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, 33 (1), 48-53

New Insights Into Pathways of the Accessory Nerve and Transverse Cervical Artery for Distal Selective Accessory Nerve Blockade

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New Insights Into Pathways of the Accessory Nerve and Transverse Cervical Artery for Distal Selective Accessory Nerve Blockade

Yanguk Heo et al. Korean J Pain.

Abstract

Background: The aim of this study was to clarify the topographical relationship between the accessory nerve (AN) and transverse cervical artery (TCA) to provide safe and convenient injection points for AN blockade.

Methods: This study included 21 and 30 shoulders of 14 embalmed Korean adult cadavers and 15 patients, respectively, for dissection and ultrasound (US) examination.

Results: The courses of the TCA and AN in the scapular region were classified into four types based on their positional relationships. Type A indicated the nerve that was medial to the artery and ran parallel without changing its location (38%). In type B (38%), the nerve was lateral to the artery and ran parallel without changing its location. In type C (19%), the nerve or artery traversed each other only once during the whole course. In type D (5%), the nerve or artery traversed each other more than twice forming a twist. At the levels of lines I-IV, the nerve was relatively close to the artery (approximately 10 mm). TCAs were observed in all specimens around the superior angle of the scapula at the level of line II, whereas they were not found below line VI. In US images of the patients, the TCA was commonly observed at the level of line II (93.3%) where all ANs and TCAs were observed in cadaveric dissection.

Conclusions: The results expand the current knowledge of the relation between the AN and TCA, and provide helpful information for selective diagnostic nerve blocks in the scapular region.

Keywords: Accessory Nerve; Diagnosis; Injections; Scapula; Scapular Region; Selective Nerve Blockade; Transverse Cervical Artery; Ultrasound.

Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Marking method showing the course of the accessory nerve (yellow colored head pins) and transverse cervical artery (red colored head pins). Tz: trapezius muscles.
Fig. 2
Fig. 2
Lines and points defined for analyzing the positional relationship between the spinal accessory nerve and reference line connecting the superior and inferior angles of the scapula. SA: superior angle of scapula, SS: spine of scapula, IA: inferior angle of scapula.
Fig. 3
Fig. 3
Frequency and distance of the transverse cervical artery (A) and accessory nerve (B) at the level of each line of the cadavers (green and red colored bars indicate the structures passing toward the medial and lateral sides of the reference line connecting the superior and inferior angles of the scapula, respectively).
Fig. 4
Fig. 4
Ultrasound (US) images and frequency of the detected transverse cervical artery; In the panels A–D show US images of the same patient at the lines I–IV, respectively. Tz: trapezius muscle, Rm: rhomboid minor muscle, Sc: scapula, SS: supraspinatus muscle.
Fig. 5
Fig. 5
Recommendable point under ultrasound guided or blind injection technique. SA: superior angle of scapula, SS: spine of scapula, IA: inferior angle of scapula.

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