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Distal Conduction Blocks
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The approaches to the medial brachial cutaneous and intercostobrachial nerves are easy, but not always reliable, even in experienced hands. Suprascapular nerve block is difficult and potentially dangerous.
Peripheral nerve disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Michael Fox, David Warwick, H. Srinivasan
The suprascapular nerve arises from the upper trunk of the brachial plexus in the posterior triangle of the neck and then courses through the suprascapular notch beneath the superior transverse scapular ligament to supply the supraspinatus and infraspinatus muscles. It also sends sensory branches to the posterior part of the glenohumeral joint, the acromioclavicular joint, the subacromial bursa, the ligaments around the shoulder and (in a small proportion of people) the skin on the outer, upper aspect of the arm.
Cryoneurolysis: Principles and Practice
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
The suprascapular nerve arises from the upper trunk of the brachial plexus and travels downward and laterally to pass through the suprascapular notch to provide innervation to the supraspinatus, infraspinatus, and shoulder joint. Clinically, the patient complains of a poorly localized upper shoulder pain, usually triggered by a lifting injury with the arm internally rotated. Tenderness is elicited by palpation of the suprascapular notch (the “Vulcan death grip”). Diagnostic blocks should be performed using a peripheral nerve stimulator. The classic approach to the suprascapular notch is to advance the needle perpendicular to the scapular spine from above, and then “walk it off” anteriorly until the needle drops into the suprascapular notch. This technique, however, has a high risk of pneumothorax. I recommend instead that the needle (with a peripheral nerve stimulator) be directed perpendicular to the scapula itself, using the scapular wall as a “backstop,” and then directed medially or laterally to find the nerve. This technique works for both the diagnostic nerve block and the cryoneuroablation.
Is there any difference between anterior and posterior approach for the spinal accessory to suprascapular nerve transfer? A systematic review and meta-analysis
Published in Neurological Research, 2023
Michal Makel, Andrej Sukop, David Kachlík, Petr Waldauf, Adam Whitley, Radek Kaiser
Both approaches have advantages and disadvantages. Traction injuries often cause lesions of the suprascapular nerve at the level of scapular notch and nerve transfer proximal to this injury could result in unsuccessful restoration of abduction [21]. Posterior approach allows for further exploration of the scapular notch and placing the neurorrhaphy distal from the injury. In cases of clavicular fracture with callus formation, ventral preparation could be difficult and there is a high risk of further injuring the nerve structure [30]. Another advantage of dorsal approach is shorter reinnervation distance and exclusion of articular branches which can mislead donor axons [14,22]. This was shown by Souza et al., who noted earlier electromyographic signs of reinnervation following the dorsal approach; however, the success rate of muscle recovery was the same 18 months after reconstruction from both anterior and posterior approach [14]. The dorsal approach in double nerve transfer using a branch of the radial nerve as a donor for the axillary nerve does not require position changing during surgery unless other nerve transfers are necessary [8]. Donor site morbidity is considered lower in the dorsal approach as more proximal branches of the spinal accessory nerve are spared and thus better function of the proximal part of trapezius muscle is preserved [13].
Ultrasound guided suprascapular and costoclavicular nerve block versus interscalene nerve block for postoperative analgesia in arthroscopic shoulder surgery: A randomized non-inferiority clinical trial
Published in Egyptian Journal of Anaesthesia, 2022
Emad Zarief Kamel, Golnar M Fathy, Mohamed Talaat, Mohamed H. Bakri, Omar M. Soliman, Mohamed Abd El-Radi Abd El-Salam, Eman A. Ismail
The suprascapular nerve innervates the infraspinatus and supraspinatus muscles and delivers 70% of sensory input to the glenohumeral joint [14]. Based on this anatomical basis, the SSB has been proposed as an alternative to the ISB for better appropriate analgesia after shoulder surgery [15]. Patients with morbid obesity, obstructive sleep apnea, and severe chronic obstructive pulmonary disease seem to be suitable candidates for the SSB [16–18]. The infraclavicular nerve block (ICB) anesthetizes the axillary nerve (which supplies the anterior and posterior shoulder joints) as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the SSB anesthetizes the posterior shoulder joint. While combined ICB-SSB has been successfully employed for proximal humeral surgery, its benefits for shoulder surgery need to be investigated further [19].
Shoulder abduction reconstruction for C5–7 avulsion brachial plexus injury by dual nerve transfers: spinal accessory to suprascapular nerve and partial median or ulnar to axillary nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Gavrielle Hui-Ying Kang, Fok-Chuan Yong
All surgeries were performed in the supine position. A supraclavicular approach was used for brachial plexus roots exploration and nerve transfer of the spinal accessory to the suprascapular nerve. The spinal accessory nerve was identified on the deep surface of the trapezius muscle and confirmed with a nerve stimulator. The dissection was continued distally to its termination into two or three branches. A vessel loop was placed around it for later identification when it would be transected at this junction for coaptation to the suprascapular nerve stump. The suprascapular nerve was identified as it branches off from the upper trunk of the brachial plexus. It was dissected and traced distally until healthy nerve tissue was encountered. This was verified by its turgor and the visualization of nerve fascicles within the epineurium upon transection of the nerve. When scarred or fibrotic nerve tissue was encountered, the nerve would be progressively cut back distally until a healthy nerve stump was seen. Coaptation of the spinal accessory nerve to the healthy suprascapular nerve stump was performed under magnification with 10–0 nylon sutures, and reinforced with a biological adhesive (TISSEEL Fibrin Sealant, Baxter International Inc.).