Background and objectives Ultrasonography of the brachial plexus (BP) has been described but there are limited data on visualization of the T1 ventral ramus and the inferior trunk. This prospective observational study aimed to evaluate a high definition ultrasound imaging technique to systematically identify the individual elements of the BP above the clavicle.
Methods Five healthy young volunteers underwent high definition ultrasound imaging of the BP above the clavicle. The ultrasound scan sequence (transverse oblique scan) commenced at the supraclavicular fossa after which the transducer was slowly swept cranially to the upper part of the interscalene groove and then in the reverse direction to the supraclavicular fossa. The unique sonomorphology of the C7 transverse process was used as the key anatomic landmark to identify the individual elements of the BP in the recorded sonograms.
Results The neural elements of the BP that were identified in all volunteers included the ventral rami of C5–T1, the three trunks, divisions of the superior trunk, and formation of the inferior trunk (C8–T1). The C6 ventral ramus exhibited echogenic internal septation with a split (bifid) appearance in four of the five volunteers. In three of the four volunteers with a bifid C6 ventral ramus, the C7 ventral ramus was also bifid.
Conclusion We have demonstrated that it is feasible to accurately identify majority of the main components of the BP above the clavicle, including the T1 ventral ramus and the formation of the inferior trunk, using high definition ultrasound imaging.
Trial registration number ChiCTR1900021749.
- brachial plexus
- upper extremity
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Contributors MKK was involved with conception, planning and design of study, conduct of study, acquisition of data, review of data, data interpretation, and reporting/preparation of manuscript. JP was involved with planning and design of the study, conduct of study, acquisition of data, review of data, data interpretation, and preparation of manuscript. BS and AP were involved with conduct of study, acquisition of data, review of data, data interpretation, and review of manuscript.
Funding This work was locally funded by the Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This prospective, observational study was approved by The Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data sharing not applicable as no data sets generated and/or analyzed for this study. Prospective observational study so no data sets generated.