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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5779_Библиотеки_им_академика_М_И_Перельмана
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240 Chapter 8
GreaterAuricularNerve
1. Probe/patient position: The patient’s head is rotated to the opposite side, and the probe is
placed posteriorly on the sternocleidomastoid muscle in the slight sagittal oblique axis in the
upper third of the muscle. The greater auricular nerve is visualized overlying the sternocleidomastoid muscle (Figure 8-10).
4
A
Figure 8-10. Greater auricular nerve.
(A) Probe placement posteriorly on
the sternocleidomastoid muscle in the
slight sagittal oblique axis in the upper third of the muscle. (B) The greater auricular nerve (white arrow) is visualized
overlying the sternocleidomastoid muscle (SCM).
B
2. Landmark: Sternocleidomastoid muscle in the upper third of the muscle belly
3. Relevant anatomy: The greater auricular nerve originates from the cervical plexus and is
composed of the C2 and C3 spinal nerves. It emerges around the posterior border of the sternocleidomastoid muscle and ascends superiorly to give sensory innervation to the skin over
the parotid gland, mastoid process, and outer ear.
5
Peripheral Nerves 241
SpinalAccessoryNerve
1. Probe/patient position: The patient’s head is rotated to the opposite side, and the probe is
placed on the sternocleidomastoid muscle in the sagittal oblique axis in the upper third of the
muscle in a posterior-to-anterior orientation. The spinal accessory nerve is visualized within
the belly of the sternocleidomastoid muscle (Figure 8-11).
4
A
Figure 8-11. Spinal accessory
nerve. (A) Probe placement on the
sternocleidomastoid muscle in the
sagittal oblique axis in the upper third
of the muscle in a posterior-to-anterior
orientation. (B) The spinal accessory
nerve (white arrow) is visualized within
the belly of the sternocleidomastoid
muscle.
B
2. Landmark: Sternocleidomastoid muscle in the upper third of the belly
3. Relevant anatomy: The spinal accessory nerve is the 11th cranial nerve. It gives motor inner-
vation to the sternocleidomastoid and trapezius muscles. It pierces the sternocleidomastoid
muscle and courses obliquely across the posterior triangle of the neck. As it traverses the
sternocleidomastoid muscle, it gives innervating branches to the muscle and is then joined by
branches from the C2, C3, and C4 spinal nerve roots posteriorly to form a plexus that gives
innervation to the trapezius muscle.
5
242 Chapter 8
DorsalScapularNerve
1. Probe/patient position: The patient’s head is rotated to the opposite side, and t he probe is
placed in the sagittal oblique axis, posterior to the sternocleidomastoid muscle and over the
middle scalene belly at the level of the C5 nerve root. The dorsal scapular nerve is visualized
within the middle scalene muscle belly (Figure 8-12).
A B
Figure 8-12. Dorsal scapular nerve.
(A) Probe placement in the sagittal
oblique axis, posterior to the
sternocleidomastoid muscle and over
the middle scalene belly at the level of
the C5 nerve root. (B) The dorsal scapular nerve (white arrow) is visualized within the middle scalene (MS) muscle belly.
4
2. Landmarks: Middle scalene muscle and C5 nerve root
3. Relevant anatomy: The dorsal scapular nerve arises from the brachial plexus and has fiber
contribution from the C5 nerve root. It gives motor innervation to the rhomboids and levator
scapulae muscle. It pierces the middle scalene and then passes beneath the levator scapulae
muscle as it courses posteriorly.
3,5
Peripheral Nerves 243
FacialNer ve
1. Probe/patient position: The patient’s head is rotated to the opposite side, and the probe is
placed along the LX of the nerve just below the ear. The nerve is visualized in the LX going
through the parotid gland (Figure 8-13).
6
A
Figure 8-13. Facial n er ve. (A) Probe
placement. (B) The facial nerve (white
arrows) is visualized in the LX going
through the parotid gland (PG).
B
2. Landmarks:
a. Internal: Parotid gland
b. External: Just below the ear
3. Relevant anatomy: The facial nerve is the seventh cranial nerve. It exits the skull through the
stylomastoid foramen and divides into 5 branches as it pierces through the parotid gland:
temporal, zygomatic, buccal, mandibular, and cervical.
244 Chapter 8
GreaterandLesserOccipitalNerves
1. Probe/patient position:
a. Greater occipital nerve: The p robe is placed in an oblique axis between the spinous process
of the C2 and mastoid process. The greater occipital nerve is visualized between the semispinalis capitis and obliquus capitis inferior muscles (Figure 8-14).
4
A
Figure 8-14. Greater occipital nerve.
(A) Probe placement in the oblique
axis between the spinous process of
the C2 and mastoid process. (B) The
greater occipital nerve (white arrow)
is visualized between the semispinalis
capitis (SSC) and obliquus capitis
inferior (OCI) muscles.
B
Peripheral Nerves 245
b. Lesser occipital nerve: The patient’s head is rotated to the opposite side, and the probe is
placed transversely on the posterior border of the sternocleidomastoid at the level of the
upper third of the muscle, just below the hairline. The lesser occipital nerve is visualized
between the sternocleidomastoid and levator scapulae muscles (Figure 8-15).
A
Figure 8-15. Lesser occipital nerve.
(A) Probe placement transversely
on the posterior border of the
sternocleidomastoid muscle at the
level of the upper third of the muscle,
just below the hairline. (B) The lesser
occipital nerve (white arrow) is visualized between the sternocleidomastoid (SCM) and levator scapulae (LS) muscles.
B
2. Landmarks:
a. Greater occipital nerve: The spinous process of the C2 and mastoid process are external
landmarks. The semispinalis capitis and obliquus capitis inferior muscles are internal
landmarks.
b. Lesser occipital nerve: The posterior border of the sternocleidomastoid and levator scapu-
lae muscles. The levator scapulae muscle is lined by the hyperechoic deep cervical fascia.
3. Relevant anatomy: The greater occipital nerve arises from the medial branch of the dorsal
ramus of the C2. The lesser occipital nerve arises from the ventral ramus of the C2.
246 Chapter 8
PhrenicNerve
1. Probe/patient position: The patient’s head is rotated to the opposite side, and the p robe is
placed on the sternocleidomastoid muscle at the level of the mid-belly. The phrenic nerve is
visualized superficial to the anterior scalene muscle and deep to the thyrocervical trunk of the
subclavian artery (Figure 8-16).
A B
Figure 8-16. Phrenic nerve. (A) Probe
placement on the sternocleidomastoid
muscle at the mid-belly level. (B)
The phrenic ner ve (yellow arrow) is
visualized superficial to the anterior
scalene muscle (AS).
4
2. Landmarks:
a. External: Posterior border of the sternocleidomastoid muscle at the mid-belly level
b. Internal: Anterior scalene muscle and thyrocervical trunk of the subclavian artery and
sternocleidomastoid muscle
3. Relevant anatomy: The phrenic nerve originates from the anterior division of C3, C4, and C5.
It receives contribution from both the cervical plexus and brachial plexus.
Peripheral Nerves 247
SubclavianNerve
1. Probe/patient position: The patient’s head is rotated to the opposite side, and the p robe is
placed above and along the clavicle. The subclavian nerve is visualized just above the subclavian artery. Immediately next to it, the brachial plexus cluster can be visualized (Figure 8-17).
A B
Figure 8-17. Subclavian nerve. (A)
Probe placement above and along
the clavicle. (B) The subclavian nerve
(between the yellow arrows) is
visualized just above the subclavian
artery (A) and immediately next to the
brachial plexus cluster (white arrows).
4
2. Landmarks:
a. External: Clavicle
b. Internal: Subclavian artery and brachial plexus
3. Relevant anatomy: The subclavian nerve originates from the junction point of the C5 and C6
nerve roots. It is connected by a filament with the phrenic nerve.
5
248 Chapter 8
LongThoracicNerve
1. Probe/patient position: The probe is placed in the SX over the middle scalene muscle at the
level of the C5 and C6 nerve root. The long thoracic nerve is visualized within the middle
scalene muscle, posterior to the C5 and C6 nerve roots (Figure 8-18).
A B
Figure 8-18. Long thoracic nerve.
(A) Probe placement in the SX over
the middle scalene muscle at the level
of the C5 and C6 nerve roots. (B) The
long thoracic nerve (yellow arrow) is
visualized within the middle scalene
muscle, posterior to the C5 and C6
nerve roots.
4
2. Landmarks: Middle scalene muscle and C5 and C6 nerve roots
3. Relevant anatomy: The long thoracic nerve arises from the C5, C6, and C7 nerve roots and
supplies the serratus anterior muscle.
5
Peripheral Nerves 249
Shoulder and Arm Region
SuprascapularNerve
1. Probe/patient position:
a. Suprascapular notch: The probe is positioned over the suprascapular notch and aligned
along the direction of the axis of the coracoid process. The suprascapular nerve is visualized in the suprascapular notch with the superior transverse ligament overlying it and the
suprascapular artery superficial to the ligament (Figure 8-19).
A B
Figure 8-19. Suprascapular nerve from
the suprascapular notch. (A) Probe
placement over the suprascapular
notch, with the probe aligned along
the direction of the axis of the coracoid process. (B) Suprascapular nerve (yellow arrow) and artery (red arrow).
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