The posterior triangle of the neck refers to the area between the clavicular head of the sternocleidomastoid muscle anterior and the anterior margin of the trapezius muscle posterior the middle third of the clavicle forms the base of the triangle. Boezaart: Departments of Anesthesiology and Orthopaedic Surgery, Division of Acute and Peri-operative Pain Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, Florida 32610, USA Tel: 35 (Work) Fax: 35 E-mail: Introduction Keywords: Anterior scalene muscle, Brachial plexus, Cervical paravertebral space, Dermatomes, Dorsal middle scalene muscle, Dorsal scapular nerve, Inferior trunk, Long thoracic nerve, Middle trunk Cords, Nerve to levator scapulae, Neurotomes, Osteotomes, Phrenic nerve, Posterior scalene muscle, Scalene minimi muscle, Shoulder joint innervation, Spinal accessory nerve, Spinal roots, Superior trunk, Suprascapular nerve, Ventral middle scalene muscle. The authors discuss the innervation of the five joints around the shoulder girdle in some detail in this chapter. These multiple sections are presented in the form of three figures of strategic positions, and also as a movie where these multiple sections have been added together to play sequentially. Finally, multiple anatomic sagittal sections of the neck, starting from the spine and ending at the mid-clavicular line, show the supraclavicular brachial plexus. Photographs of anatomical dissections of the five scalene muscles are discussed, especially the crossover of the fibers of the anterior and middle scalene muscles, which forms the paravertebral trough, and the seven most commonly found positional anomalies of the muscles with the roots of the cervical ventral rami. Anatomical dissections of the lateral view of the neck and its posterior triangle are presented, as well as trans-sectional anatomical views at the level of the 6th cervical vertebra. The sensory dermatomal and osteotomal innervation of the spinal roots are discussed, as well as the neurotomal distribution of each peripheral terminal branch. In this chapter, the authors present the most common arrangement of the brachial plexus its five roots of origin, three trunks, anterior and posterior divisions, three cords, and, finally, its terminal branches. ² Department of Anesthesiology, University of Maryland, Baltimore, Maryland, USA Abstract ¹ Departments of Anesthesiology and Orthopaedic Surgery and Rehabilitation, Division of Acute and Perioperative Pain Medicine, University of Florida College of Medicine, Gainesville, Florida, USA Read moreĪpplied Macroanatomy of the Upper Extremity Nerves Above the Clavicle If more in depth information is needed, the extensive text and reference list would adequately compliment this knowledge. The basic working philosophy and design of this textbook is that the reader can obtain a good practical working knowledge of the macro-, micro-, sono-, and functional anatomy required for regional anesthesia and acute pain medicine simply by viewing the figures and movies and reading the legends to the figures. With this fundamental understanding, we can now better appreciate, on an anatomical basis, why blocks sometimes fail where the “sweet spot” of a nerve is and how to find it why epidural blocks are segmental while subarachnoid blocks are not why older patients are less prone to postdural puncture headache, and many more issues of regional anesthesia and pain medicine. If we fully understand where nerves live (macroanatomy), we completely understand what the nerves live in – the membranes and barriers that surround them (microanatomy) and we know how to find these nerves (sono- and functional anatomy) we can use any technique to do any nerve block and we will be successful. The fundamental truth of regional anesthesia and acute pain medicine is, according to the timeless wisdom of Alon Winnie, the in depth knowledge and true understanding of anatomy. Similarly, the fundamental truth of anesthesia is the management of physiological reflexes. If we truly understand that the fundamental truth of Critical Care Medicine, for example, is the management and maintenance of physiological barriers. The answer to this question is that every discipline of medicine has a unique fundamental truth, and true understanding this fundamental truth is essential for success. Too often do scholars focus on learning techniques of RA and APM from experts, and then get lost in a myriad of bad results that include primary or secondary block failures. Students and practitioners of regional anesthesia and acute pain medicine often ask how they can be consistently as successful with their blocks as the true experts are.
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