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Neuroanatomy
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
The following diagram is a schematic representation of the brachial plexus. It shows the roots C5-T1; note the contribution to the phrenic nerve that innervates the diaphragm (‘C 3,4, 5 keep the diaphragm alive’). The dorsal scapular nerve supplies the rhomboid muscles and levator scapulae muscle. The suprascapular nerve supplies supraspinatus and infraspinatus (two of the rotator cuff muscles; teres minor is supplied by the axillary nerve and subscapularis by the upper and lower subscapular nerves). The long thoracic nerve of Bell innervates the serratus anterior muscle and a lesion of this nerve results in winging of the scapula (‘C 5, 6, 7 bells of heaven’). The axillary nerve supplies the deltoid muscles; this nerve is commonly injured in shoulder dislocations; always check the sensation over the ‘regimental badge area’ before attempting shoulder reduction to assess if damage has already occurred.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Course of the dorsal scapular nerve: Arises from the upper trunk of the brachial plexus, carrying fibers from the C4 and C5 nerve roots.Pierces the medial scalenus muscle.Innervates the levator scapulae (C4–C5), which elevates the scapula.Courses along the medial border of the scapula to innervate the rhomboids (C5), which adduct the medial border of the scapula.Rhomboids and levator scapulae keep the scapula attached to the posterior chest wall during arm motion.
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The roots, trunks, divisions, and cords of the brachial plexus, as well as their distal bifurcations, are explained in the box above. So, what about the nerves that branch directly from the more proximal portion of the brachial plexus? Two nerves branch from this plexus at the level of the roots: the dorsal scapular nerve and the long thoracic nerve (Figure 4.3). The dorsal scapular nerve is named logically; as will be explained in Section 4.3, this nerve supplies posterior muscles (dorsal muscles, in comparative anatomy) that attach to the scapula; namely, the levator scapulae, rhomboid major, and rhomboid minor. Because these three muscles lie on the medial side of the back, the dorsal scapular nerve thus performing the second of the four “tricks” (i.e., the “medial trick’) listed above to reach them by branching early and passing medially to the scapula (Plate 4.7b). The other nerve to branch from the roots is the long thoracic nerve—its name also makes sense because it is a long nerve that has to run all the way down (inferiorly) to the inferior thoracic region, to innervate the serratus anterior.
Ultrasound imaging of the upper trapezius muscle for safer myofascial trigger point injections: a case report
Published in The Physician and Sportsmedicine, 2019
Vincenzo Ricci, Levent Özçakar
The vascular anatomy of the trapezius muscle is quite complicated and highly variable but the two dominant vessels of this anatomic region are the superficial branch of the TCA (which crosses over the levator scapulae muscle) and the deep branch of the TCA (which runs deep to the levator scapulae muscle with the dorsal scapular nerve). The former one gives rise to descending and ascending ramifications which supply the upper and lower portions of the trapezius muscle [3]. In clinical practice, the injections of the MTrPs of the neck muscles (especially the upper trapezius) are commonly performed (and usually as blind injections). In this sense, we imply that US guidance can readily provide prompt navigation for a safer intervention, i.e. not only avoiding any complication as regards bleeding but also neural injuries affecting the trapezius and sternocleidomastoid muscles due to spinal accessory nerve involvement or the rhomboid muscles due to dorsal scapular nerve involvement [4,5]. Last but not the least, clear visualization of the pleura under the intercostal muscles allows the physician to direct the needle tip far from the lung avoiding pneumothorax, a rare but possible complication especially in very slim patients [6].
Current concepts review: peripheral neuropathies of the shoulder in the young athlete
Published in The Physician and Sportsmedicine, 2020
Tamara S. John, Felicity Fishman, Melinda S. Sharkey, Cordelia W. Carter
SCAPULAR WINGING: Long Thoracic and Spinal Accessory Nerve Injury Scapular winging results from disruption of the dynamic stabilizing structures of the scapula. Most frequently, winging occurs due to paralysis of the serratus anterior, but can also result from injury to the trapezius or (rarely) the rhomboid major and minor; these muscles are innervated by the long thoracic nerve (LTN), spinal accessory nerve (SAN), and dorsal scapular nerve, respectively (Figure 3). In young athletes, traction and/or compression are the most common injury mechanisms.