• Manoj Kumar Karmakar, Jatuporn Pakpirom, Banchobporn Songthamwat, and Pornpatra Areeruk.
• Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong Faculty of Medicine, New Territories, Shatin, Hong Kong karmakar@cuhk.edu.hk.
• Reg Anesth Pain Med. 2020 May 1; 45 (5): 344-350.

Background And ObjectivesUltrasonography of the brachial plexus (BP) has been described but there are limited data on visualization of the T1 ventral ramus and the inferior trunk. This prospective observational study aimed to evaluate a high definition ultrasound imaging technique to systematically identify the individual elements of the BP above the clavicle.MethodsFive healthy young volunteers underwent high definition ultrasound imaging of the BP above the clavicle. The ultrasound scan sequence (transverse oblique scan) commenced at the supraclavicular fossa after which the transducer was slowly swept cranially to the upper part of the interscalene groove and then in the reverse direction to the supraclavicular fossa. The unique sonomorphology of the C7 transverse process was used as the key anatomic landmark to identify the individual elements of the BP in the recorded sonograms.ResultsThe neural elements of the BP that were identified in all volunteers included the ventral rami of C5-T1, the three trunks, divisions of the superior trunk, and formation of the inferior trunk (C8-T1). The C6 ventral ramus exhibited echogenic internal septation with a split (bifid) appearance in four of the five volunteers. In three of the four volunteers with a bifid C6 ventral ramus, the C7 ventral ramus was also bifid.ConclusionWe have demonstrated that it is feasible to accurately identify majority of the main components of the BP above the clavicle, including the T1 ventral ramus and the formation of the inferior trunk, using high definition ultrasound imaging.Trial Registration NumberChiCTR1900021749.© American Society of Regional Anesthesia & Pain Medicine 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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