GS - Regional Anaesthesia of the Shoulder

Question 1

What types of shoulder surgery can we do?

Answer 1

Types of shoulder surgery;
- Arthroscopy
- Rotatory cuff repair
- Glenoid labrum repair
- Subacromial decompression
- Capsular release
- Open reduction and internal fixation of clavicle or proximal humerus
- Plate removal (for previous fracture)

Question 2

Which dermatomes would you need to block in order to give an adequate block for shoulder surgery?

Answer 2

C4 + C5

Question 3

What structures around the shoulder joint would you need to anaesthetise to give adequate analgesia during shoulder surgery ?

Answer 3

• Skin
• Articular capsule
• Articular surface

Question 4

Do nerve supplying dermatomes C3 + C4 arise from brachial plexus?

Answer 4

No, C3 + C4 arise from the cervical plexus via the Supraclavicular nerves !

Question 5

How would you describe Hilton’s Law?

Answer 5

Hiltons Law;
- A joint receives innervation from the same nerves that supply the muscles acting on that joint

Question 6

What nerve supplies the Supraspinatus muscle?

Answer 6

Suprascapular nerve (C5 + C6)

Question 7

What nerve supplies the Deltoid muscle?

Answer 7

Axillary nerve (C5 + C6)

Question 8

What nerve supplies the Subscapularis muscle?

Answer 8

Superior and inferior subscapular nerves (C5 + C6)

Question 9

What nerve supplies the Pectoralis major muscle?

Answer 9

Lateral Pectoral nerve (C5 - C7)

Question 10

What is the common cervical nerve root value of the muscles supplying the Glenohumeral joint ?

Answer 10

C5 + C6

Question 11

What are the 2 parts of the brachial plexus you would block to anaesthetise the shoulder ?

Answer 11

C5 + 6 nerve roots (superior roots) and the superior trunk

Question 12

What technique do we use to anaesthetise the shoulder and what are the landmarks and nerves affected?

Answer 12

Interscalene blockade;
- Most widely used
- Targets superior roots and superior trunk of brachial plexus as they pass between the anterior and middle scalene muscles
- Probe slowly moved out from the midline at about the level of cricoid cartilage to get lateral border of SCM, interscalene groove identified between anterior and middle scalene, roots are within this groove
- Surrounds roots with local anaesthetic

Question 13

How would you check that an interscalene block has been effective?

Answer 13

Effective interscalene block;
- Motor function: Patient cannot abduct of flex shoulder
- Cutaneous sensation: loss of temperature sensation over blocked dermatomes (as temperature sensation is carried in same nerve fibres as pain sensation)
- Articular sensation: If patient usually has pain on movement after interscalene blockade shoulder movement should be pain free

Question 14

What structures are at risk of damage during an Interscalene blockade?

Answer 14

Structures at risk;
- Phrenic nerve
- Apex of lung
- Sympathetic chain

Procedure isn’t risk free !