Isolated Dorsal Scapular Neuropathy Associated with Repetitive Minor
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Risk of Encountering Dorsal Scapular and Long Thoracic Nerves During Ultrasound-Guided Interscalene Brachial Plexus Block with Nerve Stimulator
Korean J Pain 2016 July; Vol. 29, No. 3: 179-184 pISSN 2005-9159 eISSN 2093-0569 http://dx.doi.org/10.3344/kjp.2016.29.3.179 | Original Article | Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Wonkwang Institute of Science, Iksan, *Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, University of Seonam College of Medicine, Jeonju, Korea Yeon Dong Kim, Jae Yong Yu*, Junho Shim*, Hyun Joo Heo*, and Hyungtae Kim* Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). -
Muscle Attachment Sites in the Upper Limb
This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Muscle Attachment Sites in the Upper Limb The Clavicle Pectoralis major Smooth superior surface of the shaft, under the platysma muscle Deltoid tubercle: Right clavicle attachment of the deltoid Deltoid Axillary nerve Acromial facet Trapezius Sternocleidomastoid and Trapezius innervated by the Spinal Accessory nerve Sternocleidomastoid Conoid tubercle, attachment of the conoid ligament which is the medial part of the Sternal facet coracoclavicular ligament Conoid ligament Costoclavicular ligament Acromial facet Impression for the Trapezoid line, attachment of the costoclavicular ligament Subclavian groove: Subclavius trapezoid ligament which binds the clavicle to site of attachment of the Innervated by Nerve to Subclavius which is the lateral part of the the first rib subclavius muscle coracoclavicular ligament Trapezoid ligament This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Scapula Trapezius Right scapula: posterior Levator scapulae Supraspinatus Deltoid Deltoid and Teres Minor are innervated by the Axillary nerve Rhomboid minor Levator Scapulae, Rhomboid minor and Rhomboid Major are innervated by the Dorsal Scapular Nerve Supraspinatus and Infraspinatus innervated by the Suprascapular nerve Infraspinatus Long head of triceps Rhomboid major Teres Minor Teres Major Teres Major -
Examination of the Shoulder Bruce S
Examination of the Shoulder Bruce S. Wolock, MD Towson Orthopaedic Associates 3 Joints, 1 Articulation 1. Sternoclavicular 2. Acromioclavicular 3. Glenohumeral 4. Scapulothoracic AC Separation Bony Landmarks 1. Suprasternal notch 2. Sternoclavicular joint 3. Coracoid 4. Acromioclavicular joint 5. Acromion 6. Greater tuberosity of the humerus 7. Bicipital groove 8. Scapular spine 9. Scapular borders-vertebral and lateral Sternoclavicular Dislocation Soft Tissues 1. Rotator Cuff 2. Subacromial bursa 3. Axilla 4. Muscles: a. Sternocleidomastoid b. Pectoralis major c. Biceps d. Deltoid Congenital Absence of Pectoralis Major Pectoralis Major Rupture Soft Tissues (con’t) e. Trapezius f. Rhomboid major and minor g. Latissimus dorsi h. Serratus anterior Range of Motion: Active and Passive 1. Abduction - 90 degrees 2. Adduction - 45 degrees 3. Extension - 45 degrees 4. Flexion - 180 degrees 5. Internal rotation – 90 degrees 6. External rotation – 45 degrees Muscle Testing 1. Flexion a. Primary - Anterior deltoid (axillary nerve, C5) - Coracobrachialis (musculocutaneous nerve, C5/6 b. Secondary - Pectoralis major - Biceps Biceps Rupture- Longhead Muscle Testing 2. Extension a. Primary - Latissimus dorsi (thoracodorsal nerve, C6/8) - Teres major (lower subscapular nerve, C5/6) - Posterior deltoid (axillary nerve, C5/6) b. Secondary - Teres minor - Triceps Abduction Primary a. Middle deltoid (axillary nerve, C5/6) b. Supraspinatus (suprascapular nerve, C5/6) Secondary a. Anterior and posterior deltoid b. Serratus anterior Deltoid Ruputure Axillary Nerve Palsy Adduction Primary a. Pectoralis major (medial and lateral pectoral nerves, C5-T1 b. Latissimus dorsi (thoracodorsal nerve, C6/8) Secondary a. Teres major b. Anterior deltoid External Rotation Primary a. Infraspinatus (suprascapular nerve, C5/6) b. Teres minor (axillary nerve, C5) Secondary a. -
Stichting Voor Ooglijders Prof. Dr. HJ
De publicatie van dit proefschrift werd mede mogelijk gemaakt met fmanciele steun van: Stichting voor Ooglijders Prof. Dr. H.J. Flieringa Stichting Medical Workshop BV Kabi Pharmacia Bournonville-Pharma BV Ter herinnering aan mijn vader Omslag: Henry Cannon I Ebbo Clerlo: CLINICAL ASPECTS AND ETIOLOGY OF FUCHS' HETEROCHROMIC CYCLITIS (KLINISCHE ASPECTEN EN ETIOLOGIE VAN DE HETEROCHROME CYCLITIS VAN FUCHS) proefschrift Ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de Rector Magnificus Prof. dr. P.W.C. Akkermans M. Lit. en volgens besluit van het College van Dekanen. De openbare verdediding zal plaatsvinden op woensdag 3 November 1993 om 15.45 uur. door Ellen Carolien La Heij geboren te Arnstelveen PROMOTIE-COMMISSIE PROMOTORES' Prof. dr. P.T.V.M. de Jong Prof. dr. A. Kijlstra OVERIGE LEDEN, Prof. dr. F.T. Bosman Prof. dr. H.A. Drexhage CONTENTS Chapter 1 1.1 General Introduction ........................ 7 1. 2 Aim of the Thesis_ ................... __ ...... 8 Chapter 2 Fuchs' Heterochromic Cyclitis: Review of the Literature (submitted for publication) 2.1 Historical Background ........................ 9 2.2 Terminology and Classification ............... 9 2. 3 Epidemiology. .11 2. 4 Clinical Features ........................... 11. 2.5 Histopathology of the Iris ................. 22 2. 6 Etiologic Mechanisms ........................ 25 2.7 Therapy and Prognosis .................... ... 37 Chapter 3 Clin~c~l analysis of Fuchs' heterochromic cycl1t1s ........................................ 49 (Doc Ophthalmol. 1991;78:225-235). Chapter 4 Treatment and prognosis of secondary glaucoma in Fuchs' heterochromic cyclitis ............... .... 61 (Am J Ophthalmol. 1993, in press) Chapter 5 Quantitative analysis of iris translucency in Fuchs' heterochromic cyclitis ................. .. 83 (Invest Ophthalmol & Vis Sci. -
Orphanet Report Series Rare Diseases Collection
Marche des Maladies Rares – Alliance Maladies Rares Orphanet Report Series Rare Diseases collection DecemberOctober 2013 2009 List of rare diseases and synonyms Listed in alphabetical order www.orpha.net 20102206 Rare diseases listed in alphabetical order ORPHA ORPHA ORPHA Disease name Disease name Disease name Number Number Number 289157 1-alpha-hydroxylase deficiency 309127 3-hydroxyacyl-CoA dehydrogenase 228384 5q14.3 microdeletion syndrome deficiency 293948 1p21.3 microdeletion syndrome 314655 5q31.3 microdeletion syndrome 939 3-hydroxyisobutyric aciduria 1606 1p36 deletion syndrome 228415 5q35 microduplication syndrome 2616 3M syndrome 250989 1q21.1 microdeletion syndrome 96125 6p subtelomeric deletion syndrome 2616 3-M syndrome 250994 1q21.1 microduplication syndrome 251046 6p22 microdeletion syndrome 293843 3MC syndrome 250999 1q41q42 microdeletion syndrome 96125 6p25 microdeletion syndrome 6 3-methylcrotonylglycinuria 250999 1q41-q42 microdeletion syndrome 99135 6-phosphogluconate dehydrogenase 67046 3-methylglutaconic aciduria type 1 deficiency 238769 1q44 microdeletion syndrome 111 3-methylglutaconic aciduria type 2 13 6-pyruvoyl-tetrahydropterin synthase 976 2,8 dihydroxyadenine urolithiasis deficiency 67047 3-methylglutaconic aciduria type 3 869 2A syndrome 75857 6q terminal deletion 67048 3-methylglutaconic aciduria type 4 79154 2-aminoadipic 2-oxoadipic aciduria 171829 6q16 deletion syndrome 66634 3-methylglutaconic aciduria type 5 19 2-hydroxyglutaric acidemia 251056 6q25 microdeletion syndrome 352328 3-methylglutaconic -
Dorsal Scapular Nerve Neuropathy: a Narrative Review of the Literature Brad Muir, Bsc.(Hons), DC, FRCCSS(C)1
ISSN 0008-3194 (p)/ISSN 1715-6181 (e)/2017/128–144/$2.00/©JCCA 2017 Dorsal scapular nerve neuropathy: a narrative review of the literature Brad Muir, BSc.(Hons), DC, FRCCSS(C)1 Objective: The purpose of this paper is to elucidate Objectif : Ce document a pour objectif d’élucider this little known cause of upper back pain through a cette cause peu connue de douleur dans le haut du narrative review of the literature and to discuss the dos par un examen narratif de la littérature, ainsi que possible role of the dorsal scapular nerve (DSN) in de discuter du rôle possible du nerf scapulaire dorsal the etiopathology of other similar diagnoses in this (NSD) dans l’étiopathologie d’autres diagnostics area including cervicogenic dorsalgia (CD), notalgia semblables dans ce domaine, y compris la dorsalgie paresthetica (NP), SICK scapula and a posterolateral cervicogénique (DC), la notalgie paresthésique (NP), arm pain pattern. l’omoplate SICK et un schéma de douleur postéro- Background: Dorsal scapular nerve (DSN) latérale au bras. neuropathy has been a rarely thought of differential Contexte : La neuropathie du nerf scapulaire dorsal diagnosis for mid scapular, upper to mid back and (NSD) constitue un diagnostic différentiel rare pour la costovertebral pain. These are common conditions douleur mi-scapulaire, costo-vertébrale et au bas/haut presenting to chiropractic, physiotherapy, massage du dos. Il s’agit de troubles communs qui surgissent therapy and medical offices. dans les cabinets de chiropratique, de physiothérapie, de Methods: The methods used to gather articles for this massothérapie et de médecin. paper included: searching electronic databases; and Méthodologie : Les méthodes utilisées pour hand searching relevant references from journal articles rassembler les articles de ce document comprenaient la and textbook chapters. -
Board Review for Anatomy
Board Review for Anatomy John A. McNulty, Ph.D. Spring, 2005 . LOYOLA UNIVERSITY CHICAGO Stritch School of Medicine Key Skeletal landmarks • Head - mastoid process, angle of mandible, occipital protuberance • Neck – thyroid cartilage, cricoid cartilage • Thorax - jugular notch, sternal angle, xiphoid process, coracoid process, costal arch • Back - vertebra prominence, scapular spine (acromion), iliac crest • UE – epicondyles, styloid processes, carpal bones. • Pelvis – ant. sup. iliac spine, pubic tubercle • LE – head of fibula, malleoli, tarsal bones Key vertebral levels • C2 - angle of mandible • C4 - thyroid notch • C6 - cricoid cartilage - esophagus, trachea begin • C7 - vertebra prominence • T2 - jugular notch; scapular spine • T4/5 - sternal angle - rib 2 articulates, trachea divides • T9 - xiphisternum • L1/L2 - pancreas; spinal cord ends. • L4 - iliac crest; umbilicus; aorta divides • S1 - sacral promontory Upper limb nerve lesions Recall that any muscle that crosses a joint, acts on that joint. Also recall that muscles innervated by individual nerves within compartments tend to have similar actions. • Long thoracic n. - “winged” scapula. • Upper trunk (C5,C6) - Erb Duchenne - shoulder rotators, musculocutaneous • Lower trunk (C8, T1) - Klumpke’s - ulnar nerve (interossei muscle) • Radial nerve – (Saturday night palsy) - wrist drop • Median nerve (recurrent median) – thenar compartment - thumb • Ulnar nerve - interossei muscles. Lower limb nerve lesions Review actions of the various compartments. • Lumbosacral lesions - usually -
Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies
Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies Zachary Simmons, MD* KEYWORDS Brachial plexus Brachial plexopathy Axillary nerve Musculocutaneous nerve Suprascapular nerve Nerve conduction studies Electromyography KEY POINTS The brachial plexus provides all motor and sensory innervation of the upper extremity. The plexus is usually derived from the C5 through T1 anterior primary rami, which divide in various ways to form the upper, middle, and lower trunks; the lateral, posterior, and medial cords; and multiple terminal branches. Traction is the most common cause of brachial plexopathy, although compression, lacer- ations, ischemia, neoplasms, radiation, thoracic outlet syndrome, and neuralgic amyotro- phy may all produce brachial plexus lesions. Upper extremity mononeuropathies affecting the musculocutaneous, axillary, and supra- scapular motor nerves and the medial and lateral antebrachial cutaneous sensory nerves often occur in the context of more widespread brachial plexus damage, often from trauma or neuralgic amyotrophy but may occur in isolation. Extensive electrodiagnostic testing often is needed to properly localize lesions of the brachial plexus, frequently requiring testing of sensory nerves, which are not commonly used in the assessment of other types of lesions. INTRODUCTION Few anatomic structures are as daunting to medical students, residents, and prac- ticing physicians as the brachial plexus. Yet, detailed understanding of brachial plexus anatomy is central to electrodiagnosis because of the plexus’ role in supplying all motor and sensory innervation of the upper extremity and shoulder girdle. There also are several proximal upper extremity nerves, derived from the brachial plexus, Conflicts of Interest: None. Neuromuscular Program and ALS Center, Penn State Hershey Medical Center, Penn State College of Medicine, PA, USA * Department of Neurology, Penn State Hershey Medical Center, EC 037 30 Hope Drive, PO Box 859, Hershey, PA 17033. -
A Cadaveric Investigation of the Dorsal Scapular Nerve
Hindawi Publishing Corporation Anatomy Research International Volume 2016, Article ID 4106981, 5 pages http://dx.doi.org/10.1155/2016/4106981 Research Article A Cadaveric Investigation of the Dorsal Scapular Nerve Vuvi H. Nguyen,1 Hao (Howe) Liu,2 Armando Rosales,1 and Rustin Reeves1 1 Center for Anatomical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA 2Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA Correspondence should be addressed to Rustin Reeves; [email protected] Received 24 June 2016; Accepted 19 July 2016 Academic Editor: Udo Schumacher Copyright © 2016 Vuvi H. Nguyen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Compression of the dorsal scapular nerve (DSN) is associated with pain in the upper extremity and back. Even though entrapment of the DSN within the middle scalene muscle is typically the primary cause of pain, it is still easily missed during diagnosis. The purpose of this study was to document the DSN’s anatomy and measure the oblique course it takes with regard to the middle scalene muscle. From 20 embalmed adult cadavers, 23 DSNs were documented regarding the nerve’s spinal root origin, anatomical route, and muscular innervations. A transverse plane through the laryngeal prominence was established to measure the distance of the DSN from this plane as it enters, crosses, and exits the middle scalene muscle. Approximately 70% of the DSNs originated from C5, with 74% piercing the middle scalene muscle. -
Muscles of the Upper Limb.Pdf
11/8/2012 Muscles Stabilizing Pectoral Girdle Muscles of the Upper Limb Pectoralis minor ORIGIN: INNERVATION: anterior surface of pectoral nerves ribs 3 – 5 ACTION: INSERTION: protracts / depresses scapula coracoid process (scapula) (Anterior view) Muscles Stabilizing Pectoral Girdle Muscles Stabilizing Pectoral Girdle Serratus anterior Subclavius ORIGIN: INNERVATION: ORIGIN: INNERVATION: ribs 1 - 8 long thoracic nerve rib 1 ---------------- INSERTION: ACTION: INSERTION: ACTION: medial border of scapula rotates scapula laterally inferior surface of scapula stabilizes / depresses pectoral girdle (Lateral view) (anterior view) Muscles Stabilizing Pectoral Girdle Muscles Stabilizing Pectoral Girdle Trapezius Levator scapulae ORIGIN: INNERVATION: ORIGIN: INNERVATION: occipital bone / spinous accessory nerve transverse processes of C1 – C4 dorsal scapular nerve processes of C7 – T12 ACTION: INSERTION: ACTION: INSERTION: stabilizes / elevates / retracts / upper medial border of scapula elevates / adducts scapula acromion / spine of scapula; rotates scapula lateral third of clavicle (Posterior view) (Posterior view) 1 11/8/2012 Muscles Stabilizing Pectoral Girdle Muscles Moving Arm Rhomboids Pectoralis major (major / minor) ORIGIN: INNERVATION: ORIGIN: INNERVATION: spinous processes of C7 – T5 dorsal scapular nerve sternum / clavicle / ribs 1 – 6 dorsal scapular nerve INSERTION: ACTION: INSERTION: ACTION: medial border of scapula adducts / rotates scapula intertubucular sulcus / greater tubercle flexes / medially rotates / (humerus) adducts -
Scapular Winging Secondary to Apparent Long Thoracic Nerve Palsy in a Young Female Swimmer
THIEME Case Report e57 Scapular Winging Secondary to Apparent Long Thoracic Nerve Palsy in a Young Female Swimmer Shiro Nawa1 1 Department of Judo Seifuku and Health Sciences, Faculty of Health Address for correspondence Shiro Nawa, MS, Department of Judo Promotional Sciences, Tokoha University, Hamamatsu City, Seifuku and Health Sciences, Faculty of Health Promotional Sciences, Shizuoka-ken, Japan Tokoha University, 1230 Miyakoda-cho, Kita-ku, Hamamatsu City, Shizuoka-ken, 431-2102, Japan J Brachial Plex Peripher Nerve Inj 2015;10:e57–e61. (e-mail: [email protected]). Abstract Background In neurological diseases, winging of the scapula occurs because of serratus anterior muscle dysfunction due to long thoracic nerve palsy, or trapezius muscle dysfunction due to accessory nerve palsy. Several sports can cause long thoracic nerve palsy, including archery and tennis. To our knowledge, this is the first report of long thoracic nerve palsy in an aquatic sport. Objective The present study is a rare case of winging of the scapula that occurred during synchronized swimming practice. Methods The patient’s history with the present illness, examination findings, rehabili- tation progress, and related medical literature are presented. Keywords Results A 14-year-old female synchronized swimmer had chief complaints of muscle ► winging of the weakness, pain, and paresthesia in the right scapula. Upon examination, marked scapula winging of the scapula appeared during anterior arm elevation, as did floating of the ► accessory nerve palsy superior angle. After 1 year of therapy, right shoulder girdle pain and paresthesia had ► long thoracic nerve disappeared; however, winging of the scapula remained. palsy Conclusions Based on this observation and the severe pain in the vicinity of the second ► synchronized dorsal rib, we believe the cause was damage to the nerve proximal to the branch arising swimming from the upper nerve trunk that innervates the serratus anterior. -
Occupational Shoulder.Pdf
ORIGINAL PAPER International Journal of Occupational Medicine and Environmental Health 2021;34(3):427 – 435 https://doi.org/10.13075/ijomeh.1896.011634 OCCUPATIONAL SHOULDER DISABILITY: FUNCTIONAL RECOVERY AFTER DECOMPRESSION AND NEUROLYSIS OF THE UPPER BRACHIAL PLEXUS AND THE LONG THORACIC NERVE RAHUL K. NATH, ALYSSA M. LEAL, and CHANDRA SOMASUNDARAM Texas Nerve and Paralysis Institute, Houston, USA Research Division Abstract Objectives: This study aimed to assess the surgical outcomes of patients with work-related upper extremity musculoskeletal disorders (UE-MSDs) who failed conservative treatment. Material and Methods: This was a retrospective study of 17 patients who had work-related UE-MSDs and under- went the following surgeries and follow-up evaluations: decompression, external and internal neurolysis of the upper trunk of the brachial plexus and the long thoracic nerve (LTN), and a partial resection of the anterior and middle scalene muscle. A detailed history of clinical presentation including pain, physical and clinical examinations of the extent of scapular winging (ESW), and upper extremity anatomical postures, such as active forward arm flexion and shoulder abduction, were recorded before and after 3 months of the surgery. Nerve conduction velocity and electromyography exami- nation reports were obtained to assess the sensory or motor loss of the nerve injury before their operation. Results: All 17 patients included in this report showed some improvement anatomically in the scapula appearance and functionally in their shoulder movements. More specifically, 9 (53%) patients got a restored to near healthy appearance of the scapula, and 11 (65%) patients recovered a full range of motion, 180° post-surgically. Over- all, the mean shoulder flexion and abduction improved to 157±37.5° and 155±40.2° after the surgery from 106±30.2° and 111±34.8°, respectively (p < 0.0001).