US guided suprascapular nerve block pearls

[nvrsumr]

Hi All. I do these infrequently but have done a number both with fluoro and US. Recently had a patient who had a successful block but really couldnt see the suprascapular notch to save my life. He was pretty thick-BMI 30

Thoughts? Thank you in advance.

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[specepic]

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[drf]

Just taught this at a course today. Here is how I explained it.

Curved probe on most patients.

1. Transverse scan over scapular spine, ie probe north south.
2. Scan cephalad into supraspinatus fossa. Scan far enough so that the very top of the scapula is visible.
3. Keep the top of the scapula on the edge of your screen and slowly scan laterally.
4. Look for a little dip in the bone of the top of scapula. You can also sometimes see the scapular artery in this view.
5. When you see this dip, or the artery, turn the probe 90'.
6. At this point you are looking into the supraspinatus fossa in short axis to the nerve and artery. If you don't see the ligament over a notch or the pulsations of the artery then very minor anterior or posterior movements should pop it into view.
7. Place needle in plane medial to lateral (coracoid will often be in the way on the lateral side here). Artery is often outside ligament. Nerve is under ligament. Drop 5 ml or stim for infraspinatus twitch.

 

[nvrsumr]

Just taught this at a course today. Here is how I explained it.

Curved probe on most patients.

1. Transverse scan over scapular spine, ie probe north south.
2. Scan cephalad into supraspinatus fossa. Scan far enough so that the very top of the scapula is visible.
3. Keep the top of the scapula on the edge of your screen and slowly scan laterally.
4. Look for a little dip in the bone of the top of scapula. You can also sometimes see the scapular artery in this view.
5. When you see this dip, or the artery, turn the probe 90'.
6. At this point you are looking into the supraspinatus fossa in short axis to the nerve and artery. If you don't see the ligament over a notch or the pulsations of the artery then very minor anterior or posterior movements should pop it into view.
7. Place needle in plane medial to lateral (coracoid will often be in the way on the lateral side here). Artery is often outside ligament. Nerve is under ligament. Drop 5 ml or stim for infraspinatus twitch.

Thank you. As always an education. I have another one coming up so will let you know how it goes.