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Critical analysis of the macro- and sonographic anatomy of the brachial plexus

Dissertation (MSc)--University of Pretoria, 2017.

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Other Authors: Van Schoor, Albert-Neels
Format: Thesis
Language:English
Published: University of Pretoria 2018
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access_status_str Open Access
author2 Van Schoor, Albert-Neels
author_browse Van Schoor, Albert-Neels
author_facet Van Schoor, Albert-Neels
collection Thesis
dc_rights_str_mv © 2018 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria.
description Dissertation (MSc)--University of Pretoria, 2017.
format Thesis
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institution University of Pretoria (South Africa)
language English
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publishDate 2018
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publisher University of Pretoria
publisherStr University of Pretoria
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spelling oai:repository.up.ac.za:2263/65871 Critical analysis of the macro- and sonographic anatomy of the brachial plexus Van Schoor, Albert-Neels u11083647@tuks.co.za Tshabalala, Zithulele Nkosinathi Govender, Sabashnee UCTD Brachial Plexus Sonographic Anatomy Variations Nerve Blocks South African Population Cadaveric Dissections Sonographic Scans Surgical Procedures Health sciences theses SDG-03 SDG-03: Good health and well-being Health sciences theses SDG-04 SDG-04: Quality education Health sciences theses SDG-10 SDG-10: Reduced inequalities Dissertation (MSc)--University of Pretoria, 2017. Various institutions and government hospitals in South Africa, still perform nerve blocks using anatomical landmarks to approximate the precise position of the targeted nerve(s). Although this technique has been reported to be successful, variation does occur within the South African population therefore increasing the risk of complications. Thus causing surgeons and anaesthesiologist’s to employ sonography-guided techniques. Sonography allows the visualisation of structures in real time. This technique provides adequate coverage of the needle insertion site and its surrounding structures, to allow for readjustment in order to obtain a successful block in the event of a variation. The aim of this study was to investigate the sonographic anatomy of the brachial plexus at the three common areas in which brachial plexus nerve blocks are performed, i.e. the interscalene groove, supraclavicular fossa and the infraclavicular space. The anatomy of the brachial plexus was also studied on 60 cadavers and then further compared to the anatomy seen on the sonographic screen. Bilateral dissections were done on 60 embalmed cadavers, comprising of 43 males and 17 females, from the Department of Anatomy in the School of Medicine at the Faculty of Health Sciences of the University of Pretoria, South Africa. The use of these cadavers was in accordance with the South African National Health Act 61 of 2003. Dissection was done to expose the brachial plexus in situ. The various segments of the brachial plexus were evaluated. The root contributions, branching patterns and relationships were noted. Upper limb sonographic scans were done bilaterally for the 3 approaches to measure the distance of surrounding structures to the brachial plexus, the skin to structure distances and to determine the ideal placement of the probe for each approach. A full step-by-step guideline was recorded. Variations found in the cadaveric component of the study include the following: a direct branching of the C5 cord into the suprascapular nerve; the direct branching of the medial cutaneous nerve of the arm distinctly as a larger single branch; a communicating branch forming between the musculocutaneous and median nerve; abnormal formation of the median nerve from two lateral roots from the lateral cord and one medial root from the medial cord and; a post fixed brachial plexus. In the interscalene approach, the roots of the brachial plexus were found lying in a horizontal plane between the anterior and middle scalene muscles or the roots were found lying anterior to the anterior scalene muscle yet posterior to the sternocleidomastoid muscle. In the supraclavicular approach the brachial plexus was situated between the subclavian artery and vein and in the infraclavicular approach, the cords of the brachial plexus were found at variable angles to the subclavian artery/axillary artery. This study focused on variations that may be present, each of which are important to note if any clinical or surgical procedures are to be performed in the area. The most prevalent variation found was the direct braching of the suprascapular nerve from the C5 root instead of the superior trunk. The study aimed to improve “blind”, as well as sonographic-guided, nerve blocks that may be performed in a South African population. em2025 Anatomy MSc Unrestricted SDG-03: Good health and well-being SDG-04: Quality education SDG-10: Reduced inequalities 2018-07-25T06:53:38Z 2018-07-25T06:53:38Z 2018/04/13 2017 Dissertation Govender, S 2017, Critical analysis of the macro- and sonographic anatomy of the brachial plexus, MSc Dissertation, University of Pretoria, Pretoria, viewed yymmdd <http://hdl.handle.net/2263/65871> A2018 http://hdl.handle.net/2263/65871 en © 2018 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. application/pdf University of Pretoria
spellingShingle UCTD
Brachial Plexus
Sonographic Anatomy
Variations
Nerve Blocks
South African Population
Cadaveric Dissections
Sonographic Scans
Surgical Procedures
Health sciences theses SDG-03
SDG-03: Good health and well-being
Health sciences theses SDG-04
SDG-04: Quality education
Health sciences theses SDG-10
SDG-10: Reduced inequalities
Critical analysis of the macro- and sonographic anatomy of the brachial plexus
title Critical analysis of the macro- and sonographic anatomy of the brachial plexus
title_full Critical analysis of the macro- and sonographic anatomy of the brachial plexus
title_fullStr Critical analysis of the macro- and sonographic anatomy of the brachial plexus
title_full_unstemmed Critical analysis of the macro- and sonographic anatomy of the brachial plexus
title_short Critical analysis of the macro- and sonographic anatomy of the brachial plexus
title_sort critical analysis of the macro and sonographic anatomy of the brachial plexus
topic UCTD
Brachial Plexus
Sonographic Anatomy
Variations
Nerve Blocks
South African Population
Cadaveric Dissections
Sonographic Scans
Surgical Procedures
Health sciences theses SDG-03
SDG-03: Good health and well-being
Health sciences theses SDG-04
SDG-04: Quality education
Health sciences theses SDG-10
SDG-10: Reduced inequalities
url http://hdl.handle.net/2263/65871