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Download USW Scan Plan Infra-Clavicular to Terminal Nerves
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Scan Plan Ultrasound Workshop Ultrasound Imaging for Regional Anesthesia A Practical Guide The Infraclavicular Region View Superficial to Deep page 71 Pectoralis Major Pectoralis Minor Axillary Artery Axillary Vein Caudad to Artery Cords: Lateral Posterior and Medial Move Cephalad to view Clavicle Move Lateral to view the Coracoid Process Arm Abduction Maneuver to 90 degrees brings the cords closer together p74 View the rib with the Curvilinear or increase the depth using the linear p74 The Axillary Region p84 Axillary Artery Veins with less transducer pressure: Axillary and Basillic p88 Humerus Muscles: Coracobrachialis, Bicep, Tricep Long Head, Tricep Lateral Head Latisimus Dorsi Tendon, Teres Major Terminal Nerves: Musculocutaneous Median, Ulnar and Radial (sometimes it is easier to block the radial first) Trace the Nerves down the arm to follow their course Musculocutaneous nerve in plane between the bicep and coracobrachialis The Mid Humeral Region p91 Junction of upper third and middle third Brachial Artery: a 2nd smaller artery is a high takeoff of the radial artery p94 Veins with less transducer pressure Humerus Terminal Nerves Musculocutaneous, Median, Ulnar and Radial and Deep Brachial Artery page 101 and 102 The Elbow Region Musculocutaneous p97 Median Brachial Artery page 98 and 99 Radial Muscles: Brachioradialis and Brachialis page 102 and 103 Ulnar Medial Epicondyle page 104 and 105 View the Forearm nerves 1. Radial Nerve a. Scan Path: Scan from the cubital fossa lateral to the bicep tendon in a spiral path to the mid humerus lateral and behind the deltoid insertion b. Start at the cubital fossa and i. Anatomy recall: 1. the radial nerve is in between the brachialis and the brachio-radialis 2. from the axilla, it has swung around from behind the humerus ii. Place probe on lateral aspect of the cubital fossa by first placing your thumb or finger on the bicep tendon and then placing the probe to the lateral side of that c. End at the Mid Humerus i. Anatomy recall: 1. The course will be in a spiral around the lower arm to a point lateral to the deltoid insertion. 2. Using the right hand on the patient’s left arm put your hand at the deltoid with your thumb on the medial side and your four fingers on the lateral side 3. The probe will see the nerve under the four fingers d. Note the typical appearance of the radial nerve in these two locations i. Cubital Fossa Radial nerve in between the two muscles over the bones of the forearm ii. Mid Humerus 1. The radial nerve on the surface of the humerus 2. with a curved fascia that represents the path of the cutaneous nerves departure from the radial nerve 3. accompanied by an artery the circumflex humerus artery 2. Median nerve a. Scan Path: Start at the cubital fossa medial to the bicep tendon and over the pulse of the brachial artery and scan down the forearm to the wrist b. Start at the cubital fossa i. Anatomy recall: 1. The median nerve is medial to the brachial artery 2. From there it will descend on the ultrasound screen and then rise to its location at the wrist
