T H OM AS B . C LARK & S T ANLE Y K . H . L AM

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C O N TR I B UTO R S :

T HOM AS B . C LAR K

S TANLE Y K . H . L AM

U L T R A S O U N D G U I D E D

N E R V E H Y D R O D I S S E C T I O N

1 S T E D I T I O N

J U N E 2 0 1 6

1 0 1 N E R V E E N T R A P M E N T S :

1

2

N E C KI N T E R S C A L E N E / B R A C H I A L P L E X U S 6C 6 7C 5 8D O R S A L S C A P U L A R N E R V E 9C 7 1 0C 8 1 1S U P R A C L A V I C U L A R B R A C H I A L P L E X U S 1 2L O N G T H O R A C I C N E R V E 1 3S T E L L A T E G A N G L I O N 1 4C E R V I C A L P L E X U S 1 5A C C E S S O R Y S P I N A L N E R V E 1 6G R E A T A U R I C U L A R N E R V E 1 7S U P R A C L A V I C U L A R N E R V E 1 8C E R V I C A L S P I N E - M E D I A L B R A N C H E S 1 93 R D O C C I P I T A L N E R V E 2 0D O R S A L S C A P U L A R N E R V E 2 1S U P R A S C A P U L A R N E R V E - S U P R A S C A P U L A R N O T C H 2 2S U P R A S C A P U L A R N E R V E - I N T R A S P I N A L G L E N O I D N O T C H 2 3G R E A T E R O C C I P I T A L N E R V E 2 4G R E A T E R O C C I P I T A L N E R V E - C E P H A L A D A P P R O A C H 2 5G R E A T E R O C C I P I T A L N E R V E - C A U D A L A P P R O A C H 2 6L E S S E R O C C I P I T A L N E R V E 2 7

C H E S T

S U P R A C L A V I C U L A R N E R V E 2 8S U B C L A V I C U L A R B R A C H I A L P L E X U S 2 9P E C T O R A L N E R V E S 3 0I N F R A C L A V I C U L A R B R A C H I A L P L E X U S 3 1M U S C U L O C U T A N E O U S N E R V E 3 2A X I L L A R Y B R A C H I A L P L E X U S 3 3L O N G T H O R A C I C N E R V E 3 4I N T E R C O S T A L B R A C H I A L N E R V E S 3 5T H O R A C O D O R S A L N E R V E 3 6

S H O U L D E R

S U B S C A P U L A R N E R V E 3 7S C A P U L A R C I R C U M F L E X 3 8A X I L L A R Y N E R V E 3 9R A D I A L N E R V E 4 0P O S T E R I O R B R A C H I A L C U T A N E O U S N E R V E 4 1M E D I A L B R A C H I A L C U T A N E O U S N E R V E 4 2

3

E L B O W

M E D I A L A N T E B R A C H I A L C U T A N E O U S N E R V E 4 3L A T E R A L A N T E B R A C H I A L C U T A N E O U S N E R V E 4 4D E E P R A D I A L N E R V E 4 5S U P E R F I C I A L R A D I A L N E R V E 4 6M E D I A N N E R V E 4 7U L N A R N E R V E - C U B I T A L T U N N E L 4 8U L N A R N E R V E - F L E X O R C A R P I U L N A R I S 4 9

W R I S T

D O R S A L R A D I A L N E R V E 5 0D O R S A L U L N A R N E R V E 5 1P O S T E R I O R I N T E R O S S E O U S N E R V E 5 2A N T E R I O R I N T E R O S S E O U S N E R V E 5 3M E D I A N N E R V E - S H O R T A X I S 5 4M E D I A N N E R V E - L O N G A X I S 5 5U L N A R N E R V E - G U Y O N ’ S C A N A L 5 6

T H O R A C I C S P I N E

I N T E R C O S T A L N E R V E S 5 8P A R A V E R T E B R A L S P A C E - N E R V E R O O T S 5 9S U B C O S T A L N E R V E 6 0L U M B A R S P I N E 6 1M E D I A L B R A N C H 6 2L A T E R A L B R A N C H 6 3I L I O H Y P O G A S T R I C N E R V E - L 1 6 4I L I O I N G U I N A L N E R V E - L 1 6 5G E N I T O F E M O R A L N E R V E - N E R V E - L 2 6 6L U M B A R P L E X U S - L U M B A R N E R V E R O O T - L O N G A X I S 6 7L U M B A R P L E X U S - L U M B A R N E R V E R O O T - S H O R T A X I S 6 8

S A C R A L S P I N E

S U P E R I O R C L U N E A L M E D I A L B R A N C H 6 9S U B C O S T A L N E R V E S 7 0I L I O H Y P O G A S T R I C N E R V E 7 1M I D D L E C L U N E A L N E R V E 7 2S A C R A L N E R V E R O O T S 7 3S A C R A L H I A T U S 7 4

4

P O S T E R I O R P E L V I S

S U P E R I O R G L U T E A L N E R V E 7 5S A C R A L P L E X U S 7 6P U D E N D A L N E R V E 7 7P O S T E R I O R C U T A N E O U S T H I G H N E R V E 7 8S C I A T I C N E R V E 7 9

A N T E R I O R P E L V I S

I L I O H Y P O G A S R T I C N E R V E - A N T E R I O R B R A N C H 8 0I L I O I N G U I N A L N E R V E 8 1G E N I T O F E M O R A L N E R V E - F E M O R A L B R A N C H 8 2G E N I T O F E M O R A L N E R V E - G E N I T A L B R A N C H 8 3F E M O R A L N E R V E 8 4L A T E R A L F E M O R A L C U T A N E O U S N E R V E S 8 5O B T U R A T O R N E R V E S 8 6

K N E E

S A P H E N O U S N E R V E - A D D U C T O R 8 8O B T U R A T O R N E R V E - A N T E R I O R B R A N C H E S 8 9O B T U R A T O R N E R V E - P O S T E R I O R B R A N C H E S 9 0M E D I A L G E N I C U L A T E N E R V E S 9 1L A T E R A L G E N I C U L A T E N E R V E S 9 2P O S T E R I O R C A P S U L E N E R V E S 9 3C O M M O N P E R O N E A L N E R V E 9 4D E E P P E R O N E A L N E R V E 9 5S U P E R F I C I A L P E R O N E A L N E R V E 9 6L A T E R A L S U R A L B R A N C H 9 7M E D I A L S U R A L B R A N C H 9 8S O L E U S C A N A L 9 9

A N K L E

C O M M O N S U R A L B R A N C H 1 0 0P O S T E R I O R T I B I A L N E R V E 1 0 1T A R S A L T U N N E L 1 0 2M E D I A L P L A N T A R N E R V E 1 0 3L A T E R A L P L A N T A R N E R V E 1 0 4B A X T E R ' S N E R V E 1 0 5D E E P P E R O N E A L N E R V E 1 0 6S U P E R F I C I A L P E R O N E A L N E R V E S 1 0 7

5

1 0 1 N E R V E E N T R A P M E N T S :

INTERSCALENE - BRACHIAL PLEXUS

TRAJECTORYSHORT AXIS IN PLANE, LATERAL TO MEDIAL THRUMIDDLE & POSTERIOR SCALENE

PATIENT POSITIONOBLIQUE SUPINE, HEAD SLIGHTLY ROTATED AWAY

LABELSSCM STERNOCLEIDOMASTOID

MS MIDDLE SCALENEAS ANTERIOR SCALENEIJ INTERNAL JUGULAR

CA COMMON CAROTID ARTERY

DOPPLERCAROTID ARTERYVERTEBRAL ARTERY

TRANSVERSE CERVICAL ARTERYINFERIOR THYROID ARTERY

CLINICAL INDICATIONSCRUSHED NECK INJURY WITH RADIATING PAIN TOUPPER LIMB ON THE SAME SIDECOMPLEX REGIONAL PAIN SYNDROME OF UPPER LIMBON THE SAME SIDE

KEY IMPRESSIONS & CONCERNSRADICULAR ARM PAIN

TRANSVERSE CERVICAL ARTERY

6

U L T R A S O U N D G U I D E D N E R V E H Y D R O D I S S E C T I O N

C6

TRAJECTORYSHORT AXIS, IN PLANE, LATERAL TO MEDIAL, THRUMIDDLE SCALENE

PATIENT POSITIONOBLIQUE SUPINE, HEAD SLIGHTLY ROTATED AWAY

LABELSSCM STERNOCLEIDOMASTOID

MS MIDDLE SCALENEIJ INTERNAL JUGULAR

CA COMMON CAROTID ARTERYLS LEVATOR SCAPUALELC LONGUS COLI

DOPPLERCOMMON CAROTID ARTERYVERTEBRAL ARTERY

TRANSVERSE CERVICAL ARTERYRADICULAR ARTERY

CLINICAL INDICATIONSPATIENTS WITH POST RADIATION NEURITIS OR NERVECOMPRESSION FROM FIBROSIS OF THE NECKMUSCLES. SELECTIVE NERVE ROOT COMPRESSION FROMVARIOUS CAUSES

KEY IMPRESSIONS & CONCERNSRADICULAR ARM PAIN

VERTEBRAL ARTERYRADICULAR ARTERY

7