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Head and Neck
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The nerves emerge at the posterior border of sternocleidomastoid at approximately the midpoint between mastoid and sternum, also called Erb’s point (Figure 1.36 and Table 1.25).
Surgical Anatomy of the Neck
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Laura Warner, Christopher Jennings, John C. Watkinson
The course of the accessory nerve after leaving the sternocleidomastoid varies. It usually leaves the posterior aspect of the muscle one centimetre above Erb’s point, where the cervical plexus branches emerge, however the point of emergence is variable and the nerve may not pass through the muscle at all. From the sternocleidomastoid the nerve runs in the roof of the posterior triangle to the trapezius, deep to the investing fascia and superficial to the prevertebral fascia within the fibro-fatty tissue. All-important structures of the posterior triangle are located caudal to the nerve. The nerve reaches the trapezius at the junction of the lower and middle one-third of the anterior surface of the muscle and enters the deep surface of the muscle.
Thoracic outlet syndromes
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Hugh A. Gelabert, Erdogan Atasoy
The clinical diagnosis of neurogenic TOS is based on the presence of core symptoms of pain or paresthesias extending from the base of the neck to the hand. These symptoms are frequently exacerbated by overhead or forward use of arms in tasks such as driving or typing. Physical examination is characterized by sensitivity to palpation or percussion over the brachial plexus at Erb’s point. Additional examination findings may include loss of the radial pulse with arm abduc- tion, fatigue or symptom reproduction with overhead stress testing, or upper extremity limb tensioning.
Targeting rule implementation decreases neck injuries in high school football: a national injury surveillance study
Published in The Physician and Sportsmedicine, 2022
Kyle K. Obana, John D. Mueller, Jack R. Zhong, Bryan M. Saltzman, T. Sean Lynch, Robert L. Parisien, Christopher S. Ahmad, David P. Trofa
With 90.8% of neck injuries in NCAA football resulting from direct contact, reducing helmet-to-helmet contact and axial compression is essential in minimizing neck and cervical spine injuries [6]. Neck injuries in football have been attributed to helmet-to-helmet contact when blocking, tackling, or headbutting [5]. This often occurs when the neck flexes forward prior to contact, thus resulting in a straightened cervical spine. This neck positioning places the player at increased risk of injury from an axially directed force via the lack of shock reduction provided by the natural cervical lordotic curvature [9]. Axial loading from helmet-to-helmet contact is the greatest risk factor for cervical spine injury and quadriplegia compared to hyperextension or hyperflexion [5,9,10]. As a result, 96.3% of spinal cord injuries in football players occur at the cervical level [11]. Other common mechanisms include forced full-range extension, compression of the brachial plexus or Erb’s point (stingers), direct trauma, or repeated impacts.
The devil is in the details: developing a modern methodology for detailed medical illustrations
Published in Journal of Visual Communication in Medicine, 2021
Emily M. Adams, Caroline Erolin
To prepare for the creation of the 3D model, many 2D drawings were created (see Figure 2). The more refined sketches created during this part of the process were sent to Dr. Catherine Carr and Dr. Seaneen McDougall (anatomists at CAHID) and Mr. Mountain (ENT surgeon at Ninewells). They noted the great auricular nerve and phrenic nerve needed to be adjusted and that the phrenic nerve originates from C3 to C5 however it was originally depicted coming from C4 (C. Carr, personal communication, May 20, 2020; S. McDougall, personal communication, 20 May 2020). The sketch was also adjusted to clarify the location of the SAN relative to the great auricular nerve by adding a close up of Erb’s Point. Erb’s Point is the place where the SAN sits approximately 1mm above the great auricular nerve, which is a place of clinical relevance (R. Mountain, personal communication, 27 May 2020).
IONM Troubleshooting in Spinal Procedures
Published in The Neurodiagnostic Journal, 2021
For upper extremity SSEP, asymmetry of cortical response amplitude and/or morphology is often the best indicator that something is wrong with the electrode placement. Having a peripherally recorded Erb’s point channel for your upper extremity SSEPs will allow the IONM Specialist to quickly tell if there is an issue with stimulation or a peripheral positioning problem. If there is not a problem with asymmetry of the left and right upper extremity recorded from your Erb’s point electrodes, it should point toward a scalp electrode problem. When scalp electrodes that should be placed over the homunculus (where the upper extremities are represented) are misplaced anterior-rostral of their intended position, the result is often a smaller N20 response with some preservation of the later cortical wave. For response viability, with SSEP scalp electrodes it is always better to err posteriorly, which is far less likely to adversely affect signal quality and typically spares N20 responses.