TY - JOUR T1 - High definition ultrasound imaging of the individual elements of the brachial plexus above the clavicle JF - Regional Anesthesia & Pain Medicine JO - Reg Anesth Pain Med DO - 10.1136/rapm-2019-101089 SP - rapm-2019-101089 AU - Manoj Kumar Karmakar AU - Jatuporn Pakpirom AU - Banchobporn Songthamwat AU - Pornpatra Areeruk Y1 - 2020/02/25 UR - http://rapm.bmj.com/content/early/2020/02/25/rapm-2019-101089.abstract N2 - 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. ER -