Shoulder Anatomy & Clinical Exam

Total Page：16

File Type：pdf, Size：1020Kb

MSK Ultrasound - Spine - Incheon Terminal Orthopedic Private Clinic Yong-Hyun, Yoon C,T-spine Basic Advanced • Medial branch block • C-spine transforaminal block • Facet joint block • Thoracic paravertebral block • C-spine intra-discal injection • Superficial cervical plexus block • Vagus nerve block • Greater occipital nerve block(GON) • Third occipital nerve block(TON) • Hydrodissection • Brachial plexus(1st rib level) • Suboccipital nerve • Stellate ganglion block(SGB) • C1, C2 nerve root, C2 nerve • Brachial plexus block(interscalene) • Recurrent laryngeal nerve • Serratus anterior plane • Cervical nerve root Cervical facet joint Anatomy Diagnosis Cervical facet joint injection C-arm Ultrasound Cervical medial branch Anatomy Nerve innervation • Medial branch • Same level facet joint • Inferior level facet joint • Facet joint • Dual nerve innervation Cervical medial branch C-arm Ultrasound Cervical nerve root Anatomy Diagnosis • Motor • Sensory • Dermatome, myotome, fasciatome Cervical nerve root block C-arm Ultrasound Stallete ganglion block Anatomy Injection Vagus nerve Anatomy Injection L,S-spine Basic Advanced • Medial branch block • Lumbar sympathetic block • Facet joint block • Lumbar plexus block • Superior, inferior hypogastric nerve block • Caudal block • Transverse abdominal plane(TAP) block • Sacral plexus block • Epidural block • Hydrodissection • Interlaminal • Pudendal nerve • Transforaminal injection • Genitofemoral nerve • Superior, inferior cluneal nerve • Rectus abdominal sheath • Erector spinae plane Lumbar facet joint Anatomy Diagnosis Lumbar facet joint C-arm Ultrasound Lumbar medial branch Anatomy Nerve innervation • Dual nerve innervation • L34 facet joint – L23 MBB • L5 is exception • L5/S1 dorsal rami Lumbar medial branch C-arm Ultrasound Lumbar plexus Anatomy Indications • Psoas muscle dysfunction • Plexopathy(from Cyriax) Lumbar plexus block C-arm Ultrasound Caudal block Anatomy Indications Caudal block C-arm Ultrasound Q & A • Contact • [email protected] • Incheon Terminal Orthopaedic Clinic • https://www.koreanonop.com/ • CP • 010-2886-3854 Take home message • Diagnosis, Diagnosis, Diagnosis • Anatomy, Anatomy, Anatomy • Accurate Treatment! • Review the chart or procedure • After 2 Treatments, no effect -> review the chart & diagnosis.

Copy Link

Recommended publications

Comparing the Injectate Spread and Nerve
Journal name: Journal of Pain Research Article Designation: Original Research Year: 2018 Volume: 11 Journal of Pain Research Dovepress Running head verso: Baek et al Running head recto: Ultrasound-guided GON block open access to scientific and medical research DOI: http://dx.doi.org/10.2147/JPR.S17269 Open Access Full Text Article ORIGINAL RESEARCH Comparing the injectate spread and nerve involvement between different injectate volumes for ultrasound-guided greater occipital nerve block at the C2 level: a cadaveric evaluation In Chan Baek1 Purpose: The spread patterns between different injectate volumes have not yet been investigated Kyungeun Park1 in ultrasound-guided greater occipital nerve (GON) block at the C2 level. This cadaveric study Tae Lim Kim1 was undertaken to compare the spread pattern and nerve involvements of different volumes of Jehoon O2 dye using this technique. Hun-Mu Yang2,* Materials and methods: After randomization, ultrasound-guided GON blocks with 1 or 5 mL dye solution were performed at the C2 level on the right or left side of five fresh cadavers. The Shin Hyung Kim1,* suboccipital regions were dissected, and nerve involvement was investigated. 1 Department of Anesthesiology and Results: Ten injections were successfully completed. In all cases of 5 mL dye, we observed the Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University deeply stained posterior neck muscles, including the suboccipital triangle space. The suboccipital College of Medicine, Seoul, Republic and third occipital nerves, in addition to GONs, were consistently stained when 5-mL dye was 2 of Korea; Department of Anatomy, used in all injections (100%). Although all GONs were successfully stained in the 1-mL dye Yonsei University College of Medicine, Seoul, Republic of Korea cases, three of five injections (60%) concomitantly stained the third occipital nerves.
[Show full text]
Superficial (And Intermediate) Cervical Plexus Block
Superficial (and Intermediate) Cervical Plexus Block Indications: -Tympanomastoid surgery. When combined with the auricular branch of the vagus (‘nerve of arnold’) by infiltrating subcutaneously into the medial side of the tragus), obviates the need for opiates. -Pinnaplasty or Otoplasty -Lymph node excision (within the anterior and posterior triangles of the neck) -Clavicular surgery or fractures (may require intermediate cervical plexus block and its combination with interscalene block, see below) -Central Venous Catheters: Renal replacement therapy central venous catheters, tunnelled central venous catheters and portacaths inserted into the subclavian or jugular veins (may require combination with ‘Pecs 1’ block for component of pain below the clavicle) -Tracheostomy (see below discussion on safety profile of performing bilateral blocks and risks of respiratory distress due to phrenic nerve or recurrent largyngeal nerve block) -More commonly in adults: thyroid (again, bilateral) and carotid surgery Contraindications: -local sepsis or rash Anatomy: The cervical plexus arises from C1-C4 mixed spinal nerves (fig. 1): Somatic sensory branches: -arise from C2-C4 as the mixed spinal nerves leave the sulcus between the anterior and posterior tubercles of the transverse process (note C7 does not have an anterior tubercle or bifid spinous process): -pass between longus capitis and middle scalene perforating the prevertebral fascia. Note at C4 level the anterior scalene has largely disappeared having taken the bulk of its vertebral bony origin lower down. The bulkiest of the scalene muscles is the middle scalene and remains in view at this level: -then pass behind the internal jugular vein out into the potential space between the investing layer of deep fascia ensheathing the sternocleidomastoid, and the prevertebral layer of deep fascia covering levator scapulae (fig.
[Show full text]
33. Spinal Nerves. Cervical Plexus
GUIDELINES Students’ independent work during preparation to practical lesson Academic discipline HUMAN ANATOMY Topic SPINAL NERVES. CERVICAL PLEXUS. 1. Relevance of the topic: The knowledge of structures of the peripheral nervous system, particularly cervical plexus and its branches is the base of clinical thinking in terms of differential diagnosis for the doctor of any specialty, but above all a neurologist, vertebroneurologist, traumatologist, dermatologist, general practitioner. 2. Specific objectives of practical lesson - Analyse the composition of fibres of anterior and posterior roots of spinal nerves. - Explain the formation of spinal nerve. - Suggest the definition of spinal nerve. - Classify spinal nerve branches. - Explain functional anatomy of thoracic spinal nerve branches. - Define term "plexus of somatic nerves" including the formation of cervical plexus. - Draw a scheme of spinal nerve: o а - in cervical region of spinal cord (except for the CVIII); o b - in thoracic region of spinal cord; o c - on the level of SII – SIV. - Analyse the connection of somatic nerve (thoracic spinal nerve) with ganglia of sympathetic trunk. - Create the conception of grey and white connecting branches in the functional aspect. 3. Basic level of preparation (interdisciplinary integration) of the student includes knowledge of medical biology and histology of the development of nervous system in phylogenesis and ontogenesis. Name of previous disciplines Obtained skills 1. Medical Biology and Histology Know ontogenesis and phylogenesis of nervous system. The structure of the neuron. 2. Sections of Human Anatomy: - osteology The student should have skills to describe the structure of - myology the spine in general, to be able to demonstrate structural features of the cervical vertebrae, their connections with each other and with the bones of the skull.
[Show full text]
The Peripheral Nervous System
The Peripheral Nervous System Dr. Ali Ebneshahidi Peripheral Nervous System (PNS) – Consists of 12 pairs of cranial nerves and 31 pairs of spinal nerves. – Serves as a critical link between the body and the central nervous system. – peripheral nerves contain an outermost layer of fibrous connective tissue called epineurium which surrounds a thinner layer of fibrous connective tissue called perineurium (surrounds the bundles of nerve or fascicles). Individual nerve fibers within the nerve are surrounded by loose connective tissue called endoneurium. Cranial Nerves Cranial nerves are direct extensions of the brain. Only Nerve I (olfactory) originates from the cerebrum, the remaining 11 pairs originate from the brain stem. Nerve I (Olfactory)- for the sense of smell (sensory). Nerve II (Optic)- for the sense of vision (sensory). Nerve III (Oculomotor)- for controlling muscles and accessory structures of the eyes ( primarily motor). Nerve IV (Trochlear)- for controlling muscles of the eyes (primarily motor). Nerve V (Trigeminal)- for controlling muscles of the eyes, upper and lower jaws and tear glands (mixed). Nerve VI (Abducens)- for controlling muscles that move the eye (primarily motor). Nerve VII (Facial) – for the sense of taste and controlling facial muscles, tear glands and salivary glands (mixed). Nerve VIII (Vestibulocochlear)- for the senses of hearing and equilibrium (sensory). Nerve IX (Glossopharyngeal)- for controlling muscles in the pharynx and to control salivary glands (mixed). Nerve X (Vagus)- for controlling muscles used in speech, swallowing, and the digestive tract, and controls cardiac and smooth muscles (mixed). Nerve XI (Accessory)- for controlling muscles of soft palate, pharynx and larynx (primarily motor). Nerve XII (Hypoglossal) for controlling muscles that move the tongue ( primarily motor).
[Show full text]
A Case Report of an Enlarged Suboccipital Nerve with Cutaneous Branch
Open Access Case Report DOI: 10.7759/cureus.2933 A Case Report of an Enlarged Suboccipital Nerve with Cutaneous Branch Sasha Lake 1 , Joe Iwanaga 2 , Rod J. Oskouian 3 , Marios Loukas 4 , R. Shane Tubbs 5 1. Anatomical Studies, St. George's, St. George, GRD 2. Medical Education and Simulation, Seattle Science Foundation, Seattle, USA 3. Neurosurgery, Swedish Neuroscience Institute, Seattle, USA 4. Anatomical Sciences, St. George's University, St. George's, GRD 5. Neurosurgery, Seattle Science Foundation, Seattle, USA Corresponding author: Joe Iwanaga, [email protected] Abstract Variations of the suboccipital nerve are infrequently reported. This nerve derived from the C1 spinal nerve is usually a small branch that primarily innervates the short suboccipital muscles. During the routine dissection of the occipital region in an adult cadaver, a vastly enlarged left-sided suboccipital nerve was identified. The nerve innervated the short suboccipital muscles and overlying semispinalis capitis in normal fashion. However, it continued cranially to end in the overlying skin of the occiput. Although not normally thought to have a cutaneous branch, recalcitrant occipital neuralgia might be due to such a variant branch. Future studies are necessary to further elucidate this proposed pathomechanism. Categories: Neurology, Pathology Keywords: suboccipital nerve, c1 nerve, occiput cutaneous innervation, sensory suboccipital nerve Introduction The suboccipital nerve is the dorsal ramus of C1. This nerve is found between the skull and atlas and within the suboccipital triangle. Here, it is positioned between the posterior arch of the atlas and vertebral artery bordering the nerve inferiorly and superiorly, respectively [1]. The suboccipital nerve innervates the rectus capitis posterior major and minor, obliquus capitis superior, obliquus capitis inferior, and semispinalis capitis.
[Show full text]
Comparing the Injectate Spread and Nerve
Journal name: Journal of Pain Research Article Designation: Original Research Year: 2018 Volume: 11 Journal of Pain Research Dovepress Running head verso: Baek et al Running head recto: Ultrasound-guided GON block open access to scientific and medical research DOI: http://dx.doi.org/10.2147/JPR.S17269 Open Access Full Text Article ORIGINAL RESEARCH Comparing the injectate spread and nerve involvement between different injectate volumes for ultrasound-guided greater occipital nerve block at the C2 level: a cadaveric evaluation In Chan Baek1 Purpose: The spread patterns between different injectate volumes have not yet been investigated Kyungeun Park1 in ultrasound-guided greater occipital nerve (GON) block at the C2 level. This cadaveric study Tae Lim Kim1 was undertaken to compare the spread pattern and nerve involvements of different volumes of Jehoon O2 dye using this technique. Hun-Mu Yang2,* Materials and methods: After randomization, ultrasound-guided GON blocks with 1 or 5 mL dye solution were performed at the C2 level on the right or left side of five fresh cadavers. The Shin Hyung Kim1,* suboccipital regions were dissected, and nerve involvement was investigated. 1Department of Anesthesiology and For personal use only. Results: Ten injections were successfully completed. In all cases of 5 mL dye, we observed the Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University deeply stained posterior neck muscles, including the suboccipital triangle space. The suboccipital College of Medicine, Seoul, Republic and third occipital nerves, in addition to GONs, were consistently stained when 5-mL dye was 2 of Korea; Department of Anatomy, used in all injections (100%).
[Show full text]
SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej
[Show full text]
Reconstruction of Complex Defects of the Extracranial Facial Nerve: Technique of “The Trifurcation Approach”
European Archives of Oto-Rhino-Laryngology (2019) 276:1793–1798 https://doi.org/10.1007/s00405-019-05418-4 HEAD AND NECK Reconstruction of complex defects of the extracranial facial nerve: technique of “the trifurcation approach” Dirk Beutner1 · Maria Grosheva2 Received: 28 January 2019 / Accepted: 31 March 2019 / Published online: 4 April 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose Reconstruction of complex defects of facial nerve (FN) after extensive cancer surgery requires individualized solutions. We describe the trifurcation technique as a modifcation of the combined approach on example of two patients with locally advanced parotid cancer. Methods Due to perineural invasion, extensive resection of the FN from the mastoid segment to the peripheral branches was required. For reanimation of the upper face, a complex cervical plexus graft was sutured end-to-end to the mastoid segment of the FN trunk. The branches of the graft enabled reanimation of three peripheral temporal and zygomatic branches. The mandibular branch was sutured end-to-side to the hypoglossal nerve (hypoglossal–facial nerve transfer, HFNT). Addition- ally, the buccal branch was independently reanimated with ansa cervicalis. Results Facial reanimation was successful in both patients. Good resting tone and voluntary movement were achieved with a mild degree of synkinesis after 13 months. Patient 1 showed the Sunnybrook (SB) composite score 69 [76 (voluntary move- ment score) − 0 (resting symmetry score) − 7 (synkinesis score)]. In patient 2, the SB composite score was 76 (80 − 0 − 4, respectively). Conclusions In this trifurcation approach, cervical cutaneous plexus provides a long complex nerve graft, which allows bridging the gap between proximal FN stump and several peripheral branches without great expenditure.
[Show full text]
Specializations of Joints Between Vertebrae A. Atla
CRANIOVERTEBRAL JOINTS AND SUBOCCIPITAL REGION © 2019zillmusom I. CRANIOVERTEBRAL JOINTS - specializations of joints between vertebrae A. Atlanto-occipital joint: joint between atlas (vertebra C1) and occipital bone; movements - flexion - extension of the neck (nodding the head in "yes" movement). B. Atlanto-axial joint: joint between atlas (C1) and axis (C2); movement: rotation of atlas on axis (shaking head in "no" movement) C. Ligaments of joint - stabilize joints and protect medulla and spinal cord; some prevent excessive movement; some are extensions of ligaments of spinal column 1. Anterior Atlanto-Occipital membrane = extension of anterior longitudinal ligament - extends from atlas to occipital bone 2. Membrana Tectoria = extension of posterior longitudinal ligament of spinal column - extends from axis to occipital bone, posterior to cruciate ligament. 3. Posterior Atlanto-Occipital membrane = extension of ligamenta flava - extends from atlas to occipital bone 4. Cruciate (cruciform or cross) ligament - composed of 1) Transverse ligament of atlas - transverse band within vertebral canal which is attached to inner side of atlas; holds dens of axis against inner aspect of anterior arch of atlas; 2) Superior and inferior bands - upper and lower extensions from transverse ligament of atlas to occipital bone superiorly and to body of the axis inferiorly. Clinical note: Tear of Cruciate ligament of atlas can allow dens to be driven into spinal cord (resulting in quadriplegia) or medulla (resulting in death). Morbid note: Hanging someone:
[Show full text]
Comparative Study of Superficial Cervical Plexus Block and Nerve of Arnold Block with Intravenous Antiemetic Drugs Dexamethasone
Comparative Study of Superficial Cervical Plexus Block and Nerve of Arnold Block with Intravenous antiemetic drugs Dexamethasone and Ondansetron and Incidence of Post-operative Nausea Vomiting for Inner Ear Surgery Indiana University School of Medicine Riley Hospital for Children Principal Investigator: Malik Nouri, MD Co Investigator: Charles Yates, MD Version 2.0 Date: 01/27/2017 Page 1 of 12 Table of Contents: Study Schema 1.0 Background 2.0 Rationale and Specific Aims 3.0 Inclusion/Exclusion Criteria 4.0 Enrollment/Randomization 5.0 Study Procedures 6.0 Reporting of Adverse Events of Unanticipated Problems involving Risk to Participants or Others 7.0 Study Withdrawal/Discontinuation 8.0 Statistical Considerations 9.0 Privacy/Confidentiality Issues 10.0 Follow-up and Record Retention 11.0 Analysis of Results Page 2 of 12 1.0 Background Patients that undergo inner ear surgery often complain of postoperative nausea and vomiting (PONV) despite prophylactic antiemetic regiments with 5HT3 antagonists, steroids and vigorous hydration. Patients still experience this unpleasant feeling that may prolong hospital stay and can lead to nutritional issues such as dehydration and huge patient and family dissatisfaction. We would like to explore the use of regional anesthesia and potential antiemetic proprieties and compare it’s efficacy to the existing therapy. PONV is an unpleasant complication following anesthesia, it is well known that patients undergoing certain surgical procedures such as those involving the inner ear, the tympanomastoid cells, and the cochlear organ may be more prone to PONV. This complication can be anticipated in those instances and prophylactically treated with antiemetics, Vigorous hydration and cautious selection of anesthetic technique and avoidance of drugs known to promote nausea1, 2, 3.
[Show full text]
Mapping Sensory Nerve Communications Between Peripheral Nerve Territories
Clinical Anatomy 27:681–690 (2014) ORIGINAL COMMUNICATION Mapping Sensory Nerve Communications Between Peripheral Nerve Territories 1 2 1* ADIL LADAK, R. SHANE TUBBS, AND ROBERT J. SPINNER 1Department of Neurologic Surgery, Orthopedics and Anatomy, Mayo Clinic, Rochester, Minnesota 2Department of Neurosurgery, Children’s Hospital, Birmingham, Alabama The human cutaneous sensory map has been a work in progress over the past century, depicting sensory territories supplied by both the spinal and cranial nerves. Two critical discoveries, which shaped our understanding of cutaneous innervation, were sensory dermatome overlap between contiguous spinal levels and axial lines across areas where no sensory overlap exists. These concepts define current dermatome maps. We wondered whether the overlap between contiguous sensory territories was even tighter: if neural communications were present in the peripheral nerve territories consistently connecting contiguous spinal levels? A literature search using peer-reviewed articles and established anatomy texts was performed aimed at identifying the presence of communica- tions between sensory nerves in peripheral nerve territories and their relation- ship to areas of adjacent and non-adjacent spinal or cranial nerves and axial lines (lines of discontinuity) in the upper and lower limbs, trunk and perineum, and head and neck regions. Our findings demonstrate the consistent presence of sensory nerve communications between peripheral nerve territories derived from spinal nerves within areas of axial lines in the upper and lower limbs, trunk and perineum, and head and neck. We did not find examples of communications crossing axial lines in the limbs or lines of discontinuity in the face, but did find examples crossing axial lines in the trunk and perineum.
[Show full text]
Redalyc.Headaches and Pain Referred to the Teeth: Frequency And
RSBO Revista Sul-Brasileira de Odontologia ISSN: 1806-7727 [email protected] Universidade da Região de Joinville Brasil Franklin Molina, Omar; Huber Simião, Bruno Ricardo; Yukio Hassumi, Marcio; Iuata Rank, Rise Consolação; da Silva Junior, Fausto Félix; Alves de Carvalho, Adilson Headaches and pain referred to the teeth: frequency and potential neurophysiologic mechanisms RSBO Revista Sul-Brasileira de Odontologia, vol. 12, núm. 2, abril-junio, 2015, pp. 151- 159 Universidade da Região de Joinville Joinville, Brasil Available in: http://www.redalyc.org/articulo.oa?id=153041505002 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative ISSN: Electronic version: 1984-5685 RSBO. 2015 Apr-Jun;12(2):151-9 Original Research Article Headaches and pain referred to the teeth: frequency and potential neurophysiologic mechanisms Omar Franklin Molina1 Bruno Ricardo Huber Simião2 Marcio Yukio Hassumi3 Rise Consolação Iuata Rank4 Fausto Félix da Silva Junior5 Adilson Alves de Carvalho6 Corresponding author: Omar Franklin Molina Avenida Pará, 1.544 – Faculdade de Odontologia CEP 77400-000 – Gurupi – TO – Brasil E-mail: [email protected] 1 School of Dentistry (Orofacial Pain), UNIRG University Center – Gurupi – TO – Brazil. 2 School of Dentistry (Prosthodontics), UNIRG University Center – Gurupi – TO – Brazil. 3 School of Dentistry (Periodontics), UNIRG University Center – Gurupi – TO – Brazil. 4 School of Dentistry (Pedodontics), UNIRG University Center – Gurupi – TO – Brazil 5 School of Dentistry (Preventive Dentistry), UNIRG University Center – Gurupi – TO – Brazil 6 Private Practice – Goiânia – GO – Brazil.
[Show full text]