Location of Brachial Plexus Terminal Branches Determined by Ultrasound and Cadaver Examination
Poster
Video Presentation
Abstract
T he utilization of ultrasound studies to identify the musculocutaneous and axillary nerve could provide great benefits to Doctors of Osteopathic Medicine as it will expand their ability to efficiently locate and treat in a clinical setting. There is significant interest in new techniques to properly diagnose and treat injuries, impingements, and neuropathies, as well as administering local anesthetic nerve blocks, as the brachial plexus contains large variation in structure from patient to patient. Ultrasound nerve studies provide a pathway to effectively locate peripheral nerves during a procedure, provide local anesthetic or steroid injections, and diagnose impingements in the musculocutaneous and axillary nerves. There exists a limited dataset to validate these methods. This research provides a case study on the efficacy and utilization of ultrasound technology by the demonstration of how to locate the nerve. A normalized, baseline data of axillary and musculocutaneous nerve localization techniques, along with minor changes to established techniques, in both cadaveric and human participants has been explored and provided within this paper. The human population (N = 21) consisted of eleven males and ten females, ranging from 24-39 years old with a mean age of 26 and was supplemented with a cadaveric donor population (N=24) consisting of thirteen females and eleven males. Participants filled out a questionnaire and their whole arm length measurement was obtained prior to ultrasound imaging. Cadaveric measurements were taken based on the distance of the nerves from different clinically relevant bony landmarks. The case study obtained significant results with positive correlations between the different variables both in the cadaveric study as well as the ultrasound portion. A significant positive correlation p< .05 between the coracoid process to where musculocutaneous nerve pierces coracobrachialis and the length between coracobrachialis and medial epicondyle was found in males ( rp= 0.58, p=.006). A positive correlation in females was found to be nonsignificant (rp=0.12, p=.628). 21% of variance in the distance between the coracobrachialis and where musculocutaneous nerve pierces coracobrachialis is due to the distance between medial epicondyle and coracoid process (p=.003). A one-unit increase of the distance between medial epicondyle and coracoid process will increase the distance of coracoid process to musculocutaneous nerve pierces coracobrachialis by 0.40 units (p=.006). Statistical significance was denoted by p< .05. The data and techniques outlined in this research aim to provide the foundation for larger clinical studies in the realm of Osteopathic medicine.
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