; Hôpital Pierre-Paul Riquet; Toulouse France
- Anatomy Laboratory, Faculty of Medicine; Toulouse France
| | - Fabrice Ferré
- Department of Anesthesia and Critical Care Medicine; Hôpital Pierre-Paul Riquet; Toulouse France
| | - Jérémy Cances
- Department of Anesthesia and Critical Care Medicine; Hôpital Pierre-Paul Riquet; Toulouse France
| | - Meagan E Tibbo
- Department of Orthopedics; Mayo Clinic; Rochester Minnesota
| | | | - Pierre Mansat
- Department of Orthopedics; Hôpital Pierre-Paul Riquet; Toulouse France
| | - Vincent Minville
- Department of Anesthesia and Critical Care Medicine; Hôpital Pierre-Paul Riquet; Toulouse France
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