Retroclavicular

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BACKGROUND: The coracoid approach is recognized as the simplest approach to perform brachial plexus anaesthesia, but needle visualization needs to be improved. With a different needle entry point, the retroclavicular approach confers a perpendicular angle between the ultrasound and the needle, which theoretically enhances needle visualization. This trial compares these two techniques. The leading hypothesis is that the retroclavicular approach is comparable to the infraclavicular coracoid approach in general aspects, but needle visualization is better with this novel approach...

PURPOSE: This prospective randomized study compared the coracoid and retroclavicular approaches to ultrasound-guided infraclavicular brachial plexus block (IBPB) in terms of needle tip and shaft visibility and quality of block. We hypothesized that the retroclavicular approach would increase needle tip and shaft visibility and decrease the number of needle passes compared to the coracoid approach. METHODS: A total of 100 adult patients who received IBPB block for upper limb surgery were randomized into two groups: a coracoid approach group (group C) and a retroclavicular approach group (group R)...

The America Society of Anesthesiology guidelines recommend multimodal analgesia that combines regional anesthetic techniques with pharmacotherapy to improve peri-procedural pain management and reduce opioid related complications. Commonly performed emergency procedures of the upper extremity such as fracture and dislocation reduction, wound debridement, and abscess incision and drainage are ideal candidates for ultrasound-guided (USG) regional anesthesia of the brachial plexus. However, adoption of regional anesthesia by emergency practitioners has been limited by concerns for potential complications and perceived technical difficulty...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002-2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve. Among these, 110 had adequate follow-up and were included in this study...

BACKGROUND AND OBJECTIVES: The aim of this feasibility study was to determine the success rate (sensory and surgical) of the novel retroclavicular block and to thoroughly describe the technique. In addition, needle tip and shaft visibility, needling time, procedural discomfort, motor block success rate, patient satisfaction at 48-hour follow-up, and complications were also recorded. METHODS: Fifty patients scheduled for distal upper limb surgery received an in-plane, single-shot, ultrasound-guided retroclavicular block with 40 mL of mepivacaine 1...

A 77-year-old woman underwent thyroidectomy and (131)I remnant ablation for tall-cell differentiated cancer (DTC) of the left lobe. Detectable Tg levels (4.1 μg/L) under TSH suppression, with undetectable serum Tg-antibody levels, prompted neck ultrasonography, which revealed a lymph node in the left laterocervical region and in the right retroclavicular region. (18)F-FDG PET/CT showed uptake by the left lymph node. (18)F-choline PET/CT showed increased uptake by both lymph nodes. Histopathology revealed DTC solid metastasis in the left lymph node and solid and cystic metastasis in the right one...

Surgical exploration and reconstruction of the brachial plexus requires adequate exposure beyond the zone of injury. In the case of extensive lesions, some authors advocate clavicle osteotomy for an extensile approach. Such an osteotomy introduces further morbidity and may impact upon the delicate nerve reconstruction. A new simple but effective method of clavicle elevation is described that provides access to the retroclavicular brachial plexus during exploration for birth brachial plexus palsy.

The sternoclavicular joint (SCJ) is a pivotal articulation in the linked system of the upper limb girdle, providing load-bearing in compression while resisting displacement in tension or distraction at the manubrium sterni. The SCJ and acromioclavicular joint (ACJ) both have a small surface area of contact protected by an intra-articular fibrocartilaginous disc and are supported by strong extrinsic and intrinsic capsular ligaments. The function of load-sharing in the upper limb by bulky periscapular and thoracobrachial muscles is extremely important to the longevity of both joints...

The standard transclavicular approach allows only limited and narrow exposure if the cervical thoracic region for the resection of tumors of the brachial plexus is involved. We report 2 cases of retroclavicular tumors of the brachial plexus. We performed a complete resection in both cases using the transmanubrial transclavicular approach. This approach consists of retracting an osteomuscular flap that involves the medial portion of the clavicle, part of the sternal manubrium, the sternoclavicular joint, and the sternocleidomastoid muscle...

UNLABELLED: The enhanced absorption of X-rays in calcified structures is a basic prerequisite for performing conventional bone radiography. On the other hand, nothing has been reported on possible absorption effects of 'calcifications' as frequent findings in thyroid nodules or in the sternal bone / sternoclavicular joints. This may be caused by the general opinion, that the high energy of 99mTc-photons (140 keV) do not make visible absorptions effects very likely. PATIENTS, METHODS: To prove possible absorption effects of calcifications on thyroid scintigraphy experimentally, effects of calcium absorbers were tested on a technetium flood phantom...

BACKGROUND: Adult brachial plexus reconstruction remains a dilemma to the reconstructive microsurgeon, especially when attempting to reconstruct cases of total root avulsion. A significant improvement in results has been achieved by a better understanding of various methods of reconstruction and prolonged postoperative rehabilitation. METHODS: This study was based on review of the literature and personal experience with 819 patients operated on between 1986 and 2003...

AIMS: To determine the frequency of supradiaphragmatic lymph nodes that receive lymph from the lower limbs and the intraabdominal organs. METHODS: Three hundred and thirty-four bipedal lymphoscintigraphy results of the lower limbs were reviewed. RESULTS: Lymph nodes were visualized in only the supraclavicular/retroclavicular (SRC) area in 113 cases (33.2%, 109 on the left and 4 on the right), in only the mediastinum in 5 cases (1.5%), in the mediastinum and the left SRC area in 18 cases (5...

Central venous catheterisation may sometimes be associated with life-threatening complications. Of these, subclavian artery puncture (infraclavicular approach), though seldom, (incidence 1-2%) following accidental arterial cannulation, may lead to arterial occlusion, embolism, pseudoaneurysms, vessel laceration or dissection or fatal hemorrhaging. Such complications may be even more severe in critically ill patients requiring systemic anticoagulation therapy or those with acute coagulation dysfunction. The authors report a case of an accidental cannulation of the subclavian artery with a central catheter and its successful removal using an endovascular cover stent positioned via a percutaneous approach...

The anatomy of the suprascapular nerve is important to surgeons when focal nerve lesions necessitate surgical repair. Recent experience with a patient who had a complete suprascapular nerve lesion in the retroclavicular region (combined with axillary and musculocutaneous nerve lesions) is presented to illustrate that successful direct nerve repair is possible despite resection of a neuroma. Specifically, we found that neurolysis and mobilization of the suprascapular nerve and release of the superior transverse scapular ligament provided the necessary nerve length to achieve direct nerve repair after the neuroma was removed...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.