Sonographic Peripheral Nerve Topography: A Landmark-based Algorithm

232 Pages·2019·46.65 MB·English

by  Hannes Gruber, Alexander Loizides, Bernhard Moriggl

Hannes Gruber
Alexander Loizides
Bernhard Moriggl
Editors
Sonographic Peripheral
Nerve Topography
A Landmark-based Algorithm
123
Sonographic Peripheral Nerve Topography
Hannes Gruber • Alexander Loizides
Bernhard Moriggl
Editors
Sonographic Peripheral Nerve
Topography
A Landmark-based Algorithm
Editors
Hannes Gruber Alexander Loizides
Department Radiologie Department Radiologie
Medizinische Universität Innsbruck Medizinische Universität Innsbruck
Innsbruck Innsbruck
Austria Austria
Bernhard Moriggl
Clinical & Functional Anatomy
Medical University of Innsbruck
Innsbruck
Austria
Translation from the German language edition: Nervensonographie kompakt - Anatomie der peripheren
Nerven mit Landmarks edited by Gruber, Loizides, Moriggl. Copyright © Springer-Verlag GmbH
Deutschland 2018 Springer is part of Springer Nature All Rights Reserved.
ISBN 978-3-030-11032-1 ISBN 978-3-030-11033-8 (eBook)
https://doi.org/10.1007/978-3-030-11033-8
© Springer Nature Switzerland AG 2019
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Foreword
If we wish to be consistently successful in finding peripheral nerves, whether it is for regional
anesthesia, pain management, or other clinical applications, we must have in-depth knowledge
of clinically relevant anatomy. Recognizing vascular, muscular, bony, and other nearby non-
neural structures helps us identify the target nerve we seek to find. For beginners of nerve
sonography, learning to identify relevant sonoanatomy can be quite challenging at the outset
and often time consuming if it is self-taught. It is akin to traveling in a foreign land for the first
time without a map or navigation aid of any kind. It would be most helpful to be prepared
before embarking on a new journey by gathering useful information and directions. This is
especially true for ultrasound-guided regional anesthesia as well as many other interventional
pain management or diagnostic procedures.
This nerve sonography handbook authored by Professors Hannes Gruber, Alexander
Loizides, and Bernhard Moriggl, all experts in nerve sonography, is precisely such a helpful
aid. One may consider this handbook the Google Maps for nerve sonographers to navigate the
world of peripheral nerve sonography. It is a simple, easy-to-follow, reference book with some
very cool features – simplicity, landmark-based illustrations, practical tips on scanning, and
standardized algorithm for nerve localization. In this handbook, a search of the nerve not only
includes a basic nerve compass, it also highlights alternate routes to find the nerve realizing
that variation is the rule of human anatomy as Professor Moriggl, the best anatomy and ultra-
sound professor I have ever known, so often reminds us. This is a great feature to overcome
navigational difficulties by showing sonographic views and screenshots of unfamiliar anatomi-
cal terrains.
I am confident you will find this one-of-a-kind handbook an invaluable asset to sonogra-
phers of musculoskeletal and peripheral nerve anatomy. You will benefit from the authors’
wealth of knowledge, practical scanning advice, and step-by-step nerve localization algorithm.
This handbook is easy to understand, concise, and enlightening. Studying this book is a great
way to plan and get ready before embarking on a journey of peripheral nerve sonography. As
the popular slogan says, “Don’t Leave Home Without It.”
Vincent W. S. Chan, MD, FRCPC, FRCA
Department of Anesthesia
University of Toronto
Toronto, ON, Canada
v
Preface
“For whom, and why?” Our target audience and the purpose of this book.
This atlas is meant to be a useful “vade mecum” for all colleagues interested and involved
in nerve sonography in order to locate nerves as quickly and easily as possible in daily clinical
practice. You could put it this way, too: “Never search again for a nerve” – for in this book, you
have already found it. Thus, the “Why?” has already been nearly answered since nothing com-
parable exists until now. With this book, you will save valuable time, time that most certainly
can be better used for a subsequent diagnosis, intervention, and/or therapy. Quite deliberately,
this atlas does not contain any information on these latter aspects!
Due to the clear descriptions of visible and/or palpable “external” landmarks by illustra-
tions and short (!) texts, the ultrasound probe can be placed optimally from the beginning:
initial probe positioning. In the ultrasound images, a few but characteristic “internal” land-
marks are shown, which help in finding the location and topographic allocation of the “target
structure” nerve. As a valuable support for practical application, we, in particular, documented
those areas where specific nerves can be delimited best: the respective “point of optimal visi-
bility” (POV). Such a point does exist for (nearly) any peripheral nerve! Not without reason,
the “POV” does take central position in the overview tables for each single nerve! We are
convinced that, especially in cases of unfavorable sonographic conditions, the exact knowl-
edge of these POVs can be of decisive help.
All this shows that the authors paid very special attention to the practical aspects of nerve
sonography. As a result, relevant variations were mentioned, and – if feasible and reasonable –
alternative plans were addressed. Additionally, some comments (concerning, e.g., positioning
or pitfalls) were enclosed. References to the innumerable studies concerning nerve sonogra-
phy, however, were intentionally left out since including them would have conflicted with the
intention of this compact manual.
We do hope very much that you will be pleased by this atlas and that, above all, it will be
used frequently!
We should close our introduction with a “quotation” inspired by the famous German author
Wilhelm Busch (1832–1908):
“You’ll miss a nerve quite easily, if searched for it where it can’t be.”
May our book help you to avoid that calamity!
Innsbruck, Austria Bernhard Moriggl
Alexander Loizides
Hannes Gruber
vii
Contents
1 How to Use This Book Effectively: A User’s Guide! . . . . . . . . . . . . . . . . . . . . . . . . 1
Bernhard Moriggl, Alexander Loizides, and Hannes Gruber
2 Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Alexander Loizides, Sebastian Schuhmayer, and Bernhard Moriggl
3 Upper Arm, Forearm and Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Alexander Loizides, Sebastian Schuhmayer, and Bernhard Moriggl
4 Trunk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111
Alexander Loizides, Hannes Gruber, Philipp Koch, Sebastian Schuhmayer,
and Bernhard Moriggl
5 Gluteal Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Hannes Gruber, Philipp Koch, and Bernhard Moriggl
6 Thigh, Lower Leg, and Foot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
Hannes Gruber, Philipp Koch, and Bernhard Moriggl
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
ix
Contributors
Hannes Gruber Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
Philipp Koch Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
Alexander Loizides Department of Radiology, Medical University Innsbruck, Innsbruck,
Austria
Bernhard  Moriggl Division of Clinical and Functional Anatomy, Medical University
Innsbruck, Innsbruck, Austria
Sebastian Schuhmayer Department of Radiology, Medical University Innsbruck, Innsbruck,
Austria
xi
Abbreviations
A. Arteria
Aa. Arteriae
AP Alternative plan
ELM External landmarks
ILM Internal landmarks
IPOS Initial positioning of the probe
K Comments
M. Musculus
Mm. Musculi
N. Nervus
Nn. Nervi
POV Point of optimal visibility
R. Ramus
Rr. Rami
V. Vena
VAR Variations
Vv. Venae
xiii
How to Use This Book Effectively: 1
A User’s Guide!
Bernhard Moriggl, Alexander Loizides,
and Hannes Gruber
Contents
The simple structure 2
The example: Ramus palmaris of Nervus medianus 2
General remarks 5
B. Moriggl (*)
Division of Clinical and Functional Anatomy,
Medical University Innsbruck, Innsbruck, Austria
e-mail: [e-mail]
A. Loizides · H. Gruber
Department of Radiology, Medical University Innsbruck,
Innsbruck, Austria
e-mail: [e-mail];
[e-mail]
© Springer Nature Switzerland AG 2019 1
H. Gruber et al. (eds.), Sonographic Peripheral Nerve Topography, https://doi.org/10.1007/978-3-030-11033-8_1