Upper Extremity

Question 1

Brachial plexus formed by?

Answer 1

anterior rami of C5-T1 nerve roots

Question 2

Interscalene block

Answer 2

analgesia for procedures of the shoulder

• Roots (C5-7)
• blocks the ipsilateral phrenic nerve (careful in pre-existing respiratory conditions)
• roots run through the anterior and middle scalene muscles

Question 3

Horner’s Syndrome w/ Interscalene

Answer 3

Local anesthetic tracks proximally –> stellate ganglion block
- myosis, ptosis, anhidrosis

Question 4

Nerve stim w/ Interscalene

Answer 4

looking for deltoid/biceps contraction (C5)

• vascular = too deep (vertebral artery)
• hiccups/diaphragm = too anterior (phrenic)
• trapezius/SA = too posterior

Question 5

U/S interscalene

Answer 5

In-Plane or Out-plane

• visualize artery and IJ
• “Snow-man” or “traffic-light”

Question 6

Supraclavicular block

Answer 6

“spinal of the arm” –> blocks the trunks

• dense anesthesia of arm and elbow/hand
• misses axillary and suprascapular nerves
• highest risk of PTX

Question 7

U/S supraclav

Answer 7

high frequency transducer

• ID the subclavian artery and 1st rib (white line under artery)
• nerves are superficial to artery
• lower trunk is in the corner pocket

Question 8

Infraclavicular block

Answer 8

anesthesia distal to the elbow –> great place for a catheter

• spares the intercostobrachial!!!!
• blocks the divisions

Question 9

Nerve stim Infraclav

Answer 9

direct posterior advancement until finger flexion

- needle entry is 2x2 medial and caudal from coracoid process

Question 10

U/S Infraclav

Answer 10

Pec major/minor muscles are superficial

• ID the axillary artery
• catheter sits under axillary artery (posterior cord)
  
  • left (lateral cord)
  • right (medial cord)

Question 11

Axillary Block

Answer 11

blocks cords of BP

• likely need multiple injections to cover all nerves
• great placement for respiratory disease as it avoids the PTX and phrenic
• spares musculocutaneous

Question 12

Transarterial axillary

Answer 12

palpate axillary artery –> puncture and draw heme –> advance until none and then inject

Question 13

Nerve stim axillary

Answer 13

Median nerve (superior) --> wrist flexion
Ulnar nerve (inferior) --> 4/5 digit flexion
Radial nerve (infero-posterior) --> wrist extension

Question 14

U/S axillary

Answer 14

ID axillary artery

• Radial nerve is deep (infero-posterior)
• Ulnar is deep and lateral (inferior)
• Median is superficial
• musculocutaneous

Question 15

Musculocutaneous nerve

Answer 15

spared a lot on the axillary block

• innervates the lateral aspect of forearm and wrist
• elbow flexion

Question 16

Intercostobrochial block

Answer 16

Originates from T2

• superficial medial arm –> wheal
• done for tourniquet pain!