#plexus axilla | Explore Tumblr posts and blogs

kingdomjust · 3 years ago

Text

Radia nerve

Surgical procedures such as stabilization of an acute humeral fracture with humeral nailing can also cause radial neuropathies. The severity of the neuropathy depends on the level of the injury. Wrist drop is the most common presentation. Radial neuropathies occur from injury to the radial nerve due to compression, ischemia, fractures to the arm, or penetrating wounds. Muscle overuse may cause compression of the radial nerve anywhere along its path, but most commonly occurs over the elbow as it passes through the radial tunnel. Treatment for radial tunnel syndrome can be conservative or surgical if non-operative therapy fails. Radial Tunnel Syndrome typically occurs secondary to overuse or repetitive movements from pushing, pulling, gripping, pinching, or bending at the wrist typically from a job or playing sports. Less commonly these symptoms can occur at the dorsal aspect of the wrist or hand. Radial Tunnel Syndrome presents with symptoms including fatigue or dull, aching pain at the proximal portion of the forearm during use. The following is a list of the motor and cutaneous sensory functions of the radial nerve. The superficial branch then courses dorsally over the distal radius over the anatomical snuffbox to innervate the posterior lateral three and a half digits (the thumb, index, middle, and lateral half of the ring fingers) and the associated hand area. The superficial branch follows the radial artery inferiorly to the anterolateral portion of the radius, deep to the brachioradialis muscle. The deep branch is a motor branch that passes between the heads of the supinator muscle and becomes the posterior interosseous nerve to innervate the muscles of the posterior compartment of the forearm. Here, the radial nerve separates into the deep and superficial branches. The radial nerve then passes over the lateral epicondyle into the cubital fossa and forearm. After giving these two sensory branches, the radial artery passes through the lateral intermuscular septum to infiltrate the anterior compartment of the forearm between the brachialis and brachioradialis muscles. The posterior cutaneous nerve of the antebrachium also perforates through the lateral head of the triceps but continues to innervate a posterior strip of the forearm. At this point, the radial nerve gives a motor branch to the lateral head of the triceps brachii followed by two sensory branches: the inferior lateral cutaneous nerve of the arm which perforates through the lateral head of the triceps and the posterior cutaneous nerve of the forearm. After passing through the triangular interval, the radial nerve descends the radial groove before laterally wrapping around the humerus. This sensory branch is called the posterior cutaneous nerve of the arm which supplies cutaneous sensory innervation to a portion of the distal posterior arm. These motor branches innervate the medial and long heads of the triceps. It passes with the deep brachial artery and gives two motor branches and one sensory branch before traversing the triangular interval. The radial nerve derives from the posterior cord of the brachial plexus and exits the axilla posteriorly the brachial artery. It courses from the axilla to the posterior compartment of the arm, then into the anterior compartment of the arm, and continues into the posterior compartment of the forearm. The radial nerve is formed as a continuation of the posterior cord of the brachial plexus and arises from the C5-T1 nerve fibers.

#Radia nerve

0 notes

photosmains · 3 years ago

Text

Radia nerve

#Radia nerve skin#

It gives sensory supply to dorsal aspect of hand, dorsal aspect of thumb, index finger, middle finger and lateral side of ring finger except the nail beds, which are supplied by proper digital branches of median nerve. It crosses brachioradialis to enter posterior of forearm near the back of the wrist and supply dorsum of hand.

The superficial branch of the radial nerve is widely separated from the radial artery in the upper one third of the forearm, closely related to radial artery in the middle third of the forearm, and in the lower third, it descends in the forearm under the tendon of brachioradialis.

In the forearm, it is divided into a superficial branch (primarily sensory) and a deep branch (primarily motor). The radial nerve also gives articular branches to supply the elbow joint. In the radial sulcus, it gives off lower lateral cutaneous nerve of the arm and posterior cutaneous nerve of the forearm.

#Radia nerve skin#

Ībove the radial sulcus, the radial nerve gives off posterior cutaneous nerve of the arm which supplies the skin at the back of the arm. After it emerges out from the radial sulcus, it supplies the brachialis, brachioradialis and extensor carpi radialis longus. Radial nerve gives out muscular branches to supply the long head, medial head, and lateral head of triceps brachii muscles before and during its course in the radial sulcus. Then, it descends down to cross the lateral epicondyle of the humerus where the nerve terminates by branching itself into superficial and deep branch which continues into cubital fossa and then into the forearm. It travel downwards together with profunda brachii artery, between the lateral and medial heads of triceps brachii until it reaches the lateral side the arm at 5 cm below the deltoid tuberosity where it pierces the lateral intermuscular septum to reach the anterior compartment of the arm. In the arm, it runs behind the brachial artery and then enters the lower triangular space to reach the radial sulcus of back of the humerus. From the brachial plexus, it travels behind the third part of the axillary artery (part of the axillary artery distal to the pectoralis minor). The radial nerve originates from the posterior cord of the brachial plexus with root values of C5 to C8 and T1. It goes through the arm, first in the posterior compartment of the arm, and later in the anterior compartment of the arm, and continues in the posterior compartment of the forearm. The radial nerve originates as a terminal branch of the posterior cord of the brachial plexus. Radial nerve of the right axilla, posterior view This nerve was historically referred to as the musculospiral nerve. The radial nerve divides into a deep branch, which becomes the posterior interosseous nerve, and a superficial branch, which goes on to innervate the dorsum (back) of the hand. The radial nerve and its branches provide motor innervation to the dorsal arm muscles (the triceps brachii and the anconeus) and the extrinsic extensors of the wrists and hands it also provides cutaneous sensory innervation to most of the back of the hand, except for the back of the little finger and adjacent half of the ring finger (which are innervated by the ulnar nerve). It originates from the brachial plexus, carrying fibers from the ventral roots of spinal nerves C5, C6, C7, C8 & T1. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin. The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb.

#Radia nerve

0 notes

rh35211 · 4 years ago

Text

The median nerve, colloquially known as the "eye of the hand," is one of the three major nerves of the forearm and hand. It courses from the brachial plexus in the axilla to innervate the intrinsic muscles of the hand.

The median artery arises posterior to the pronator teres muscle, whereupon it turns medially to accompany the median nerve along its course in the distal two-thirds of the forearm, where it travels between flexor digitorum superficialis and flexor digitorum profundus.

Arteries (in red) are the blood vessels that deliver blood to the body. Veins (in blue) are the blood vessels that return blood to the heart.

0 notes

henrymatyn05 · 4 years ago

Text

What Is Erb’s Palsy?

Erb’s palsy is a form of childbirth injury that causes damage to the brachial plexus. The brachial plexus is made up of five groups of nerve fibers that originate in the spinal cord and intertwine and exchange as they travel to the axilla (arm pit region). Damage to these fibers during childbirth can cause loss of sensation as well as muscle weakness or paralysis in the shoulder and upper extremity muscles. Erb's palsy is a disorder in which the upper portion of the plexus is affected. Shoulder and elbow movements are weakened as a result of this injury.

Common symptoms of Erb’s palsy include:

Weakness in one arm.

Arm is bent at elbow and held against body.

Decreased in grip strength in hand of the affected side.

Numbness in arm.

Impaired circulatory, muscular and nervous development.

Partial or total paralysis of the arm.

If you think your child has Erb's palsy as a result of medical malpractice, you can seek legal advice from an erbs palsy lawyer right away.

1 note · View note

science-online · 4 years ago

Link

0 notes

stefanduell · 6 years ago

Photo

THE BRACHIAL PLEXUS ⠀ [NEUROANATOMY] ⠀ @StefanDuell x @DrJoeMuscolino ⠀ The brachial plexus is a network of nerve fibres that supplies the skin and musculature of the upper limb. It begins in the root of the neck, passes through the axilla and runs through the entire upper extremity. ⠀ As you know from my previous posts about Thoracic Outlet Syndrome, compression of the medial, lateral and posterior cords of the brachial plexus can occur between the anterior and middle scalenes, the first rib and clavicle and below the pectoralis minor muscle. ⠀ The brachial plexus originates from five nerve ROOTS: C5, C6, C7, C8, and T1. ⠀ These nerve roots coalesce to form three TRUNKS: Superior, Middle and Inferior. ⠀ The trunks divide to form six DIVISIONS: An anterior and posterior division for each of the three trunks. ⠀ The divisions coalesce to form three CORDS: Medial, lateral and posterior. ⠀ Then the cords form five terminal BRANCHES: median, radial, ulnar, axillary and musculocutaneous. ⠀ Pic 5 is a great illustration which will help you to learn the brachial plexus easily! This piece of artwork by @DrJoeMuscolino is drawn like a tree. The names of the components of the brachial plexus (roots, trunks, branches) are all parts of a tree. Even the term cord can be related to a tree, as in a cord of wood. ⠀ Video 1 explains the components of the brachial plexus. ⠀ Video 2 explains the innervation of the radial nerve which is a terminal branch nerve of the brachial plexus so it is shown as a branch of the tree. Each muscle innervated by the radial nerve is indicated by a leaf with enough letters written on the leaf (Pic 4) to indicate the name of that muscle. ⠀ Video 3 shows some of the “preterminal” branch nerves of the brachial plexus and the muscles they innervate. The brachial plexus has five “terminal” branches and eleven “preterminal” branches. ⠀ Videos 4/5 demonstrate the medial and lateral cords and the three terminal branches to which they give rise (median, ulnar and musculocutaneous). ⠀ #anatomy #fascia #chiropractic #physicaltherapy #dr #physiotherapy #osteopathy #orthopedics #shoulder #nerves #medicine #student #medstudent #education #doctor #neuroanatomy (hier: Frankfurt, Germany) https://www.instagram.com/p/B2gpbyxBHog/?igshid=5xlk2y1wkbn5

#anatomy #fascia #chiropractic #physicaltherapy #dr #physiotherapy #osteopathy #orthopedics #shoulder #nerves #medicine #student #medstudent #education #doctor #neuroanatomy

1 note · View note

lsmchiropractic1-blog · 6 years ago

Link

Many health conditions can cause pain and other symptoms in your arms and hands, from minor muscle strains to a serious problem like a heart attack. Thoracic Outlet Syndrome is a neurovascular disorder which results from the compression of the brachial plexus and subclavian vessels in the neck between the neck and axilla.

#Thoracic Outlet Syndrome Fitchburg

0 notes

shoutinthevoiddd · 7 years ago

Text

Day 8

We did the axilla, mammary gland, brachial plexus, scapula and finished dissection of the anterior portion of the arm.

The best thing so far about med school is those ' 'aaaaaah... shit' moments like the other day our professor told us that bones aren't just formed in the shape they're in. They're actually molded into shape by the muscles and ligaments and not the other way around

#i have seen the light #i am questioning everything #medblr #med school #this isn't even an astounding fact or anything wth

0 notes

juniperpublishersanesthesia · 5 years ago

Text

Tourniquet Pain after Ultrasound-Guided Axillary Blockade-Juniper Publishers

Abstract

Objective: To analyse tourniquet pain after ultrasound guided axillary block (AXB) as the sole anesthetic technique with no injection of local anaesthetic into the subcutaneous tissue of the posterior half of the axilla to prevent tourniquet pain.

Material/patients and methods: 84 patients older than 18 years ASA I-IV undergoing surgery at hand, wrist, forearm and elbow under ultrasound guided AXB requiring upper arm tourniquet, we studied prospectively. Exclusion criteria included refusal to participate, communication problems, pre-existing neuropathy, coagulopathy or allergy to local anaesthetics. Tourniquet pain was assessed according to visual analogue scale (VAS) every 15 minutes. We also analysed differences in tourniquet pain between sedated and non-sedated patients.

Main results: VAS was 0 during ischemia in 83 patients. One patient reported tourniquet pain. This was mild (VAS = 3) and reported during the first 15 minutes of ischemia. VAS dropped to 0 from then on. The median ischemia time was 62 minutes (IQR 45-86) and the median surgery time was 60 minutes (IQR 40-89.5). Intraoperative sedation was administered to 48.8% of patients. Sedated and non-sedated groups were similar. No statistical differences were found regarding tourniquet pain between both groups (p< 0.05).

Conclusion: Ultrasound guided AXB is sufficient to provide anaesthesia for tourniquet even during prolonged ischemia. However, to ensure prevention of tourniquet discomfort a multiple injection technique that include musculocutaneous blockade should be preferred.

Keywords: Tourniquet pain; Axillary block; Ultrasound-guided peripheral nerve block; Upper limb surgery; Sedation

Background

Regional anaesthesia holds potential advantages when compared to general anaesthesia. Particularly, brachial plexus blockade has demonstrated superior analgesia, reduction of opioid-related side effects and opioid consumption during the first 24 hours after surgery [1]. The axillary blockade (AXB) provides anaesthesia for upper extremity surgery of the elbow, forearm, wrist, and hand [2,3]. It has been shown as effective as supraclavicular (SCB) and infraclavicular (ICB) blocks [4] but its distal location from pleura and phrenic nerve eliminates some of the risks related to those more proximal approaches [5,6].

Ultrasound guidance allows direct observation of nerves, surrounding structures and local anaesthetic (LA) spread. Its use decreases complications and onset time [7,8], improves quality [8] and reduces the volume of LA required [9]. Due to the superficial location of the brachial plexus in the axilla, ultrasound guided AXB provides excellent visibility of both nerves and needle.

The intercostobrachial nerve (T2) is not part of the brachial plexus. It communicates with the medial brachial cutaneous nerve (C8-T1) providing innervation to the skin of the axilla and the medial and posterior aspect of the arm. The block of these nerves to prevent tourniquet pain is widely extended and has been traditionally recommended using an injection of LA into the subcutaneous tissue of the posterior half of the axilla ("semicircular subcutaneous anaesthesia" or "ring block") [1014]. However, its importance in reducing tourniquet pain has never been established and is questioned [2,15,16]. The aim of this study was to assess tourniquet pain after ultrasound guided AXB as the sole anaesthetic technique. Due to the fact that intraoperative sedation could underestimate tourniquet pain, further analyses comparing tourniquet pain in sedated and nonsedated patients were also carried out.

Material and Methods

A prospective observational study of tourniquet pain on patients who received an ultrasound guided AXB was conducted over a four month period (January- May 2013) at Galdakao- Usansolo Hospital. The study was classified as service evaluation and no ethical approval was needed as required no alteration to the routine standard of care, there was no therapeutic or equipment intervention, and no planned change to anaesthetic technique. Written consent from patients was obtained. Inclusion criteria were patients undergoing surgery at or below the elbow under ultrasound guided AXB requiring upper arm tourniquet, age >18 years and ASA (American Society of Anaesthesiologists) status I-IV. Exclusion criteria were refusal to be included, communication problems or inability to cooperate, pre-existing neuropathy, coagulopathy or allergy to LA.

After patient arrival to theatre an intravenous catheter was placed in the upper limb contralateral to the surgical site and ASA standard monitoring were applied. Ultrasound guided AXB were performed by either consultants with expertise in regional anaesthesia or residents supervised by those consultant. A portable ultrasound machine (Sonosite M-Turbo®) and high frequency linear probe was used. Administration of premedication or intraoperative sedation was left to the discretion of the treating anaesthesiologist. The ultrasound probe was applied in the axilla to obtain a short-axis view of the axillary artery. The four terminal nerves (median, ulnar, radial and musculocutaneous nerve) were sought out and their identity confirmed by scanning distally along the arm following the characteristic course that each nerve takes. A 22 gauge needle (Braun Stimuplex D) was used to surround each individual nerve with LA after skin infiltration with lidocaine 1% (Figure 1). The AXB approach (in plane or out of plane) and the type and amount of LA was decided by the anaesthetist who performed the block.

AA: Axillary Artery; RN: Radial Nerve; UN: Ulnar Nerve; MN: Median Nerve; MsN: Musculocutaneous nerve; Conjoint tendon of the latissimus dorsi and teres major

Once the block was finished, a pneumatic tourniquet was applied to all patients on the mid-upper arm over a single wrap of cotton wool padding. The limb was exsanguinated using an Esmarch bandage and the tourniquet cuff inflated between 250- 300mmHg.

The variables collected included age, gender, weigh, ASA status, type of surgery, premedication administered, type and amount of local anaesthetic used to surround each nerve, time between the end of the block and the tourniquet inflation, pressure of the tourniquet, ischemia and surgery time, intraoperative sedation and tourniquet pain. The primary objective was to analyse tourniquet pain assessed according to a 0-10cm visual analogue scale (VAS), whereby '0' represents no pain and '10' represents the worst imaginable pain. Tourniquet pain was measured directly after the tourniquet was inflated and thereafter every 15 minutes (min) until the tourniquet was deflated. VAS evaluations were conducted by the same person who performed the block. As a second objective we analysed differences in tourniquet pain between intraoperative sedated and non-sedated patients.

Statistical analysis

Descriptive analysis of socio-demographic and clinical variables was made by using frequencies and percentages for categorical variables and means and standard deviations for continuous variables. The exception being variables with a high level of deviation. These were represented by median and interquartile range. The differences between sedated and non-sedated patient were evaluated using the Chi-square test (or Fisher exact test when expected values<5) for categorical variables and non-parametric Wilcoxon test for continuous variables. All effects were considered significant at p<0.05. All statistical analyses were performed using SAS for Windows statistical software, version 9.2 (SAS Institute, Inc., Carey, NC).

Results

Over the four month period 84 patients were recruited.Patient characteristics and type of surgery are summarized in Table 1. All patients received premedication prior to the block. Intraoperative sedation was administered to 48.8% of patients. Sedatives used to sedate patients during surgery were propofol and midazolam but one patient received 50 mcg of fentanyl (Table 2). Mepivacaine 1.5% were the LA of choice to surround the four nerves in all patients. Occasionally Ropivacaine 0.2% or Levobupicaine 0.25% were added to provide longer analgesia. The mean total volume of LA used was 34.37±5.37 ml (Figure 2).

The median time since the block was finished until the cuff was inflated was 10min (IQR 5-15). The median surgery time was 60 min (IQR 40-89.5) and the median ischemia time was 62min (IQR 45-86) (Table 3).

Among 84 patients included, 83 scored tourniquet pain as VAS = 0cm during the time tourniquet was inflated. One of these patients complained about pain in the surgery field without pain on the tourniquet site after 180min of surgery and had to undergo general anaesthesia. In this case, a 30min reperfusion period was used after 135min of ischemia and the total ischemia time with the patient awake was 150 min. One patient reported tourniquet pain. In this patient VAS was 3 cm when the cuff was inflated and in the following 15 minutes. He was administered 50mg of fentanyl and 20mg of propofol respectively. Since then VAS reminded 0cm until the tourniquet was deflated 31 minutes later. No more sedatives were administered.

Sedated and non-sedated groups were similar in demographic variables, ASA status, premedication administrated, type of surgery, type and amount of LA used, time of ischemia and surgery and tourniquet pressure. No statistical differences (p< 0.05) were found regarding tourniquet pain between both groups (Table 4).

ASA: American Society of Anaesthesiologists; AXB: Axillary Block; VAS: Visual Analogue Scale;

Results shown as number of patients (%). *mean ± standard deviation (SD). †Median [Interquartile range = p25-p75]. NA = Not applicable. --- = Unknown.

Discussion

Tourniquets are commonly used in upper limb procedures to improve visualisation, reduce bleeding and expedite surgical procedures. Despite its advantages, tourniquet might associate injury that usually involves nerve or other soft tissues and is often complicated by the development of tourniquet pain [17]. Contrary to the old belief that a dermal component represents one of the major causes of tourniquet-related pain, ischemia and compression have been identified as the main sources of noxious stimuli during the maintenance of tourniquet inflation [18-21]. Due to these findings, there is progressively more belief that during AXB a tourniquet is well tolerable without requiring additional dermal anaesthesia [15,16]. Similarly, popliteal blockade is sufficient for tourniquet on the caff with no need of femoral or saphenous block [22]. It is important to highlight the importance of achieving a "complete" AXB [23]. Pain associated to tourniquet has been showed to be significantly reduced when a multiple injection AXB technique is used [24]. S. Sia et al. [25] comparing a triple injection AXB technique (blockade of median, musculocutaneous and radial nerves) and a "selective" approach in which only the nerves involved in surgery were blocked, reported a significant increase of patient requesting intraoperative administration of fentanyl for tourniquet pain in the "selective" group.

Despite the numerous anatomical variations of the four main nerves at the axilla, median, ulnar and radial nerves they all lie very close to the axillary artery [25]. Due to this proximity, the injection of a determinate amount of LA to block one of them could cause blockage of the others. By contrast, musculocutaneous nerve lies far lateral to the axillary artery, in the fascial plane between biceps brachii and coracobrachialis muscle. It innervates the muscles in the anterior compartment of the arm - the coracobrachialis, biceps brachii and the brachialis. To achieve its block the needle has to be redirected but its blockade is essential to prevent tourniquet pain [26]. We identified the four nerves by scanning distally along the arm and observing the nerve tracing. They were surrounded by LA independently. Among 84 patients, 83 reported "no pain" [27]. Only one patient complained about tourniquet discomfort (VAS= 3cm) during the first 15 minutes but VAS dropped to 0 cm from then on. This is more likely to be attributed to a block in progress than to a real need of additional blocks. Time between block finished and cuff inflation was just 3 min in this patient whereas, Tran DQ, et al. [28] concluded that the mean onset time is 18.9 minutes when using 4 injections AXB and lidocaine 1.5% with epinephrine 5mcg/ml.

The use of sedation in regional anaesthesia has been shown to increase patient satisfaction and can also modify pain perception [28,29]. However, there were no differences in tourniquet pain between intraoperative sedated and nonsedated patients in our study.

Tourniquet pain has been related to the duration of inflation [18]. Five of our patients had ischemia for more than 120min but none of them complained about tourniquet pain. JP Estebe et al. [30], reported a tourniquet pain tolerance of approximately 2030 minutes in volunteers. Tolerance was defined in that study when VAS was > 6cm or when volunteers decided their pain tolerance limit was reached. In daily practice, letting patients reach either points is unacceptable. Patients on the operating table suffering a painful experience could lead to anxiety, patient movement and unsuccessful surgery. Therefore if a tourniquet is required for surgery, associated pain should always be prevented and treated.

Fitzgibbons PG et al. [31] carried out a review regarding safe tourniquet use recommended tourniquet pressure of 250mmHg for less than 150min in the upper extremity. We used tourniquet pressure slightly higher and only one patient exceeded a total ischemia time of 150min, however a reperfusion time was used on this patient. Although higher pressures and longer ischemia times than the ones recommended have not demonstrated increased complication [32], tourniquet-related injury resulting from excessive tourniquet inflation pressure or prolonged ischemic time were not an objective of our study and were not followed up. Some of the limitations of this study included a relatively small number of patients, observational methodology and nonrandomized design. Test of sensory and motor blockade were not recorded, but no incomplete blocks were reported. No blinded observer data was collected. Ultrasound guided AXB alone provides enough anaesthesia to cover tourniquet-related pain even during prolonged ischemia. Use of additional dermal blocks are not required, however a multiple injection AXB technique that ensures musculocutaneous blockade should be performed.

For more Open Access Journals in Juniper Publishers please click on: https://juniperpublishers.com

For more articles in Journal of Anesthesia & Intensive Care Medicine please click on: https://juniperpublishers.com/jaicm/index.php

For more Open Access Journals please click on: https://juniperpublishers.com

#Tourniquet pain #Axillary block #Upper limb surgery #Sedation

0 notes