New insights into pathways of the dorsal scapular nerve and artery for selective dorsal scapular nerve blockade
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Background: The aim of this study was to clarify the topographical relationships between the dorsal scapular nerve (DSN) and the dorsal scapular artery (DSA) in the interscapular region to identify safe and convenient injection points related to DSN blockade. Methods: Thirty shoulders of embalmed Korean cadavers and 50 live subjects were used for dissection and ultrasound (US) analysis. Results: The running patterns of the DSA and DSN in the interscapular region were classified into 3 types. Type I was defined as nerves that were medial to the artery and parallel without changing location (80.0% of specimens). In type II (13.3%), the nerve and artery traversed one another only one time over their entire length. In type III (6.7%), the nerve and artery traversed one another, resembling a twist. Above the level of the scapular spine, the nerve was always medial to the artery. Below the scapular spine, the number of arteries was obviously decreased. Most of the arteries were lateral to the medial border of the scapula, except at the level of the superior angle of the scapula artery (SA). The positional tendency of the DSN toward the medial or lateral sides from the medial border of the scapula was similar. In US imaging of live subjects, the DSA was most observed at the level of the SA (94.0%). Conclusions: Results of this study enhance the current knowledge regarding the pathway of the DSN and DSA and provide helpful information for selective diagnostic nerve blocks in the interscapular region.
Abstract
Background: The aim of this study was to clarify the topographical relationships between the dorsal scapular nerve (DSN) and the dorsal scapular artery (DSA) in the interscapular region to identify safe and convenient injection points related to DSN blockade. Methods: Thirty shoulders of embalmed Korean cadavers and 50 live subjects were used for dissection and ultrasound (US) analysis. Results: The running patterns of the DSA and DSN in the interscapular region were classified into 3 types. Type I was defined as nerves that were medial to the artery and parallel without changing location (80.0% of specimens). In type II (13.3%), the nerve and artery traversed one another only one time over their entire length. In type III (6.7%), the nerve and artery traversed one another, resembling a twist. Above the level of the scapular spine, the nerve was always medial to the artery. Below the scapular spine, the number of arteries was obviously decreased. Most of the arteries were lateral to the medial border of the scapula, except at the level of the superior angle of the scapula artery (SA). The positional tendency of the DSN toward the medial or lateral sides from the medial border of the scapula was similar. In US imaging of live subjects, the DSA was most observed at the level of the SA (94.0%). Conclusions: Results of this study enhance the current knowledge regarding the pathway of the DSN and DSA and provide helpful information for selective diagnostic nerve blocks in the interscapular region.
참고문헌 (17)
- Tubbs RS, "Surgical anatomy of the dorsal scapular nerve", J Neurosurg, 102, pp.910~911 (2005)
- 김연동, "Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator", The Korean Journal of Pain, 29(3), pp.179~184 (2016), 대한통증학회
- Sultan HE, "Role of dorsal scapular nerve entrapment in unilateral interscapular pain", Arch Phys Med Rehabil, 94, pp.1118~1125 (2013)
- Srikumaran U, "Scapular winging : a great masquerader of shoulder disorders : AAOS exhibit selection", J Bone Joint Surg Am, 96, pp.e122~ (2014)
- Akgun K, "Winged scapula caused by a dorsal scapular nerve lesion : a case report", Arch Phys Med Rehabil, 89, pp.2017~2020 (2008)
- Haim K, "Dorsal scapular nerve block : description of technique and report of a case", Anesthesiology, 78, pp.361~363 (1993)
- Auyong DB, "Selective blockade of the dorsal scapular nerve for scapula surgery", J Clin Anesth, 26, pp.684~687 (2014)
- Chang KV, "Sonographic tracking of trunk nerves : essential for ultrasound-guided pain management and research", J Pain Res, 10, pp.79~88 (2017)
- Ballyns JJ, "Objective sonographic measures for characterizing myofascial trigger points associated with cervical pain", J Ultrasound Med, 30, pp.1331~1340 (2011)
- Maigne JY, "Dorsal thoracic pain in manual medicine", J Orthop Med, 24, pp.102~103 (2002)
- Martin RM, "Scapular winging : anatomical review, diagnosis, and treatments", Curr Rev Musculoskelet Med, 1, pp.1~11 (2008)
- Debeer P, "Scapular winging : an unusual complication of bracing in idiopathic scoliosis", Clin Orthop Relat Res, 461, pp.258~261 (2007)
- Benedetti MG, "Winged scapula caused by rhomboid paralysis : a case report", Joints, 4, pp.247~249 (2017)
- Martin RM, "Scapular winging : anatomical review, diagnosis, and treatments", Curr Rev Musculoskelet Med, 1, pp.1~11 (2008)
- Hanson NA, "Systematic ultrasound identification of the dorsal scapular and long thoracic nerves during interscalene block", Reg Anesth Pain Med, 38, pp.54~57 (2013)
- Urmey WF, "One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography", Anesth Analg, 72, pp.498~503 (1991)
- Christ S, "Superficial cervical plexus neuropathy after single-injection interscalene brachial plexus block", Anesth Analg, 109, pp.2008~2011 (2009)