A novel method to measure sensory nerve conduction of the supraclavicular nerve.

INTRODUCTION: In this report we describe a reliable method for recording sensory nerve action potentials (SNAPs) of the supraclavicular nerve. METHODS: Supraclavicular SNAPs were recorded by placing a surface active electrode at the posterior border of the sternocleidomastoid muscle at a distance of 6 cm from the sternoclavicular joint. The nerve was stimulated at the lower border of the clavicle 4.5 cm lateral to the sternoclavicular joint. RESULTS: Supraclavicular SNAPs were recorded bilaterally from 20 healthy volunteers. Mean onset latency was 1.0 ± 0.2 ms, and mean peak latency was 1.4 ± 0.3 ms. Mean baseline-to-peak amplitude for the SNAPs was 6.1 ± 2.2 µV, and mean maximum conduction velocity was 59.8 ± 6.2 m/s. The mean percentage of side-to-side difference in amplitude was 12.9 ± 11.0%. CONCLUSIONS: Supraclavicular SNAPs could be obtained in all normal subjects. Assessment of supraclavicular nerve conduction is very useful in the diagnosis of supraclavicular neuropathy.

Safe drilling angles and depths for plate-screw fixation of the clavicle: avoidance of inadvertent iatrogenic subclavian neurovascular bundle injury.

BACKGROUND: Plate fixation is frequently used to repair clavicle fractures, but over drilling can cause subclavian neurovascular bundle damage. The aims of this study were to investigate the anatomic relationship between the clavicle and subclavian neurovascular bundle and to determine safe drilling angles and depths. METHODS: Twenty-six healthy subjects underwent magnetic resonance imaging. Coronal and sagittal images of the periclavicular region including the whole clavicle and nearby vital anatomic structures were obtained. The clavicle was divided into three sections: section I: between the sternoclavicular joint and point N (where the subclavian neurovascular bundle coursed below the midaxial level of the clavicle); section II: from N to the projection point of the coracoid process to the clavicle (CP'); and section III: from CP' to the acromioclavicular joint. Dangerous drilling depths and angles were determined for each section. RESULTS: In section I, the safe drilling angle was >59.7 degrees cephalad and >95.3 degrees caudad, while safe drilling depth was <17.0 +/- 2.4 mm. Corresponding values in section II were <1.2 degrees caudad and >142.4 degrees caudad. Safe drilling depth was no more than 36.2 mm +/- 12.4 mm. Depth and direction limitations were not assessed for section III, because the neurovascular bundle coursed well below the level of the coracoid process. CONCLUSIONS: We have used magnetic resonance imaging to determine safe drilling directions and depth for plate-screw fixation of the clavicle. On confirmation, these findings could be used in the clinical setting to reduce the risk of inadvertent iatrogenic subclavian neurovascular bundle injury during surgical clavicle fracture repair.

Stability of the sternoclavicular joint. A retrospective study.

Enlargement of the sternoclavicular joint is a well-documented but little recognised complication of radical neck dissection [AJR 3 (1971) 584]. We examined the stability of the sternoclavicular joint in 61 patients who had had radical neck dissection, functional neck dissection or sternomastoid division in the treatment of torticollis. Our findings support the hypothesis that postoperative stability of the sternoclavicular joint depends on the integrity of the accessory nerve and probably the proprioceptive branches of C3 and C4 of the cervical plexus. We conclude that in patients who require surgical section of the sternomastoid muscle in the treatment of torticollis, or for venous access in microvascular reconstruction, enlargement of the sternoclavicular joint should not occur as a postoperative complication, unlike those patients who have radical neck dissection with resection of the accessory nerve.

Formation of new myotubes occurs exclusively at the multiple innervation zones of an embryonic large muscle.

This work examines the general principle of whether production of embryonic muscle fibres is invariably linked to sites of innervation, as we have previously reported in small rodent muscles (Duxson et al. [1989] Development 107:743-750). The experimental strategy has been to make a detailed electron microscopic analysis of the formation of new myotubes in a large muscle having multiple, discrete innervation zones. The particular model system is the guinea pig sternomastoid muscle, a strap-like, parallel-fibred muscle with four distinct endplate bands, both in the embryo and the adult. Primary myotubes in the developing muscle extended from tendon to tendon of the muscle and were innervated at each of the multiple endplate zones. Each point of innervation of the primary myotubes was a focus around which many new secondary myotubes formed, and each secondary myotube was approximately centred on one of the innervation sites of its supporting primary myotube. This confirms our previous report, in rat IVth lumbrical muscle, of an invariable association between sites of formation of new secondary myotubes and sites of innervation. We suggest that, in vivo, nerve terminals either directly induce the initial myoblast fusions which give rise to new secondary myotubes, or induce some precondition for fusion. An alternative hypothesis is that a common patterning influence in the muscle localizes both innervation and secondary myotube formation to the same zone. The pattern of secondary myotube production in the embryo has important implications for the size and final architecture of muscles in larger animals, and some of these are discussed.