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Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
The five roots of the brachial plexus lie in the posterior triangle of the neck between scalenus anterior and scalenus medius muscles. Injuries between the posterior root ganglion and the spinal cord are termed preganglionic. The three trunks of the brachial plexus lie in front of one another and in the posterior triangle of the neck. The divisions of the plexus lie posterior to the clavicle. The medial, lateral and posterior cords of the plexus are related to the second part of the axillary artery deep to pectoralis minor.
General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
What are the boundaries and contents of the posterior triangle of the neck?Boundaries − SCM, trapezius and middle third of the clavicleSubdivided into occipital and supraclavicular trianglesContents − XI nerve, nodes, occipital artery, inferior belly omohyoid, external jugular vein, suprascapular vessels, cutaneous branches of cervical plexusBeneath prevertebral fascia − brachial plexus, subclavian artery, cervical plexus and phrenic nerve
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The boundaries of the posterior triangle of the neck are: posterior border of sternocleidomastoid, anterior border of trapezium, and the medial third of the clavicle. The roof is formed by investing fascia, platysma, and the external jugular vein. The floor is composed of prevertebral fascia covering muscles, subclavian artery, trunks of the brachial plexus, and cervical plexus. The carotid sheath is contained in the anterior triangle of the neck.
Comparison of subomohyoid plane block and interscalene nerve block for arthroscopic shoulder surgery
Published in Egyptian Journal of Anaesthesia, 2022
Rabab S. S Mahrous, Tarek I Ismail
On the other hand, supraclavicular fossa and subomohyoid plane are close anatomical spaces, and any injection high up to the level of the clavicle can directly spread either retrograde or antegrade to the phrenic nerve, and this could explain the occurrence of phrenic nerve block in some cases in subomohyoid group [37]. Sehmbi et al. [23] during the cadaveric dye study could confirm our explanation where the suprascapular nerve beneath the inferior belly of omohyoid muscle in the posterior triangle of the neck was delineated. Ten bilateral subomohyoid suprascapular nerve injections with ultrasound guidance were carried out using a 5 mL contrast dye in five fresh cadavers. They found that following injection of only 5 ml of dye, 20% of the cases had staining of the phrenic nerve. Currently, no trials demonstrate the spread of local anesthetics from the subomohyoid plane to contiguous spaces, and future research is warranted.
Anatomical aspects of the selective infraspinatus muscle neurotization by spinal accessory nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Radek Kaiser, Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová
SAN is a motor nerve, supplying the sternocleidomastoid and the trapezius muscles. After exiting the skull it descends medial to the styloid process and stylohyoid and digastric muscles. It then passes into (70–80%) or under (20–30%) the sternocleidomastoid and exits the posterior border at a point 7–9 cm above the clavicle. It crosses the posterior triangle of the neck in an inferolateral direction, superficial to the levator scapulae. It then pierces the trapezius muscle, most commonly on at a point 2–4 cm above the clavicle [7]. After providing the perforating branches to the upper trapezius muscle, it runs distally from the point lying on the line between C7 and acromion as the isolated main trunk [8]. Although at least one communicating branch between the SAN and the roots of the cervical plexus can be found in each cadaver dissection [9,10], motor input from the cervical plexus to the trapezius muscle is seen in only one third of cases [9].
Superficial location of the brachial plexus and axillary artery in relation to pectoralis minor: a case report
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
The brachial plexus innervates all the structures of the upper limb, and originates from spinal roots C5, C6, C7, C8 and T1, which are located between the anterior and middle scalene muscles.3 The trunks arise in the posterior triangle of the neck from the union of the roots; C5 and C6 roots join to form the superior trunk, C8 and T1 unite to form the inferior trunk, while C7 continues as the middle trunk. The trunks surround the first part of the axillary artery and pass over rib one, deep to the clavicle, where they each divide into anterior and posterior divisions. All three of the posterior divisions unite posterior to the axillary artery to form the posterior cord, the anterior divisions of the superior and middle trunk form the lateral cord on the lateral side of the axillary artery, while only the anterior division of the inferior trunk gives rise to the medial cord on the medial side of the artery. The cords are therefore named according to their position relative to the second part of the axillary artery and are situated deep to the pectoralis major and minor muscles. The terminal branches of the brachial plexus arise from the cords in the region of the third part of the axillary artery, inferior to the distal border of pectoralis minor, and supply skin and muscles of the upper limb.4 The lateral cord gives rise to the musculocutaneous nerve and the lateral root of the median nerve, the medial cord gives rise to the medial root of the median nerve and the ulnar nerve, and the posterior cord divides into the radial and axillary nerves.3