scholarly journals Anatomical variations of the phrenic nerve and its clinical implication for supraclavicular block

2003 ◽  
Vol 91 (6) ◽  
pp. 916-917 ◽  
Author(s):  
P.E. Bigeleisen
Keyword(s):  
Phrenic Nerve ◽  
Clinical Implication ◽  
Anatomical Variations ◽  
Supraclavicular Block

scholarly journals Bilateral variations in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver

2016 ◽  
Vol 33 (03) ◽  
pp. 164-167
Author(s):  
S. Ahmadpour ◽  
K. Foghi
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Practical Importance ◽  
Anatomical Variations ◽  
Rare Variation ◽  
Male Cadaver ◽  
Supraclavicular Block ◽  
The Right ◽  
Mediastinal Pleura

AbstractPhrenic nerve provides the major motor supply to diaphragm. Various anatomical variations in the course and distribution of the phrenic nerve have reported before. Here we report a rare bilateral asymmetric variation in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver. Specifically, the right phrenic nerve was arising from the upper trunk of the brachial plexus (C5) and the left side nerve originated from the supraclavicular nerve and a tiny branch from C5. In the same cadaver both sides phrenic nerve were buried in the mediastinal pleura. Another interesting finding was absence of the fibrous pericardium. To the best of our knowledge the presented case showed a very rare variation in the roots of origin of the phrenic nerve accompanied with pericardial anomaly which has been less reported. We think such case is of practical importance during supraclavicular block during anesthesia

scholarly journals Anatomical variations of the phrenic nerve: an actualized review

2015 ◽  
Vol 32 (01) ◽  
pp. 053-056 ◽  
Author(s):  
A. Prates Júnior ◽  
L. Vasques ◽  
L. Bordoni
Keyword(s):  
Subclavian Artery ◽  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Internal Thoracic Artery ◽  
Anatomical Variations ◽  
Surgical Anatomy ◽  
Diaphragm Muscle ◽  
Normal Anatomy ◽  
The Subject ◽  
Superior Portion

Abstract Introduction: The phrenic nerve normally arises from ventral rami of C3, C4 and C5. It emerges laterally to the superior portion oflateral border of scalenus anterior muscle and presents a descendent course between subclavian artery and vein. It crosses anterior to internal thoracic artery and descends through the mediastinum, until the diaphragm muscle, to supply it with motor and sensitive fibers. Matherials and Methods: A bibliographic review was conducted, based on anatomy, neuroanatomy and surgical anatomy textbooks, published in Brazil and abroad, as well as a review of scientific articles, published over the last 20 years, available on research databases PubMed, Scielo, LILACS and MEDLINE, from keywords phrenic nerve, variation and anomaly. Results: Variations of the phrenic nerve are frequent, but they are not often discussed. Thus, we aimed to conduct an actualized review over the subject. Regarding the variations in the origin of the phrenic nerve, textbooks vaguely inform that it is mainly formed by C4, but the recent cadaveric studies pointed the segments C4 and C5 as the most common origin. About the variations in its course, the most described is its passage anterior to the subclavian vein, before reaching the thorax. However, the presence of accessory phrenic nerve represents the greatestvariation, mostly arising from nerve to subclavian. There are few reports in literature about the complications associated to these variations, but some are suggested, as the possibility of causing its damage during the puncture of the subclavian vein, when the nerve descends anterior to it, which may lead to a hemidiaphragmatic paresis. When variations are present, even simple procedures may cause injuries. Conclusion: Therefore it is fundamental to know the normal anatomy and the possible variations of the phrenic nerve, in order to perform safe procedures in its topography, as well as to enable a timely recognition of complications.

In-situ left-sided bilateral internal thoracic artery: elevated hemidiaphragm

2018 ◽  
Vol 26 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Oren Lev-Ran ◽  
Dan Abrahamov ◽  
Nina Baram ◽  
Menachem Matsa ◽  
Yaron Ishai ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Phrenic Nerve ◽  
Internal Thoracic Artery ◽  
Statistical Significance ◽  
Anatomical Variations ◽  
Transverse Sinus ◽  
Phrenic Nerve Injury ◽  
Right Internal Thoracic Artery ◽  
Bilateral Internal Thoracic Artery

Background Procurement of the internal thoracic artery risks ipsilateral phrenic nerve injury and elevated hemidiaphragm. Anatomical variations increase the risk on the right side. Patients receiving left-sided in-situ right internal thoracic artery configurations appear to be at greatest risk. Methods From 2014 to 2016, 432 patients undergoing left-sided in-situ bilateral internal thoracic artery grafting were grouped according to right internal thoracic artery configuration: retroaortic via transverse sinus (77%) or ante-aortic (23%); targets were the circumflex and left anterior descending artery territories, respectively. Elevated hemidiaphragm was assessed by serial chest radiographs and categorized by side, complete (≥2 intercostal spaces) versus partial, and permanent versus transient. Results Right elevated hemidiaphragm occurred in 4.2% of patients. The incidence of radiological complete right elevated hemidiaphragm was 2.8% (12/432); 8 cases were transient with recovery in 3.5 ± 0.3 weeks. Permanent right elevated hemidiaphragm occurred in 0.9% (retroaortic group only). Permanent left elevated hemidiaphragm occurred in 0.9% and was significantly higher in the ante-aortic group (3/99 vs. 1/333, p = 0.039). No bilateral hemidiaphragm elevation was documented. Partial right elevated hemidiaphragm occurred in 1.4% and was not associated with adverse early or late respiratory outcomes. Conclusions Despite susceptible right phrenic nerve-internal thoracic artery anatomy, the incidence of permanent right elevated hemidiaphragm is low and no higher than left-sided in prone bilateral internal thoracic artery subsets. This reflects skeletonized internal thoracic artery procurement. Although statistical significance was not achieved, a retroaortic right internal thoracic artery configuration may constitute a higher risk of right phrenic nerve injury.

scholarly journals Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication

ISRN Anatomy ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Rakhi Rastogi ◽  
Virendra Budhiraja ◽  
Kshitij Bansal
Keyword(s):  
Brachial Plexus ◽  
Clinical Implication ◽  
Axillary Artery ◽  
Anatomical Variations ◽  
Axillary Nerve ◽  
Upper Extremities ◽  
Surgical Approaches ◽  
Lower Trunk ◽  
Medical Undergraduate ◽  
Posterior Division

Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures.

scholarly journals ANATOMICAL VARIATIONS IN THE FORMATION OF MEDIAN NERVE WITH ITS CLINICAL IMPLICATION: A CADAVERIC STUDY

2019 ◽  
Vol 7 (3.1) ◽  
pp. 6706-6711
Author(s):  
Afewerki Bekele Degene ◽  
◽  
Brhanu Gebremeskel Gebremedhn ◽  
Kidanemariam Gaim kidanu ◽  
◽  
...  
Keyword(s):  
Median Nerve ◽  
Clinical Implication ◽  
Anatomical Variations ◽  
Cadaveric Study

Symptomatic Phrenic Nerve Palsy After Supraclavicular Block in an Obese Man

Orthopedics ◽  
2009 ◽  
Vol 32 (5) ◽  
pp. 368-370 ◽  
Author(s):  
John M. Erickson ◽  
Dean S. Louis ◽  
Norah N. Naughton
Keyword(s):  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Phrenic Nerve Palsy ◽  
Supraclavicular Block

scholarly journals Brachial plexus variations in its formation and main branches

2003 ◽  
Vol 18 (suppl 5) ◽  
pp. 14-18 ◽  
Author(s):  
Valéria Paula Sassoli Fazan ◽  
André de Souza Amadeu ◽  
Adilson L. Caleffi ◽  
Omar Andrade Rodrigues Filho
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Anatomical Variations ◽  
Anatomical Structure ◽  
The Body ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve ◽  
Close Relationship ◽  
Axillary Region ◽  
The Right

PURPOSE: The brachial plexus has a complex anatomical structure since its origin in the neck throughout its course in the axillary region. It also has close relationship to important anatomic structures what makes it an easy target of a sort of variations and provides its clinical and surgical importance. The aims of the present study were to describe the brachial plexus anatomical variations in origin and respective branches, and to correlate these variations with sex, color of the subjects and side of the body. METHODS: Twenty-seven adult cadavers separated into sex and color had their brachial plexuses evaluated on the right and left sides. RESULTS: Our results are extensive and describe a large number of variations, including some that have not been reported in the literature. Our results showed that the phrenic nerve had a complete origin from the plexus in 20% of the cases. In this way, a lesion of the brachial plexus roots could result in diaphragm palsy. It is not usual that the long thoracic nerve pierces the scalenus medius muscle but it occurred in 63% of our cases. Another observation was that the posterior cord was formed by the posterior divisions of the superior and middle trunks in 9%. In these cases, the axillary and the radial nerves may not receive fibers from C7 and C8, as usually described. CONCLUSION: Finally, the plexuses studied did not show that sex, color or side of the body had much if any influence upon the presence of variations.

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