Rotator cuff repair

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

Abstract

A 45-year-old female presents for repair of a rotator cuff injury sustained while rock climbing. She has no significant past medical history. This procedure will be performed in the lateral position. Objectives 1. Review the innervation to the shoulder joint and skin covering the shoulder. 2. Discuss the regional anesthetic techniques available for this surgery. 3. Contrast the benefits of an interscalene catheter vs. a single-injection block. 4. Review alternative regional techniques if the patient had significant pulmonary disease. 5. Discuss methods for placement of suprascapular and axillary nerve blocks. 1. Review the innervation to the shoulder joint and skin covering the shoulder The shoulder joint is primarily innervated by the suprascapular nerve, the axillary nerve, and, to a lesser extent, the lateral pectoral nerve. Suprascapular nerve: Arising from the superior trunk of the brachial plexus (C5, C6, and often C4), the suprascapular nerve travels across the posterior triangle of the neck. It then passes through the scapular notch under the superior transverse scapular ligament [1]. It is responsible for 70% of the innervation of the glenohumeral joint capsule including the posterior, medial, and superior aspects [1-3]. It also supplies the supraspinatus and infraspinatus muscles. Axillary nerve: A terminal branch of the posterior cord (C5, C6), the axillary nerve innervates the inferior, lateral, and anterior structures of the glenohumeral joint [2]. It also innervates the deltoid and teres minor exiting the axilla through the quadrangular space. It then supplies the skin over the inferior half of the deltoid as the superior lateral cutaneous nerve [1]. Lateral pectoral nerve: A terminal branch of the lateral cord (C5-C7), that pierces the clavipectoral fascia to supply the pectoralis major and, to a lesser extent, the pectoralis minor [1]. 2. Discuss the regional anesthetic techniques available for this surgery Single-injection interscalene block Single-injection interscalene block (ISB) is performed at the root or trunk level of the brachial plexus. Either C5 and C6 roots or the upper trunk must be anesthetized for the block to be successful [3]. ISB block performed using nerve stimulation alone is performed at the level of the cricoid cartilage, corresponding to the C6 level.

Original languageEnglish
Title of host publicationDecision-Making in Orthopedic and Regional Anesthesiology
Subtitle of host publicationA Case-Based Approach
PublisherCambridge University Press
Pages163-167
Number of pages5
ISBN (Electronic)9781316145227
ISBN (Print)9781107093546
DOIs
StatePublished - 1 Jan 2015

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