Applied Sonoanatomy of the Posterior Triangle of the Neck

Overview

Journal Int J Shoulder Surg

Date 2011 Apr 8

PMID 21472066

Citations 4

Authors

Barys Ihnatsenka

Andre P Boezaart

Affiliations

Soon will be listed here.

Abstract

The posterior triangle of the neck is an area of the body frequently visited by regional anesthesiologists, acute and chronic pain physicians, surgeons of all disciplines, and diagnosticians. It houses the entire brachial plexus from the roots to the divisions, the scalene muscles, the cervical sympathetic ganglions, the major blood vessels to and from the brain, the neuroforamina and various other structures of more or less importance to these physicians. Ultrasound (US) offers a handy visual tool for these structures to be viewed in real time and, therefore, its popularity and the need to understand it. We will discuss pertinent clinical anatomy of the neck and offer a basic visual explanation of the often-difficult two-dimensional (2-D) images seen with US.

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References

Thompson G, RORIE D . Functional anatomy of the brachial plexus sheaths. Anesthesiology. 1983; 59(2):117-22. DOI: 10.1097/00000542-198308000-00009. View

Soares L, Brull R, Lai J, Chan V . Eight ball, corner pocket: the optimal needle position for ultrasound-guided supraclavicular block. Reg Anesth Pain Med. 2007; 32(1):94-5. DOI: 10.1016/j.rapm.2006.10.007. View

Partridge B, Katz J, Benirschke K . Functional anatomy of the brachial plexus sheath: implications for anesthesia. Anesthesiology. 1987; 66(6):743-7. DOI: 10.1097/00000542-198706000-00006. View

Boezaart A, Nosovitch M . Carotid endarterectomy using single injection posterior cervical paravertebral block. Anesth Analg. 2005; 101(6):1885-1886. DOI: 10.1213/01.ANE.0000180269.86543.98. View

Matula C, Trattnig S, Tschabitscher M, Day J, KOOS W . The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol. 1997; 48(2):125-31. DOI: 10.1016/s0090-3019(97)90105-1. View

Benumof J . Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology. 2001; 93(6):1541-4. DOI: 10.1097/00000542-200012000-00033. View

Perlas A, Lobo G, Lo N, Brull R, Chan V, Karkhanis R . Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases. Reg Anesth Pain Med. 2009; 34(2):171-6. DOI: 10.1097/AAP.0b013e31819a3f81. View

Chan V, Perlas A, Rawson R, Odukoya O . Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2003; 97(5):1514-1517. DOI: 10.1213/01.ANE.0000062519.61520.14. View

WINNIE A, Collins V . THE SUBCLAVIAN PERIVASCULAR TECHNIQUE OF BRACHIAL PLEXUS ANESTHESIA. Anesthesiology. 1964; 25:353-63. DOI: 10.1097/00000542-196405000-00014. View

10.

Shibata Y, Fujiwara Y, Komatsu T . A new approach of ultrasound-guided stellate ganglion block. Anesth Analg. 2007; 105(2):550-1. DOI: 10.1213/01.ane.0000265691.02963.a4. View

11.

Peng P, Narouze S . Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures. Reg Anesth Pain Med. 2009; 34(5):458-74. DOI: 10.1097/AAP.0b013e3181aea16f. View

12.

Cornish P, Leaper C . The sheath of the brachial plexus: fact or fiction?. Anesthesiology. 2006; 105(3):563-5. DOI: 10.1097/00000542-200609000-00021. View

13.

WINNIE A . Interscalene brachial plexus block. Anesth Analg. 1970; 49(3):455-66. View

14.

Neal J, Gerancher J, Hebl J, Ilfeld B, McCartney C, Franco C . Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009; 34(2):134-70. PMC: 2779737. DOI: 10.1097/AAP.0b013e31819624eb. View

15.

Boezaart A . That which we call a rose by any other name would smell as sweet-and its thorns would hurt as much. Reg Anesth Pain Med. 2009; 34(1):3-7. DOI: 10.1097/AAP.0b013e318194cf23. View

16.

Boezaart A, Koorn R, Rosenquist R . Paravertebral approach to the brachial plexus: an anatomic improvement in technique. Reg Anesth Pain Med. 2003; 28(3):241-4. DOI: 10.1053/rapm.2003.50049. View

17.

Boezaart A, de Beer J, Nell M . Early experience with continuous cervical paravertebral block using a stimulating catheter. Reg Anesth Pain Med. 2003; 28(5):406-13. DOI: 10.1016/s1098-7339(03)00221-9. View

18.

Renes S, Rettig H, Gielen M, Wilder-Smith O, van Geffen G . Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med. 2009; 34(5):498-502. DOI: 10.1097/AAP.0b013e3181b49256. View

19.

Renes S, Spoormans H, Gielen M, Rettig H, van Geffen G . Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009; 34(6):595-9. DOI: 10.1097/aap.0b013e3181bfbd83. View

20.

Urmey W, Talts K, Sharrock N . One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991; 72(4):498-503. DOI: 10.1213/00000539-199104000-00014. View