StatPearls. 2008;48(2):1257. The LAC and MAC nerve blocks can provide either primary anesthesia for superficial forearm operations or supplement an incomplete plexus block. The resulting ischemia can cause Volkmanns ischaemic contracture. Manage Settings Selective nerve blocks can sometimes be used also for pain treatment of minor trauma or surgery. FIGURE 1. PubMed The roof consists of skin and fascia and is reinforced by the bicipital aponeurosis which is a sheet of tendon-like material that arises from the tendon of the biceps brachii. Arch Phys Med Rehabil. Unauthorized use of these marks is strictly prohibited. Nervenarzt. An official website of the United States government. How many minutes does it take to drive 23 miles? These branches provide sensory innervation to the cape area, which spans from the midline to the deltoids, and from the second rib anteriorly to the top of the scapula posteriorly. This variation underlines the importance of using the intravenous illuminator for venipuncture. The position of the catheter tips was determined by a radiologist (C.L.) The CTDS was performed on the second postoperative day. La presse mdicale 1921; 30:2946, Burnham PJ: Regional block of the great nerves of the upper arm. Muscle Nerve. Ultrasound Imaging of Brachial and Antebrachial Fasciae FIGURE 2. This site needs JavaScript to work properly. 2017 Nov 15; [PubMed PMID: 29140886], Anatomy, Shoulder and Upper Limb, Elbow Cubital Fossa. The medial antebrachial cutaneous nerve originates from the medial cord of the brachial plexus in continuation of the lower trunk. The .gov means its official. On nerve conduction study (NCS), sensory nerve action potential (SNAP) of the median (third finger), ulnar (fifth finger), radial (snuff box), and dorsal ulnar cutaneous nerves had normal peak latency and amplitude, without a significant difference to the asymptomatic side. The carpus is 2B, 3, and 4). The supraclavicular nerve is derived from the ventral rami of the third and fourth cervical nerve roots (C3C4); it is thus separate from the brachial plexus. Federal government websites often end in .gov or .mil. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft. 14). WebAs adjectives the difference between antecubital and antebrachial is that antecubital is pertaining to, or situated in the anterior part of the elbow (cubitus while antebrachial is First, some surgical sites are partially innervated by sensory nerves that are not part of the brachial plexus or not consistently anesthetized with plexus blocks. Anesthetizing the skin of the medial forearm requires block of the MAC nerve, not the ulnar nerve at the elbow. Enter two words to compare and contrast their definitions, origins, and synonyms to better understand how those words are related. The concept of the brachial plexus sheath seems to describe the anatomy inaccurately. Reg Anesth 1997; 22:1067, Cornish PB: Supraclavicular regional anaesthesia revisited: The bent needle technique. The first 5 mL of local anesthetic is injected just deep to the lateral margin of the biceps tendon; the second 5 mL area injected subcutaneously and lateral from the first injection site, along the elbow crease (Figure 7). ant--, an-ti-. Knowledge of these variations is critical to neurologists, hand surgeons, plastic surgeons, and vascular surgeons. Local anesthetic block of the lateral and medial antebrachial cutaneous nerves is indicated for superficial surgery of the forearm, such as arteriovenous fistula surgery, or as a supplement to incomplete brachial plexus block. anterbrachium is the forearm,region between elbow and the wrist It provides cutaneous innervation to the lateral (radial) half of the volar forearm. wrist. The https:// ensures that you are connecting to the Cervical rib and median sternotomy-related brachial - PubMed Brachial artery pseudoaneurysmsare a pulsatile hematoma caused by hemorrhage on soft tissues. , upper extremity versus lower extremity (figs. A copy of the written consent is available for review by the Editor-in-Chief of this journal. When LAC and/or MAC nerve blocks are supplemental to a previous incomplete brachial plexus block, the additional 1520 mL of local anesthetic should be well tolerated by patients if injected 2030 minutes after the primary block. In conclusion, this study suggests that there may not be an enveloping and encasing soft tissue structure, or sheath, around the brachial plexus. It affected her quality of life. Journal of Korean medical science. Article Reg Anesth Pain Med 2004; 29:24, Cornish PB, Leaper CJ, Hahn JL: Evaluation of spread of a bolus injection administered, Winnie AP, Radonjik R, Akkineni SR, Durrani Z: Factors influencing distribution of local anaesthetic into the brachial plexus sheath. Commonly anesthetized as a component of cervical plexus block for carotid surgery, the supraclavicular nerve may also require block for surgery involving the shoulder or supraclavicular area. It also has a floor and roof, and it is traversed by structures which make up its contents.[1][2][3][4]. Paresthesia and forearm pain after phlebotomy due to medial antebrachial cutaneous nerve injury. Medial brachial and antebrachial cutaneous nerve injuries: effect on outcome in revision cubital tunnel surgery. : relating to the antebrachium. The authors would like to thank Shiraz University of Medical Sciences, Center for Development of Clinical Research of Nemazee Hospital. She denied alcohol consumption or smoking. [2] It Within the roof runs the median cubital vein, which can be accessed for venipuncture (see clinical significance below). Antebrachial | definition of antebrachial by Medical PhilipB. Cornish, Christopher Leaper; The Sheath of the Brachial Plexus: Fact or Fiction?. As an adjective antebrachial is relating to the forearm. Springer Nature. The objective of this study was to identify electrodiagnostic and anatomic distinctions between true neurogenic thoracic outlet syndrome and median sternotomy-related brachial plexopathy, in reference to the pattern of abnormality of the medial antebrachial cutaneous sensory nerve conduction study (NCS) response. Biceps brachii / long head short head, tendon of biceps brachii, bicipital aponeurosis. Objective: Selective nerve blocks at the elbow can be recommended for hand surgery when forearm motor block is desired and motor block of the proximal brachial plexus block is not desired. The intercostobrachial nerve block is indicated for surgery involving the medial/posterior upper arm and/or for anterior arthroscopic port placement. The cubital fossa contains four main vertical structures from lateral to medial.[5][6][7][8]. Anesthesiology 1964; 25:35363, Davies DV: Gray's Anatomy, 34th edition. 2018 Mar 28; [PubMed PMID: 29599380], Sadeghi A,Setayesh Mehr M,Esfandiari E,Mohammadi S,Baharmian H, Variation of the cephalic and basilic veins: A case report. During blood pressure measurements, the stethoscope is placed over the brachial artery in the cubital fossa. There are several reasons why the tissue plane is important anatomy to understand. Polcaro L, Charlick M, Daly DT. Neither adjuvant significantly increases duration if a long-acting local anesthetic such as bupivacaine or ropivacaine is chosen. The brachial pulse may be palpated in the cubital fossa just medial to the tendon. Brachial artery suppliesoxygenated blood the forearm. Cutaneous innervation of the upper extremity. WebBrachial definition, belonging to the arm, foreleg, wing, pectoral fin, or other forelimb of a vertebrate. antebrachial 2019 Jan 21; [PubMed PMID: 30662383], Lung BE,Bisogno M, Anatomy, Shoulder and Upper Limb, Forearm Brachioradialis Muscle 2018 Jan; [PubMed PMID: 30252366], Pires L,Rfare AL,Peixoto BU,Pereira TOJS,Pinheiro DMM,Siqueira MEB,Vaqueiro RD,de Paula RC,Babinski MA,Chagas CAA, The venous patterns of the cubital fossa in subjects from Brazil. Selective elbow blocks are inferior alternatives to brachial plexus blocks. 1996 Dec;67(12):1034-7. doi: 10.1007/s001150050089. Also, the authors are grateful for editorial assistance from Dr. Nasrin Shokrpour and Dr. Fatemeh Babaeian. 14). WebBrachial Antebrachial Humerus Anatomical neck of the humerus Surgical neck of the humerus Shaft of the humerus Greater tubercle (the bony ridge on top of you shoulder) Kelly EW, Morrey BF, ODriscoll SW. actually distal to the brachium. Tsao BE, Ferrante MA, Wilbourn AJ, Shields RW. Manage cookies/Do not sell my data we use in the preference centre. Ma CX,Pan WR,Liu ZA,Zeng FQ,Qiu ZQ,Liu MY, Deep lymphatic anatomy of the upper limb: an anatomical study and clinical implications. Dark areasadjacent to the nerves are adipose tissue. 2009 Feb;5(1):73-7. doi: 10.1007/s11420-008-9105-4. Continue with Recommended Cookies. 2018 Jun; [PubMed PMID: 29625795], Haadaj R,Wysiadecki G,Dudkiewicz Z,Polguj M,Topol M, The High Origin of the Radial Artery (Brachioradial Artery): Its Anatomical Variations, Clinical Significance, and Contribution to the Blood Supply of the Hand. J Med Case Reports 17, 91 (2023). Radial and median nerves are approached at the level of the epicondyles. The ulnar nerve at the elbow is located superficially in the ulnar groove (Figure 9). When was AR 15 oralite-eng co code 1135-1673 manufactured? Although most upper extremity regional anesthesia is accomplished by means of various approaches to the brachial plexus, there are occasions when individual terminal nerves or their branches are blocked selectively. J Brachial Plex Peripher Nerve Inj. The pattern of distribution of dye within the neural tissues was similar between the two systems, both in the region of the catheter tip and at the extremes of dye distribution. Clinical, electrodiagnostic and imaging features of true neurogenic thoracic outlet syndrome: Experience at a tertiary referral center. An observational study has been performed using US imaging to measure brachial and antebrachial fasciae thickness at anterior and posterior regions, 2017;70(11):15828. With the approval of the Nelson-Marlborough Ethics Committee (Nelson, New Zealand) and written informed consent, three patients with functioning brachial plexus catheters and two patients with functioning sciatic nerve catheters were enrolled in the study. The images of the two catheter systems were the same, with the exception that one was of the upper extremity and the other was of the lower extremity. A 1.5-in. This study further examines the issue. By using this website, you agree to our 2014 May;49(5):724-7. doi: 10.1002/mus.24066. Ortop Travmatol Protez 1990; 5:137, Pippa P, Rucci FS: Preferential channelling of anaesthetic solution injected within the perivascular axillary sheath. Text is available under the Creative Commons Attribution/Share-Alike License; additional terms may apply.See Wiktionary Terms of Use for details. WebThe brachial catheter CTDS was performed from the top of the clavicle to 30 mm below the glenoid fossa, and the sciatic catheter CTDS was performed from the top of the sacroiliac The suprascapular nerve (C4C5) branches from the superior trunk of the brachial plexus and, therefore, it is usually anesthetized by an interscalene block. Sarris I, Gbel F, Gainer M, Vardakas DG, Vogt MT, Sotereanos DG. Selective nerve blocks at the elbow to supplement incomplete proximal brachial plexus should be practiced with caution. Numbness and sensory complaints of the medial side of the right hand and fifth finger showed improvement, but the sensory disturbance remained at the medial side of the forearm until 6months follow-up. by injecting 1 ml of 50% diluted 300 mg/ml Omnipaque (iohexol; Amersham Health Limited, Auckland, New Zealand) dye down the respective catheters and then performing a preliminary computerized tomography scan. What is the difference of antebrachium and the brachium? The relevant anatomy will be covered with specific nerve block description. Three to 5 mL of local anesthetic is injected when a paresthesia to the hand is elicited. Introduction. The intercostobrachial nerve block is a useful supplement to any brachial plexus block when surgery involves the upper medial/posterior arm, a pneumatic tourniquet, and/or an anterior arthroscopic port. Mild tenderness in the anteromedial part of the elbow was detected. She did not have any hospital admission or drug prescription. Brachial The medial antebrachial cutaneous (MAC) nerve is a branch of the brachial plexus that carries fibers of C8T1 segments [1, 2]. The MAC nerve contains the fibers The cubital fossa is an area of transition between the anatomical arm and the forearm. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. The three patients with brachial plexus catheters had these inserted using the bent needle technique of supraclavicular block,9and all had undergone major wrist, elbow, or forearm surgery during regional anesthesia, followed by regional analgesia using their catheters. volume17, Articlenumber:91 (2023) She was nulliparous. https://doi.org/10.1186/s13256-023-03797-1, DOI: https://doi.org/10.1186/s13256-023-03797-1. American volume. Note how the dye conforms to the shape of the surrounding rigid anatomychest wall, coracoid process, and subscapularis. Ann Vasc Surg. Complications of pseudoaneurysms can cause a serious threat to the afflicted limb and the patient's life. Is it safe?]. It is suggested that only 23 mL of local anesthetic be injected to avoid excessive pressure within the tight fascial space of the ulnar groove and thereby lessen the possibility of compromising neural blood flow. Neurogenic thoracic outlet syndrome and sternotomy-related brachial plexopathy are both lower trunk brachial plexopathies, but their clinical and electrodiagnostic presentations are distinct. 1989;32(5):3667, 369. Webthe axillary vein and the brachial vein [2]. 2. A series of plain x-ray film dye studies3,19,20have shown containment of solution, but plain x-ray films do not adequately define nonbony structures, and they lack the three-dimensional perspective of computerized tomography scanning. 2016;7(03):4436. StatPearls. Also, compound nerve action potential (CNAP) of the ulnar nerve across the elbow by stimulating the wrist and recording above the elbow showed mild conduction block on the right side compared with the left. Selective nerve blocks at the elbow may cause hematoma if brachial artery is punctured during procedure. Clin Neurophysiol. Richards R, Regan W. Medial epicondylitis caused by injury to the medial antebrachial cutaneous nerve: a case report. 2004 Oct;115(10):2316-22. doi: 10.1016/j.clinph.2004.04.023. In the 10 patients with neurogenic thoracic outlet syndrome, the medial antebrachial cutaneous amplitude was most affected, followed in decreasing order of involvement by the median motor, ulnar sensory, and ulnar motor amplitudes. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Neurology. If using a peripheral nerve stimulator, one seeks the motor response of wrist extension. 8600 Rockville Pike Seror P. Medial antebrachial cutaneous nerve conduction study, a new tool to demonstrate mild lower brachial plexus lesions. The second indication is when the block of the entire brachial plexus block is not necessary for the planned procedure. lateral side and the ulna on the medial side. while brachium is the arm,region between shoulder and the elbow. Careers. FOIA If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. needle that is placed just medial to the brachial artery at the level of the epicondyles (see Figure 8). The catheters were inserted to a depth of 1011 cm from skin to catheter tip. Suprascapular nerve block is accomplished by injecting local anesthetic in the suprascapular notch. Reg Anaesth Pain Med 2003; 28:336, Lanz EL, Theiss D, Jankovic D: The extent of blockade following various techniques of brachial plexus block. The horizontal black linein the coronal section indicates an axial section that is then displayed as directed by the solid black arrow. On follow-up electrodiagnosis, after several sessions of physical therapy, the medial antebrachial cutaneous nerve sensory nerve action potential still had a significant amplitude difference. The authors report their experience with 12 patients treated surgically for painful neuroma by high resection of the proximal end or its implantation into the triceps muscle, where there was a high success rate of pain relief and functional improvement in both elbow movement and handgrip strength. Axillary block procedure guide - UpToDate of the medial antebrachial cutaneous nerve The brachial plexus catheter tips lay just inferolateral to the coracoid process of the scapula, whereas the sciatic nerve catheter tips lay between the tip of the ischial tuberosity and the femur. Coronal and corresponding axial section for 2 subjects. The patient had consented to participate in the study and for publishing the results. 2011 Dec;35(6):807-15. doi: 10.5535/arm.2011.35.6.807. Unable to load your collection due to an error, Unable to load your delegates due to an error. The first treatment is to avoid actions that cause symptoms. 2020 Aug 13;5:173-193. doi: 10.1016/j.cnp.2020.07.005. Direct damage or post-fracture swelling can cause interference to the blood supply of the forearm from the brachial artery. Journal of patient safety. What is sunshine DVD access code jenna jameson? A low ankle-brachial index The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Computerized axial tomographic dye studies were performed using continuous catheter systems for the sciatic nerve and the brachial plexus. Fig. 2017 Jun;55(6):782-793. doi: 10.1002/mus.25536. The medial antebrachial cutaneous nerve (MACN) arises from the medial cord (78%) and the lower trunk (22%) of the brachial plexus. Actual patients demonstrate large variation in the depicted pattern of innervation and significant crossover between nerves. HHS Vulnerability Disclosure, Help After identification of the ulnar groove, a short needle is placed approximately 1 cm proximal to the epicondyles and directed distally. The brachial catheter CTDS was performed from the top of the clavicle to 30 mm below the glenoid fossa, and the sciatic catheter CTDS was performed from the top of the sacroiliac joints to 20 mm below the lesser trochanter. Antebrachial - Anatomy, Function & Structure The brachial plexus is formed by the anteriorprimary rami of C5 through T1 and provides sensory and motor innervation of the upper extremity. WebAnterior brachium, superficial. This case report presents the case of a 34-year-old Persian female with dysesthesia and pain in the medial side of the forearm immediately following a blunt trauma by mechanism of elbow external rotation. Provided by the Springer Nature SharedIt content-sharing initiative. For this study, six arm cadavers from three fresh cadavers were dissected and examined to find and study possible anatomical variations of the MACN. HSS J. The anatomic differences distinguishing these disorders from each other, and from other lower trunk brachial plexopathies, have not been defined. Fig. Part of On needle electromyography of the right flexor carpi ulnaris and first dorsal interosseous, there was normal motor unit action potential (MUAP) and recruitment without spontaneous activity. Where Is The Brachial And Antebrachial? - Caniry NYSORA Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. WebAntebrachial vs Antebrachium - What's the difference? Brachial and lumbosacral plexopathies: A review. Antebrachial London, Longmans, Green, 1967, p 605, Thompson GE, Rorie DK: Functional anatomy of the brachial plexus sheaths. 1991;16(1):4852. It is located in a depression on the anterior surface of the elbow joint. The external jugular vein should be avoided to prevent hematoma. Techniques for anesthetizing the LAC and MAC nerves involveonly superficial injection of local anesthetic; thus the risk of nerve injury is very low. The carpal region is the After 2days, the nature of the pain became dull. 3. It is located in a depression on the anterior surface of the elbow joint. The bicipital aponeurosis forms a partial protective covering to the medial nerve, brachialartery and ulnar artery. Search for other works by this author on: Reding M: Nouvelle mthode d'anesthsie rgionale du membre suprieur. Medial border is the lateral border of the pronator teres muscle. Clinical, Electrophysiological Findings in Adult Patients with Non-traumatic Plexopathies. Selective upper extremity nerve blocks can be useful supplements to brachial plexus blocks. A case of isolated tuberculoid leprosy of antebrachial medial cutaneous nerve. ( A) Axial section of brachial plexus catheter. 2004;114(3):6926. The uncontrolled flexion of the hand, as flexors muscles become fibrotic and short. She had a history of blunt trauma to her right forearm about 40days before the first evaluation. Correspondence to CAS The area just superficial to the cubital fossa is often used for venous access (phlebotomy). Three milliliters is deposited with a 22- to 25-gauge sharp needle into the mid belly of the sternocleidomastoid. These symptoms are often felt when the elbow is bent for an extended period of time, such as while holding a phone or while sleeping. BioMed research international. The median nerve is more superficial and identified by a needle placed just medial to the brachial artery. Communication between the radial nerve and medial cutaneous nerve of forearm on the left side in a 58-year-old male cadaver is reported and neurosurgeons should keep such variations in mind while performing the surgeries of axilla and upper arm. WebMedial Antebrachial Cutaneous Nerve Injury www.e-arm.org 915 relieved slightly. FIGURE 3. Antebrachial Patients should be informed to protect their insensate limb from external pressure or temperature extremes. ( A) Axial section of sciatic nerve catheter. In summary, this study showed isolated mild right medial antebrachial cutaneous nerve injury. Surg Clin North Am 1993; 73:83752, Vester-Andersen T, Broby-Johansen U, Bro-Rasmussen F: Perivascular axillary block VI: The distribution of gelatine solution injected into the axillary neurovascular sheath of cadavers. Surface landmarks are identified by drawing one line along the superior border of the scapular spine and then bisecting it with a second line drawn parallel with the vertebral spine. Methods: The physical ability and perception of the elderly with a high risk of sarcopenia to cope with daily activities and the tools available from Affective Science are used to measure the detectable emotional change. Physical therapy, including nerve gliding exercises, was done that was relatively effective, especially on the ulnar nerve block at the elbow. 2014. https://doi.org/10.13070/rs.en.1.665. The authors declare that they have no competing interests. Reg Anesth Pain Med 1998; 23:496501, Davies DV: Gray's Anatomy, 34th edition. The intercostobrachial nerve is anesthetized by subcutaneous injection of 35 mL local anesthetic along the axillary crease. The right elbow X-ray was normal. Isolated medial antebrachial cutaneous nerve injury after blunt Third, it is said that supraclavicular techniques are more effective than axillary techniques because the nerves are closer together. She did not have polyneuropathy, chronic systemic disease, phlebotomy, injection, or surgical intervention at the elbow. Blunt trauma can be one of the causes of MAC nerve involvement. First, there may be minimal space for soft tissue expansion at any one point,17and therefore, flow must occur along the tissue plane, according to resistances encountered along the way.18As observed in the images from this study, one of the paths of lesser resistance within the tissue plane is along the line of the nerve, and in both directions from the point of injection. There are generally three instances in which the anesthesiologist desires to perform these selective nerve blocks. Why Walden's rule not applicable to small size cations. Some authors have even reported selective catheterization to avoid unnecessary motor block or numbness of the uninvolved parts of the upper extremity. Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study. Cutaneous nerves of the forearm: Anatomy and function Antecubital vs Antebrachial - What's the difference? | WikiDiff 4. Kim SW, Jeong JS, Kim BJ, Choe YH, Yoon YC, Sung DH. The frequency of the typesbetween right and left upper limbs was also not different. Anesth Analg 1979; 58:22534, Rodriguez J, Barcena M, Alvarez J: Restricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block. WebMethods: We compared the medial antebrachial cutaneous sensory nerve action potential amplitude with the median motor, ulnar motor, and ulnar sensory NCS amplitudes in 10 Local anesthetic spread in an interscalene plexus block often blocks the cervical plexus and therefore it is adequate to block the supraclavicular nerve, but the nerve is frequently not anesthetized with a supraclavicular brachial plexus block. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Antebrachial Intraoperative Protective Mechanical Ventilation: Fact or Fiction? 11, 12 Several variations in the anatomic course of the nerve have been reported. This is a less than convincing argument because the nerves are not far apart at either level. Cutaneous Blocks for the Upper Extremity Landmarks and Nerve Stimulator Technique. Risk factors for up-per-extremity DVT include hypercoagulable state, intravenous lateral and medial antebrachial nerve was decreased. Although spontaneous recovery of this nerve may be possible, the delay in timely diagnosis can cause imposing unnecessary diagnostic work-ups to evaluate other differential diagnoses of forearm dysesthesia. FE contributed to the editing of the manuscript. A thin wall cyst with the same signal to synovial fluid just lateral to the olecranon was seen connecting to the joint space measuring 952mm incidentally. On electrodiagnostic evaluation, the medial antebrachial cutaneous nerve sensory nerve action potential of the symptomatic side had a significant amplitude drop (more than 50%), compared with the other side. The sciatic nerve is not surrounded or enveloped by a "sheath"--it lies in the tissue plane between rigid anatomical structures. A final and controversial indication for selective upper extremity nerve blocks is their use as a supplement to an incomplete brachial plexus block. Suprascapular nerve block (SSNB) can be used as an adjunct to arthroscopic shoulder surgery and total shoulder arthroplasty. FIGURE 4. Conversely, in the 14 patients with sternotomy-related brachial plexopathy, the ulnar sensory and motor amplitudes were the most affected responses. The MAC is blocked by injecting a half-ring of 57 mL local anesthetic about a quarter of the arms length above the medial elbow(Figure 7). Anatomy, Shoulder and Upper Limb, Elbow Cubital Fossa Article Anterior 2: the probe was axially moved downwards 2004;25(4):2169. Blunt trauma can be one of the causes of medial antebrachial cutaneous nerve involvement. It also innervates a portion of the anterior axilla (see Figures 1 and 2). Therefore, when faced with the choice of performing a single nerve block versus blocking several adjacent nerves, it is advisable to err on the side of multiple blocks, particularly in those adjacent cutaneous areas that represent potential crossover innervation (Figures 1 and 2).
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