Surgical and radiologic anatomy : SRA
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Ultrasound (US) has emerged in the field of regional anaesthesia in the past few years, as it allows physicians to simultaneously see the needle, the targeted nerves, and the vessels to avoid. Nevertheless, anatomical knowledge is essential for identifying all of the structures seen on the US screen. US also allows an in vivo approach to the variations of nerves and vessels. The aim of this study was to describe the anatomical structures of the axilla through a dissection, an anatomical section and US images performed during daily regional anaesthesia. This work will also discuss the usefulness of US in studying anatomical variations of vasculonervous structures. ⋯ Anatomical knowledge is of major importance for US-guided regional anaesthesia. US scan offers a new approach to anatomical variations of the vasculonervous bundle at the junction of the axilla and the upper arm.
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The entrapment of the suprascapular nerve (SSN) is commonly considered at the level of the suprascapular notch and more rarely in the spinoglenoid notch. Recent per-operative findings showed a compression of the SSN along its course in the supraspinatus fossa. The removal of a fascia for releasing the nerve between the suprascapular notch and spinoglenoid notch led us to purchase an anatomical study. ⋯ In pathologic and post-trauma conditions, the fascia can be retracted or thickened and the SSN may be entrapped along its course in the supraspinatus fossa, between the suprascapular notch and the spinoglenoid notch and without any compression in any notch. These anatomical data lead us to consider that a tunnel syndrome may concern the SSN.
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Sonography allows good visualization of the peripheral nerves and the vascular and muscular structures that surround them. Our goals are to provide an easy-to-use atlas that gives accurate information about the locations and relations among the nerves in the different parts of the arm and to correlate it with the probe position and the ultrasound images. ⋯ Ultrasound is a useful tool to identify the main nerves of the upper arm. This atlas indicates the locations and relations among the nerves, correlating with the ultrasound appearance.
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Stabilization of humeral shaft and elbow fractures can be achieved with an external-fixator. Reports about nerve injuries associated with this procedure are rare in literature. Purpose of this anatomical study was to examine the relation of the radial nerve to distal humeral half pins. ⋯ Insertion of external-fixator half pins in the distal humerus can easily injure the radial nerve. Thus we advocate a larger skin incision, blunt dissection to the lateral cortex of the humerus and retraction of soft tissue during half pin insertion.