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Semin Musculoskelet Radiol 2020; 24(02): 101-112
DOI: 10.1055/s-0040-1710067
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

High-Resolution Ultrasound of Small Clinically Relevant Nerves Running Across the Posterior Triangle of the Neck

Riccardo Picasso
1   Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
2   IRCCS Ospedale Policlinico San Martino, Genova, Italy
,
Federico Zaottini
1   Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
2   IRCCS Ospedale Policlinico San Martino, Genova, Italy
,
Federico Pistoia
1   Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
2   IRCCS Ospedale Policlinico San Martino, Genova, Italy
,
Maribel Miguel Perez
3   Departamento de Patología y Terapéutica Experimental, Facultad de Medicina y Ciencias de la Salud (Campus de Bellvitge), Unidad de Anatomía y Embriología Humana, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
,
Andrea Klauser
4   Universitätsklinik für Radiologie, Medizinische Universität, Abteilung Rheuma- und Sportbildgebung, Innsbruck, Austria
,
Federica Rossi
1   Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
2   IRCCS Ospedale Policlinico San Martino, Genova, Italy
,
Angelo Schenone
5   Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Italy
,
Alberto Stefano Tagliafico
1   Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
2   IRCCS Ospedale Policlinico San Martino, Genova, Italy
,
Carlo Martinoli
1   Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy
2   IRCCS Ospedale Policlinico San Martino, Genova, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2020 (online)

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Abstract

With the advent of high-frequency ultrasound (US) transducers, new perspectives have been opened in evaluating millimetric and submillimetric nerves that, despite their dimensions, can be considered relevant in clinical practice. In the posterior triangle of the neck, the suprascapular, long thoracic, phrenic, supraclavicular, great auricular, lesser occipital, and transverse cervical nerves are amenable to US examination and the object of special interest because they may be involved in many pathologic processes or have a value as targets of advanced therapeutic procedures. The correct identification of these nerves requires a deep knowledge of local neck anatomy and the use of a complex landmarks-based approach with US. This article describes the anatomy and US technique to examine small but clinically relevant nerves of the posterior triangle of the neck (excluding the brachial plexus), reviewing the main pathologic conditions in which they may be involved.

Keywords

long thoracic nerve - phrenic nerve - spinal accessory nerve - supraclavicular nerves - suprascapular nerve
 

  • References

  • 1 Lutz AM, Gold G, Beaulieu C. MR imaging of the brachial plexus. Neuroimaging Clin N Am 2014; 24 (01) 91-108
    CrossrefPubMedGoogle Scholar
  • 2 Mikityansky I, Zager EL, Yousem DM, Loevner LA. MR Imaging of the brachial plexus. Magn Reson Imaging Clin N Am 2012; 20 (04) 791-826
    CrossrefPubMedGoogle Scholar
  • 3 Demondion X, Herbinet P, Boutry N, Fontaine C, Francke JP, Cotten A. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol 2003; 24 (07) 1303-1309
    PubMedGoogle Scholar
  • 4 Lapegue F, Faruch-Bilfeld M, Demondion X. , et al. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging 2014; 95 (03) 259-275
    CrossrefPubMedGoogle Scholar
  • 5 Martinoli C, Bianchi S, Santacroce E, Pugliese F, Graif M, Derchi LE. Brachial plexus sonography: a technique for assessing the root level. AJR Am J Roentgenol 2002; 179 (03) 699-702
    CrossrefPubMedGoogle Scholar
  • 6 Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol 2018; 71 (04) 274-288
    CrossrefPubMedGoogle Scholar
  • 7 Razzaq AA, O'Brien D, Mathew B, Bartlett R, Taylor D. Efficacy and durability of fluoroscopically guided cervical nerve root block. Br J Neurosurg 2007; 21 (04) 365-369
    CrossrefPubMedGoogle Scholar
  • 8 Mirjalili SA, Muirhead JC, Stringer MD. Ultrasound visualization of the spinal accessory nerve in vivo. J Surg Res 2012; 175 (01) e11-e16
    CrossrefPubMedGoogle Scholar
  • 9 Novak CB, Mackinnon SE. Surgical treatment of a long thoracic nerve palsy. Ann Thorac Surg 2002; 73 (05) 1643-1645
    CrossrefPubMedGoogle Scholar
  • 10 Platzgummer H, Moritz T, Gruber GM. , et al. The lesser occipital nerve visualized by high-resolution sonography—normal and initial suspect findings. Cephalalgia 2015; 35 (09) 816-824
    CrossrefPubMedGoogle Scholar
  • 11 Nwawka OK. Ultrasound imaging of the brachial plexus and nerves about the neck. Ultrasound Q 2019; 35 (02) 110-119
    CrossrefPubMedGoogle Scholar
  • 12 Kierner AC, Zelenka I, Heller S, Burian M. Surgical anatomy of the spinal accessory nerve and the trapezius branches of the cervical plexus. Arch Surg 2000; 135 (12) 1428-1431
    PubMedGoogle Scholar
  • 13 Seok JI, Kim JW, Walker FO. Spontaneous spinal accessory nerve palsy: the diagnostic usefulness of ultrasound. Muscle Nerve 2014; 50 (01) 149-150
    PubMedGoogle Scholar
  • 14 Chepeha DB, Taylor RJ, Chepeha JC. , et al. Functional assessment using Constant's Shoulder Scale after modified radical and selective neck dissection. Head Neck 2002; 24 (05) 432-436
    CrossrefPubMedGoogle Scholar
  • 15 Orhan KS, Demirel T, Baslo B. , et al. Spinal accessory nerve function after neck dissections. J Laryngol Otol 2007; 121 (01) 44-48
    CrossrefPubMedGoogle Scholar
  • 16 Köybasioglu A, Tokcaer AB, Uslu S, Ileri F, Beder L, Ozbilen S. Accessory nerve function after modified radical and lateral neck dissections. Laryngoscope 2000; 110 (01) 73-77
    CrossrefPubMedGoogle Scholar
  • 17 Berry H, MacDonald EA, Mrazek AC. Accessory nerve palsy: a review of 23 cases. Can J Neurol Sci 1991; 18 (03) 337-341
    PubMedGoogle Scholar
  • 18 Kuhn JE, Plancher KD, Hawkins RJ. Scapular winging. J Am Acad Orthop Surg 1995; 3 (06) 319-325
    CrossrefPubMedGoogle Scholar
  • 19 Cappiello J, Piazza C, Giudice M, De Maria G, Nicolai P. Shoulder disability after different selective neck dissections (levels II-IV versus levels II-V): a comparative study. Laryngoscope 2005; 115 (02) 259-263
    CrossrefPubMedGoogle Scholar
  • 20 Cheng PT, Hao SP, Lin YH, Yeh AR. Objective comparison of shoulder dysfunction after three neck dissection techniques. Ann Otol Rhinol Laryngol 2000; 109 (8 Pt 1): 761-766
    CrossrefPubMedGoogle Scholar
  • 21 Friedenberg SM, Zimprich T, Harper CM. The natural history of long thoracic and spinal accessory neuropathies. Muscle Nerve 2002; 25 (04) 535-539
    CrossrefPubMedGoogle Scholar
  • 22 Bertelli JA, Ghizoni MF. Long thoracic nerve: anatomy and functional assessment. J Bone Joint Surg Am 2005; 87 (05) 993-998
    PubMedGoogle Scholar
  • 23 Martin JT. Postoperative isolated dysfunction of the long thoracic nerve: a rare entity of uncertain etiology. Anesth Analg 1989; 69 (05) 614-619
    PubMedGoogle Scholar
  • 24 Duncan MA, Lotze MT, Gerber LH, Rosenberg SA. Incidence, recovery, and management of serratus anterior muscle palsy after axillary node dissection. Phys Ther 1983; 63 (08) 1243-1247
    CrossrefPubMedGoogle Scholar
  • 25 Sumner AJ. Idiopathic brachial neuritis. Neurosurgery 2009; 65 (04) A150-A152
    CrossrefPubMedGoogle Scholar
  • 26 Foo CL, Swann M. Isolated paralysis of the serratus anterior. A report of 20 cases. J Bone Joint Surg Br 1983; 65 (05) 552-556
    CrossrefPubMedGoogle Scholar
  • 27 Gregg JR, Labosky D, Harty M. , et al. Serratus anterior paralysis in the young athlete. J Bone Joint Surg Am 1979; 61 (6A): 825-832
    CrossrefPubMedGoogle Scholar
  • 28 Goodman CE. Unusual nerve injuries in recreational activities. Am J Sports Med 1983; 11 (04) 224-227
    CrossrefPubMedGoogle Scholar
  • 29 Schultz JS, Leonard Jr JA. Long thoracic neuropathy from athletic activity. Arch Phys Med Rehabil 1992; 73 (01) 87-90
    PubMedGoogle Scholar
  • 30 Overpeck DO, Ghormley RK. Paralysis of the serratus magnus muscle: caused by lesions of the long thoracic nerve. JAMA 1940; 114: 1994-1996
    PubMedGoogle Scholar
  • 31 Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg 1992; 74 (03) 352-357
    PubMedGoogle Scholar
  • 32 Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg 1991; 72 (04) 498-503
    PubMedGoogle Scholar
  • 33 Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth 2008; 101 (04) 549-556
    CrossrefPubMedGoogle Scholar
  • 34 Palhais N, Brull R, Kern C. , et al. Extrafascial injection for interscalene brachial plexus block reduces respiratory complications compared with a conventional intrafascial injection: a randomized, controlled, double-blind trial. Br J Anaesth 2016; 116 (04) 531-537
    CrossrefPubMedGoogle Scholar
  • 35 Robaux S, Bouaziz H, Boisseau N, Raucoules-Aimé M, Laxenaire MC. ; S.O.S. Regional Hot Line Service. Persistent phrenic nerve paralysis following interscalene brachial plexus block. Anesthesiology 2001; 95 (06) 1519-1521
    CrossrefPubMedGoogle Scholar
  • 36 Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet 1973; 2 (7825): 359-362
    PubMedGoogle Scholar
  • 37 De A, Hayes JE. Persistent phrenic nerve paresis after interscalene block: a “triple crush” hypothesis of nerve injury. Reg Anesth Pain Med 2013; 38 (06) 553
    PubMedGoogle Scholar
  • 38 Tripp HF, Bolton JW. Phrenic nerve injury following cardiac surgery: a review. J Card Surg 1998; 13 (03) 218-223
    CrossrefPubMedGoogle Scholar
  • 39 Bell D, Siriwardena A. Phrenic nerve injury following blunt trauma. J Accid Emerg Med 2000; 17 (06) 419-420
    CrossrefPubMedGoogle Scholar
  • 40 Derveaux L, Lacquet LM. Hemidiaphragmatic paresis after cervical herpes zoster. Thorax 1982; 37 (11) 870-871
    CrossrefPubMedGoogle Scholar
  • 41 Gibson GJ. Diaphragmatic paresis: pathophysiology, clinical features, and investigation. Thorax 1989; 44 (11) 960-970
    CrossrefPubMedGoogle Scholar
  • 42 Fayssoil A, Behin A, Ogna A. , et al. Diaphragm: pathophysiology and ultrasound imaging in neuromuscular disorders. J Neuromuscul Dis 2018; 5 (01) 1-10
    PubMedGoogle Scholar
  • 43 Gottesman E, McCool FD. Ultrasound evaluation of the paralyzed diaphragm. Am J Respir Crit Care Med 1997; 155 (05) 1570-1574
    CrossrefPubMedGoogle Scholar
  • 44 Kokatnur L, Rudrappa M. Diaphragmatic palsy. Diseases 2018; 6 (01) 16
    CrossrefPubMedGoogle Scholar
  • 45 Vorster W, Lange CP, Briët RJ. , et al. The sensory branch distribution of the suprascapular nerve: an anatomic study. J Shoulder Elbow Surg 2008; 17 (03) 500-502
    CrossrefPubMedGoogle Scholar
  • 46 Siegenthaler A, Moriggl B, Mlekusch S. , et al. Ultrasound-guided suprascapular nerve block, description of a novel supraclavicular approach. Reg Anesth Pain Med 2012; 37 (03) 325-328
    CrossrefPubMedGoogle Scholar
  • 47 Chan CW, Peng PW. Suprascapular nerve block: a narrative review. Reg Anesth Pain Med 2011; 36 (04) 358-373
    CrossrefPubMedGoogle Scholar
  • 48 Hussain N, Goldar G, Ragina N, Banfield L, Laffey JG, Abdallah FW. Suprascapular and interscalene nerve block for shoulder surgery: a systematic review and meta-analysis. Anesthesiology 2017; 127 (06) 998-1013
    CrossrefPubMedGoogle Scholar
  • 49 Moen TC, Babatunde OM, Hsu SH, Ahmad CS, Levine WN. Suprascapular neuropathy: what does the literature show?. J Shoulder Elbow Surg 2012; 21 (06) 835-846
    CrossrefPubMedGoogle Scholar
  • 50 Costouros JG, Porramatikul M, Lie DT, Warner JJ. Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy 2007; 23 (11) 1152-1161
    CrossrefPubMedGoogle Scholar
  • 51 Hazrati Y, Miller S, Moore S, Hausman M, Flatow E. Suprascapular nerve entrapment secondary to a lipoma. Clin Orthop Relat Res 2003; (411) 124-128
    PubMedGoogle Scholar
  • 52 Semmler A, von Falkenhausen M, Schröder R. Suprascapular nerve entrapment by a spinoglenoid cyst. Neurology 2008; 70 (11) 890
    CrossrefPubMedGoogle Scholar
  • 53 Solheim LF, Roaas A. Compression of the suprascapular nerve after fracture of the scapular notch. Acta Orthop Scand 1978; 49 (04) 338-340
    CrossrefPubMedGoogle Scholar
  • 54 Bayramoğlu A, Demiryürek D, Tüccar E. , et al. Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study. Knee Surg Sports Traumatol Arthrosc 2003; 11 (06) 393-398
    CrossrefPubMedGoogle Scholar
  • 55 Gaskin CM, Helms CA. Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients. Radiology 2006; 240 (02) 501-507
    CrossrefPubMedGoogle Scholar
  • 56 Holzgraefe M, Kukowski B, Eggert S. Prevalence of latent and manifest suprascapular neuropathy in high-performance volleyball players. Br J Sports Med 1994; 28 (03) 177-179
    CrossrefPubMedGoogle Scholar
  • 57 Nathe T, Tseng S, Yoo B. The anatomy of the supraclavicular nerve during surgical approach to the clavicular shaft. Clin Orthop Relat Res 2011; 469 (03) 890-894
    CrossrefPubMedGoogle Scholar
  • 58 Natsis K, Totlis T, Chorti A, Karanassos M, Didagelos M, Lazaridis N. Tunnels and grooves for supraclavicular nerves within the clavicle: review of the literature and clinical impact. Surg Radiol Anat 2016; 38 (06) 687-691
    CrossrefPubMedGoogle Scholar
  • 59 Mehta A, Birch R. Supraclavicular nerve injury: the neglected nerve?. Injury 1997; 28 (07) 491-492
    CrossrefPubMedGoogle Scholar
  • 60 Gelberman RH, Verdeck WN, Brodhead WT. Supraclavicular nerve-entrapment syndrome. J Bone Joint Surg Am 1975; 57 (01) 119
    CrossrefPubMedGoogle Scholar
  • 61 Omokawa S, Tanaka Y, Miyauchi Y, Komei T, Takakura Y. Traction neuropathy of the supraclavicular nerve attributable to an osseous tunnel of the clavicle. Clin Orthop Relat Res 2005; (431) 238-240
    PubMedGoogle Scholar
  • 62 Madhavi C, Holla SJ. Triplication of the lesser occipital nerve. Clin Anat 2004; 17 (08) 667-671
    CrossrefPubMedGoogle Scholar
  • 63 Peled ZM, Pietramaggiori G, Scherer S. Anatomic and compression topography of the lesser occipital nerve. Plast Reconstr Surg Glob Open 2016; 4 (03) e639
    CrossrefPubMedGoogle Scholar
  • 64 Choi I, Jeon SR. Neuralgias of the head. J Korean Med Sci 2016; 31 (04) 479-488
    PubMedGoogle Scholar
  • 65 Lee M, Brown M, Chepla K. , et al. An anatomical study of the lesser occipital nerve and its potential compression points: implications for surgical treatment of migraine headaches. Plast Reconstr Surg 2013; 132 (06) 1551-1556
    CrossrefPubMedGoogle Scholar
  • 66 Juškys R, Šustickas G. Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients. Acta Med Litu 2018; 25 (02) 53-60
    PubMedGoogle Scholar
  • 67 Ritchie MK, Wilson CA, Grose BW, Ranganathan P, Howell SM, Ellison MB. Ultrasound-guided greater auricular nerve block as sole anesthetic for ear surgery. Clin Pract 2016; 6 (02) 856
    PubMedGoogle Scholar
  • 68 McKinney P, Katrana DJ. Prevention of injury to the great auricular nerve during rhytidectomy. Plast Reconstr Surg 1980; 66 (05) 675-679
    CrossrefPubMedGoogle Scholar
  • 69 McKinney P, Gottlieb J. The relationship of the great auricular nerve to the superficial musculoaponeurotic system. Ann Plast Surg 1985; 14 (04) 310-314
    CrossrefPubMedGoogle Scholar
  • 70 Jeon Y, Kim S. Treatment of great auricular neuralgia with real-time ultrasound-guided great auricular nerve block: a case report and review of the literature. Medicine (Baltimore) 2017; 96 (12) e6325
    PubMedGoogle Scholar
  • 71 Lu L, Ding Y, Lin Y. , et al. Greater auricular nerve graft for repair of facial nerve defects [in Chinese]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010; 24 (07) 293-296
    PubMedGoogle Scholar
  • 72 Cruz Rizzolo RJ, Madeira MC, Bernaba JM, de Freitas V. Clinical significance of the supplementary innervation of the mandibular teeth: a dissection study of the transverse cervical (cutaneous colli) nerve. Quintessence Int 1988; 19 (02) 167-169
    PubMedGoogle Scholar
  • 73 Iwai T, Shibasaki M, Nakashima H. , et al. Communication between the transverse cervical nerve and the marginal mandibular branch of the facial nerve: a rare anatomical variant. Plast Surg Case Studies 2015; 1 (01) 9-10
    PubMedGoogle Scholar