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Original Article

The Korean Journal of Pain 2020; 33(1): 48-53

Published online January 1, 2020 https://doi.org/10.3344/kjp.2020.33.1.48

Copyright © The Korean Pain Society.

New insights into pathways of the accessory nerve and transverse cervical artery for distal selective accessory nerve blockade

Yanguk Heo1,2 , Namju Cho1 , Hyunho Cho2,3 , Hyung-Sun Won1,2 , Miyoung Yang1,2 , and Yeon-Dong Kim2,3,4

1Department of Anatomy, Wonkwang University School of Medicine, Iksan, Korea
2Jesaeng-Euise Clinical Anatomy Center, Wonkwang University School of Medicine, Iksan, Korea
3Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
4Wonkwang Institute of Science, Wonkwang University School of Medicine, Iksan, Korea

Correspondence to:Yeon-Dong Kim
Department of Anesthesiology and Pain Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, 895 Muwangro, Iksan 54538, Korea
Tel: +82-63-859-1562
Fax: +82-63-857-5472
E-mail: kydpain@hanmail.net

Received: May 31, 2019; Revised: September 6, 2019; Accepted: September 10, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The aim of this study was to clarify the topographical relationship between the accessory nerve (AN) and transverse cervical artery (TCA) to provide safe and convenient injection points for AN blockade.

Methods

This study included 21 and 30 shoulders of 14 embalmed Korean adult cadavers and 15 patients, respectively, for dissection and ultrasound (US) examination.

Results

The courses of the TCA and AN in the scapular region were classified into four types based on their positional relationships. Type A indicated the nerve that was medial to the artery and ran parallel without changing its location (38%). In type B (38%), the nerve was lateral to the artery and ran parallel without changing its location. In type C (19%), the nerve or artery traversed each other only once during the whole course. In type D (5%), the nerve or artery traversed each other more than twice forming a twist. At the levels of lines I–IV, the nerve was relatively close to the artery (approximately 10 mm). TCAs were observed in all specimens around the superior angle of the scapula at the level of line II, whereas they were not found below line VI. In US images of the patients, the TCA was commonly observed at the level of line II (93.3%) where all ANs and TCAs were observed in cadaveric dissection.

Conclusions

The results expand the current knowledge of the relation between the AN and TCA, and provide helpful information for selective diagnostic nerve blocks in the scapular region.

Keywords: Accessory Nerve, Diagnosis, Injections, Scapula, Scapular Region, Selective Nerve Blockade, Transverse Cervical Artery, Ultrasound