Case study of upper extremity

SARA L. This version of the article includes supplemental content. A more recent article on peripheral nerve entrapment and injury in the upper extremity is available. Peripheral nerve injury of the upper extremity commonly occurs in patients who participate in recreational e. Nerve injury should be considered when a patient experiences pain, weakness, or paresthesias in the absence of a known bone, soft tissue, or vascular injury.
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Upper Extremity Function Test (UEFT)

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ACC Maintainance

US guidance allows for visualization of the spread of the local anesthetic and additional injections around the brachial plexus if needed to ensure an adequate spread of local anesthetic, improving nerve block success. The ability to visualize local anesthetic spread and to inject multiple aliquots also allows for a reduction in the volume of local anesthetic required to accomplish the nerve block. The brachial plexus at the interscalene level is seen lateral to the carotid artery and internal jugular vein, between the anterior and middle scalene muscles Figures 1 and 2. The prevertebral fascia, superficial cervical plexus, and sternocleidomastoid muscle are seen superficial to the plexus. The transducer is moved in the proximal-distal direction until two or more of the brachial plexus elements are seen in the space between the scalene muscles. The brachial plexus is typically visualized at a depth of 1—3 cm. The interscalene approach to brachial plexus blockade results in reliable anesthesia of the shoulder and upper arm Figure 3.
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Ultrasound-Guided Supraclavicular Brachial Plexus Nerve Block

Duretti Fufa is a board certified orthopedic surgeon specializing in hand surgery with additional expertise in reconstruction and microsurgery. She earned her undergraduate and medical degrees from Harvard University before completing her orthopaedic surgery residency at Hospital for Special Surgery. Fufa completed fellowship training in hand and upper extremity surgery at Washington University in St. Her subspecialty training continued with a plastic surgery fellowship in trauma and microsurgery at Chang Gung Memorial Hospital in Taipei, Taiwan.
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At this location, the proximity of the brachial plexus to the chest cavity and pleura had been of concern Figure 2 until ultrasound US guidance renewed interest in the supraclavicular approach to the brachial plexus nerve block. The ability to image the plexus, rib, pleura, and subclavian artery with US has increased safety due to improved monitoring of anatomy and needle placement. Because the trunks and divisions of the brachial plexus are relatively close as they pass over the first rib, the extension and quality of anesthesia are favorable. For these reasons, the supraclavicular nerve block has become a commonly used technique for surgery of the upper limb distal to the shoulder.
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