Suggestion of Safer and Easier Technique of Suprascapular Nerve Block based on Cadaver Study

OBJECTIVE: To suggest a safer and easier technique of suprascapular nerve block by assessing anatomical relationship of the suprascapular notch from a view point of surface anatomy. METHOD: Fourteen shoulders of seven cadavers were dissected in prone position. The scapular notch was exposed and the articular branch of suprascapular nerve was observed. The length and depth of spine, height and relative position of scapular notch were measured for all of the specimen. RESULTS: The length of the spine was 11.45+/-0.72 cm. The injection point was measured as relative position of scapular notch on the spine. The ratio between distance from medial border of the spine to injection point and from the injection point to posterior angle of acromion was 1.89+/-0.2: 1. The depth of the spine, which was defined as the shortest vertical distance from the injection point to the scapula was 2.69+/-0.43 cm, and the vertical distance from this contact point to the base of the scapular notch, e.g. the height of the scapular notch, was 1.18+/-0.1 cm. CONCLUSION: We expect we could perform suprascapular nerve block easily and safely with suggested surface landmarks and measured data in this study.

Comparison of the Spinal Level Assumption by Palpation of the Iliac Crest and Posterior Superior Iliac Spine

OBJECTIVE: To compare the clinical usefulness of the posterior superior iliac spine (PSIS) with that of iliac crest (IC) for identifying the lumbar vertebral level. METHOD: Lumbar spine level was identified by the line connecting bilateral upper margin of iliac crests in the antero-posterior lumbar X-rays of 120 patients. Assumed IC level and assumed PSIS level were compared by 3 examiners' palpation in 60 patients. A marker was taped on assumed IC level and assumed PSIS level by 4 examiners and the postero-anterior lumbar X-rays was taken in randomly distributed 50 patients. RESULTS: IC intersection line was ranged from the L4 spinous process to the L5-S1 interspinous process in all patients. Inter- examiner agreement of palpation was significantly greater in PSIS than IC level (p<0.05). The marker indicating assumed IC level was higher than true IC level in all patients and was higher than L3-4 interspinous process in 8%. CONCLUSION: We may use PSIS level for assumption of the lumbar vertebral level to compensate for the limitation of iliac crest palpation, but at the same time keep in the mind the variarity of the PSIS level.