Ultrasound in Peripheral Nerve Interventions
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1 Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center Assistant Clinical Professor Emory University, School of Medicine
2 Outline Ultrasound basics Nerve blocks in physiatric setting Ultrasound with nerve blocks
3 Ultrasound Basics Sound wave energy is transformed when it interacts upon different medium Reflected Absorbed Transformed
4 Sound Wave Transformation Frequency Energy heat, electricity, mechanical energy / vibration etc. Density of median -> impedance High impedance difference -> high echogenicity Mineral, fluid, gas
5 Ultrasound Machines Transforms electricity to ultrasound Receives reflected ultrasound and transforms to electricity Display of digital images
6 Ultrasound transducers Transforms electricity to vibrations of the piezoelectric crystals Higher frequency -> higher resolution, lower penetration MHz
7 J Ultrasound Med 2002; 21:315
8 Sonographic Appearance Fluid anechoic Muscle relatively hypoechoic Tendon hyperechoic Nerve hyperechoic Bone, cortex hyperechoic with acoustic shadow
9 Lateral Medial Adductor Longus Adductor Brevis Femur Adductor Magnus Sciatic Nerve Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
10 Doppler Effect Sound wave travelling away decreases in frequency Sound wave travelling towards increases in frequency
11 Doppler Imaging 3%2DVASC%2DBICPA&systemcode=e&div=ultra
12 Anisotropy
13 Anisotropy
14 Nerve Blocks Management of spasticity, contractures Pre-serial casting transient blocks Pre-manipulation blocks Diagnostic / therapeutic
15 Ultrasound Imaging for Nerve Blocks Brachial Plexus Suprascapular Median elbow, carpal tunnel Ulnar Radial Femoral Obturator Sciatic Tibial
16 Brachial Plexus Preparation for regional shoulder manipulations Anesthetic block
17
18 AnaesthesiaUK: Home>>Resources>>Anatomy>>Anatomy for anaesthetists>>applied anatomy for upper limb blocks (August 30, 2011)
19 Brachial Plexus Anatomical Appraoch
20 The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound-Assisted Nerve Blocks (14/03/2009) (Aug 30, 2011) Brachial Plexus Interscalene Approach
21 Brachial Plexus - Interscalene
22 Brachial Plexus - Interscalene
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24
25 `
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27 Brachial Plexus Suprascapular Artery
28 Yasuyuki Shibata. The Suprascapular Artery and the Brachial Plexus.
29 Yasuyuki Shibata. The Suprascapular Artery and the Brachial Plexus.
30 Brachial Plexus - Supraclavicular The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound-Assisted Nerve Blocks (14/03/2009) (Aug 30, 2011)
31 Supraclavicular Suprascapular Nerve
32 Brachial Plexus Infraclavicular
33 Brachial Plexus Infraclavicular Yasuyuki Shibata. Ultrasound-Guided Infraclavicular Brachial Plexus Block.
34 Brachial Plexus Infraclavicular Yasuyuki Shibata. Ultrasound-Guided Infraclavicular Brachial Plexus Block.
35 Musculocutaneous Nerve
36 The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound-Assisted Nerve Blocks (14/03/2009) (Aug 30, 2011)
37 Musculocutaneous and Axillary AnaesthesiaUK: Home>>Resources>>Anatomy>>Anatomy for anaesthetists>>applied anatomy for upper limb blocks (August 30, 2011)
38 Musculocutaneous and Axillary AnaesthesiaUK: Home>>Resources>>Anatomy>>Anatomy for anaesthetists>>applied anatomy for upper limb blocks (August 30, 2011)
39 The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound- Assisted Nerve Blocks (14/03/2009)
40 Suprascapular Nerve Preparation for regional shoulder manipulations In conjunction with other blocks Axillary nerve Intra-articular Acromio-clavicular Sub-acromial bursa
41 Suprascapular Nerve
42 Suprascapular Nerve Pain Physician 2007; 10:
43 Pain Physician 2007; 10:
44
45 Median Nerve Diagnostic / Therapeutic blocks Carpal tunnel injections
46 Median Nerve
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48 Carpal Tunnel Anatomy Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
49 Carpal Tunnel Anatomy Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
50 Carpal Tunnel Anatomy Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
51 Carpal Tunnel Anatomy Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
52 Carpal Tunnel Anatomy Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
53
54 Proximal Carpal Tunnel Probe Placement Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
55 Proximal Carpal Tunnel Probe Placement - Transverse Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
56 Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
57 Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
58 Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
59 Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
60 Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
61 Proximal Carpal Tunnel Probe Placement - Longitudinal Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
62 Proximal Carpal Tunnel Probe Placement - Longitudinal Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
63 Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
64 Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
65 Median Nerve Edema Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, SonoSite
66 Carpal Retinaculum Release
67
68 Ulnar Nerve Finger / wrist flexor dennervations Pre splinting / casting Epicondylar groove
69 Radial Nerve
70 Femoral Nerve Extensor contracture of quadriceps Diagnosis of the extent of tone versus soft tissue contracture prior to placing a temporary intrathecal baclofen infusion pump
71 Femoral Nerve Lateral Medial
72 Lateral Medial Femoral Nerve Femoral Artery Iliopsoas Muscle
73
74
75 Obturator Nerve Adductor spasticity / contractures Primarily for neurolysis
76 Obturator Nerve
77 Obturator Nerve Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
78 Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
79 Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
80 Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
81 Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
82 Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
83 Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
84 US Guided Obturator Nerve Block Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery 18 consecutive men, ages 54-95, mean 69 Mean time for procedure 4.2 min Successful block 97.2%
85 Yasuyuki Shibata. Ultrasound-Guided Obturator Nerve Block.
86 Yasuyuki Shibata. Ultrasound-Guided Obturator Nerve Block.
87 Sciatic / Tibial Nerves Pre-serial short leg casting of ankle contractures Diagnostic block Deformity, e.g. hammer toe refractory to intramuscular motor point blocks Versus diagnostic motor point blocks
88 Sciatic Nerve
89 Sciatic Nerve
90
91
92
93 Sciatic Nerve
94 Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
95 Lateral Medial Adductor Longus Adductor Brevis Femur Adductor Magnus Sciatic Nerve Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
96 Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
97 Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
98 Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
99 Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
100 Tibial Nerve
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105
106
107 Resources Atlas of Ultrasound- and Nerve Stimulation-Guided Regional Anesthesia Anatomical overlay of key muscles Real time videos on DVD
108 Resources Atlas of Ultrasound- and Nerve Stimulation-Guided Regional Anesthesia Extensive list of detailed peripheral nerve blocks
109 Resources Atlas of Ultrasound- Guided Regional Anesthesia: Expert Consult Online videos
110 Resources Ultrasound Guided Regional Anesthesia and Pain Medicine Numerous pain / sensory nerve blocks
111
112 Resources Ultrasound in Anesthetic Practice (with DVD)
113 Resources Critical Care Ultrasonography (with DVD) Alexander Levitov, Paul Mayo, Anthony Slonim
114 Resources Practical Ultrasound in Anesthesia for Critical Care and Pain Management (with CD) Philip M. Hopkins, Andrew R. Bodenham, Scott T. Reeves
115
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