Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5779_Библиотеки_им_академика_М_И_Перельмана

1. Probe/patient position: The patient’s head is rotated to the opposite side, and the probe is posi­tioned on the sagittal oblique axis over the scalene anterior, perpendicular to the supraclavicu­lar vessels, to visualize the cervical nerve roots in the short axis (SX) from C5-C8. Tracing the nerve roots proximally, C5 and C6 can be seen emerging between the anterior and posterior tubercles (Figure 8-1). The C7 nerve root lacks an anterior tubercle (Figure 8-2). Moving a few millimeters distally, the trunk level can be visualized in the long axis (LX) through the acoustic window of the scalene middle (Figures 8-3 through 8-5). Further distally, at the level of lateral third of the supraclavicular fossa and between the clavicle and first rib in the sagit­tal oblique view, 6 divisions of the brachial plexus appear as a cluster of hypoechoic fascicles between the omohyoid muscle and the subclavian artery and vein (Figure 8-6). The cord level of the brachial plexus is best visualized in the subpectoralis minor space, where the probe is placed in the sagittal oblique orientation over the pectoralis minor muscle and the axillary artery is identified (Figure 8-7). The posterior, medial, and lateral cords are identified around the axillary artery as hyperechoic structures.