ultrasound in neurolysis - school of medicine · 2019-10-04 · ultrasound in peripheral nerve...
TRANSCRIPT
![Page 1: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/1.jpg)
Ultrasound in Peripheral Nerve Interventions
John L. Lin, M.D. Shepherd Center
Assistant Clinical Professor Emory University, School of Medicine
![Page 2: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/2.jpg)
Outline
• Ultrasound basics
• Nerve blocks in physiatric setting
• Ultrasound with nerve blocks
![Page 3: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/3.jpg)
Ultrasound Basics
• Sound wave energy is transformed when it interacts upon different medium
– Reflected
– Absorbed
– Transformed
![Page 4: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/4.jpg)
Sound Wave Transformation
• Frequency
• Energy – heat, electricity, mechanical energy / vibration…etc.
• Density of median -> impedance
• High impedance difference -> high echogenicity
– Mineral, fluid, gas
![Page 5: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/5.jpg)
Ultrasound Machines
• Transforms electricity to ultrasound
• Receives reflected ultrasound and transforms to electricity
• Display of digital images
![Page 6: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/6.jpg)
Ultrasound transducers
• Transforms electricity to vibrations of the piezoelectric crystals
• Higher frequency -> higher resolution, lower penetration
• 15 – 17 MHz
![Page 7: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/7.jpg)
J Ultrasound Med 2002; 21:315
![Page 8: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/8.jpg)
Doppler Effect
• Sound wave travelling away decreases in frequency
• Sound wave travelling towards increases in frequency
![Page 9: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/9.jpg)
Doppler Imaging
• http://www3.medical.philips.com/en-us/secure/images_site/largeImage.asp?size=blowup&classcode=01&appcode=w&imagename=0639%2DEnVHD%2DL12%2D3%2DVASC%2DBICPA&systemcode=e&div=ultra
![Page 10: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/10.jpg)
Nerve Blocks
• Management of spasticity, contractures
• Pre-serial casting transient blocks
• Pre-manipulation blocks
• Diagnostic / therapeutic
![Page 11: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/11.jpg)
Ultrasound Imaging for Nerve Blocks
• Brachial Plexus
• Suprascapular
• Median – elbow, carpal tunnel
• Ulnar
• Radial
• Femoral
• Obturator
• Sciatic
• Tibial
![Page 12: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/12.jpg)
Brachial Plexus
• Preparation for regional shoulder manipulations
![Page 13: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/13.jpg)
AnaesthesiaUK: Home>>Resources>>Anatomy>>Anatomy for anaesthetists>>Applied anatomy for upper limb blocks
http://www.frca.co.uk/article.aspx?articleid=100359# (August 30, 2011)
![Page 14: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/14.jpg)
Brachial Plexus – Anatomical Appraoch
![Page 15: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/15.jpg)
Brachial Plexus – Interscalene Approach
The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound-Assisted Nerve Blocks (14/03/2009)
http://www.nysora.com/peripheral_nerve_blocks/ultrasound-guided_techniques/3063-ultrasound_assisted_nerve_blocks.html (Aug 30, 2011)
![Page 16: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/16.jpg)
Brachial Plexus - Interscalene
• http://www.eorthopod.com/content/thoracic-outlet-syndrome
![Page 17: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/17.jpg)
Brachial Plexus - Interscalene
• http://www.eorthopod.com/content/thoracic-outlet-syndrome
![Page 18: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/18.jpg)
![Page 19: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/19.jpg)
![Page 20: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/20.jpg)
`
![Page 21: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/21.jpg)
![Page 22: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/22.jpg)
Brachial Plexus – Suprascapular Artery
![Page 23: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/23.jpg)
• Yasuyuki Shibata. The Suprascapular Artery and the Brachial Plexus.
![Page 24: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/24.jpg)
• Yasuyuki Shibata. The Suprascapular Artery and the Brachial Plexus.
![Page 25: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/25.jpg)
Brachial Plexus - Supraclavicular
The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound-Assisted Nerve Blocks (14/03/2009)
http://www.nysora.com/peripheral_nerve_blocks/ultrasound-guided_techniques/3063-ultrasound_assisted_nerve_blocks.html (Aug 30, 2011)
![Page 26: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/26.jpg)
Supraclavicular – Suprascapular Nerve
![Page 27: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/27.jpg)
Brachial Plexus – Infraclavicular
![Page 28: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/28.jpg)
Brachial Plexus – Infraclavicular
• Yasuyuki Shibata. Ultrasound-Guided Infraclavicular Brachial Plexus Block.
![Page 29: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/29.jpg)
Brachial Plexus – Infraclavicular
• Yasuyuki Shibata. Ultrasound-Guided Infraclavicular Brachial Plexus Block.
![Page 30: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/30.jpg)
Musculocutaneous Nerve
![Page 31: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/31.jpg)
The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound-Assisted Nerve Blocks (14/03/2009)
http://www.nysora.com/peripheral_nerve_blocks/ultrasound-guided_techniques/3063-ultrasound_assisted_nerve_blocks.html (Aug 30, 2011)
![Page 32: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/32.jpg)
Musculocutaneous and Axillary
AnaesthesiaUK: Home>>Resources>>Anatomy>>Anatomy for anaesthetists>>Applied anatomy for upper limb blocks
http://www.frca.co.uk/article.aspx?articleid=100359# (August 30, 2011)
![Page 33: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/33.jpg)
The New York School of Regional Anesthesia>> Home>> Nerve Blocks >>Ultrasound-Guided Techniques >>Ultrasound-
Assisted Nerve Blocks (14/03/2009)
![Page 34: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/34.jpg)
Suprascapular Nerve
• Preparation for regional shoulder manipulations
• In conjunction with other blocks
– Axillary nerve
– Intra-articular
– Acromio-clavicular
– Sub-acromial bursa
![Page 35: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/35.jpg)
Suprascapular Nerve
![Page 36: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/36.jpg)
Suprascapular Nerve
• Pain Physician 2007; 10:743-746
![Page 37: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/37.jpg)
• Pain Physician 2007; 10:743-746
![Page 38: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/38.jpg)
![Page 39: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/39.jpg)
Median Nerve
• Diagnostic / Therapeutic blocks
• Carpal tunnel injections
![Page 40: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/40.jpg)
Median Nerve
![Page 41: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/41.jpg)
![Page 42: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/42.jpg)
Carpal Tunnel Anatomy
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 43: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/43.jpg)
Carpal Tunnel Anatomy
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 44: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/44.jpg)
Carpal Tunnel Anatomy
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 45: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/45.jpg)
Carpal Tunnel Anatomy
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 46: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/46.jpg)
Carpal Tunnel Anatomy
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 47: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/47.jpg)
![Page 48: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/48.jpg)
Proximal Carpal Tunnel Probe Placement
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 49: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/49.jpg)
Proximal Carpal Tunnel Probe Placement - Transverse
• Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
![Page 50: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/50.jpg)
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 51: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/51.jpg)
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 52: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/52.jpg)
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 53: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/53.jpg)
• Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
![Page 54: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/54.jpg)
• Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
![Page 55: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/55.jpg)
Proximal Carpal Tunnel Probe Placement - Longitudinal
• Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
![Page 56: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/56.jpg)
Proximal Carpal Tunnel Probe Placement - Longitudinal
• Ultrasound Evaluation for Carpal Tunnel Syndrome, Viewsono.com
![Page 57: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/57.jpg)
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 58: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/58.jpg)
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 59: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/59.jpg)
Median Nerve Edema
• Daniel Shelton, Carpal Tunnel: Bifid Median Nerve -SonoSite Case Study, www.MSKSono.com, SonoSite
![Page 60: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/60.jpg)
Ulnar Nerve
• Finger / wrist flexor dennervations
– Pre splinting / casting
• Epicondylar groove
![Page 61: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/61.jpg)
Radial Nerve
![Page 62: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/62.jpg)
Femoral Nerve
• Extensor contracture of quadriceps
• Diagnosis of the extent of tone versus soft tissue contracture prior to placing a temporary intrathecal baclofen infusion pump
![Page 63: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/63.jpg)
Femoral Nerve
Lateral Medial
![Page 64: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/64.jpg)
Lateral Medial
Femoral Artery
Iliopsoas Muscle
Femoral Nerve
![Page 65: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/65.jpg)
![Page 66: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/66.jpg)
![Page 67: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/67.jpg)
Obturator Nerve
• Adductor spasticity / contractures
• Primarily for neurolysis
![Page 68: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/68.jpg)
Obturator Nerve
![Page 69: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/69.jpg)
Obturator Nerve
• Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
![Page 70: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/70.jpg)
• Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
![Page 71: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/71.jpg)
• Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
![Page 72: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/72.jpg)
• Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
![Page 73: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/73.jpg)
• Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
![Page 74: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/74.jpg)
• Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
![Page 75: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/75.jpg)
• Rabah, Danny M. and Ahmed K. Thallaj. Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
![Page 76: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/76.jpg)
US Guided Obturator Nerve Block
• Rabah, Danny M. and Ahmed K. Thallaj.
• Phase 1 Study, Safety and Feasibility of Ultrasound Guided Obturator Nerve Block in Transurethral Surgery
• 18 consecutive men, ages 54-95, mean 69
• Mean time for procedure 4.2 min
• Successful block 97.2%
![Page 77: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/77.jpg)
• Yasuyuki Shibata. Ultrasound-Guided Obturator Nerve Block.
![Page 78: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/78.jpg)
• Yasuyuki Shibata. Ultrasound-Guided Obturator Nerve Block.
![Page 79: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/79.jpg)
![Page 80: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/80.jpg)
Sciatic / Tibial Nerves
• Pre-serial short leg casting of ankle contractures
• Diagnostic block
– Deformity, e.g. hammer toe refractory to intramuscular motor point blocks
– Versus diagnostic motor point blocks
![Page 81: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/81.jpg)
Sciatic Nerve
![Page 82: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/82.jpg)
Sciatic Nerve
![Page 83: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/83.jpg)
![Page 84: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/84.jpg)
Sciatic Nerve
![Page 85: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/85.jpg)
Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
![Page 86: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/86.jpg)
Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
Lateral Medial
Femur
Adductor
Longus
Adductor Brevis
Adductor
Magnus
↑
Sciatic Nerve
![Page 87: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/87.jpg)
Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
![Page 88: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/88.jpg)
Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
![Page 89: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/89.jpg)
Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
![Page 90: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/90.jpg)
Shibata, Yasuyuki, and Misako Harato. Ultrasound-Guided Anterior Sciatic Nerve Block.
![Page 91: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/91.jpg)
Tibial Nerve
![Page 92: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/92.jpg)
![Page 93: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/93.jpg)
![Page 94: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/94.jpg)
![Page 95: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/95.jpg)
![Page 96: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/96.jpg)
![Page 97: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/97.jpg)
Resources
• Atlas of Ultrasound- and Nerve Stimulation-Guided Regional Anesthesia
• Extensive list of detailed peripheral nerve blocks
![Page 98: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/98.jpg)
Resources
• Atlas of Ultrasound-Guided Regional Anesthesia: Expert Consult
• Online videos
![Page 99: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/99.jpg)
Resources
• Ultrasound Guided Regional Anesthesia and Pain Medicine
• Numerous pain / sensory nerve blocks
![Page 100: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/100.jpg)
![Page 101: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/101.jpg)
Resources
• Ultrasound in Anesthetic Practice (with DVD)
![Page 102: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/102.jpg)
Resources
• Critical Care Ultrasonography (with DVD)
• Alexander Levitov, Paul Mayo, Anthony Slonim
![Page 103: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/103.jpg)
Resources
• Practical Ultrasound in Anesthesia for Critical Care and Pain Management (with CD)
• Philip M. Hopkins, Andrew R. Bodenham, Scott T. Reeves
![Page 104: Ultrasound in Neurolysis - School of Medicine · 2019-10-04 · Ultrasound in Peripheral Nerve Interventions John L. Lin, M.D. Shepherd Center ... The New York School of Regional](https://reader035.vdocuments.us/reader035/viewer/2022070717/5eddca0ead6a402d6668fb7e/html5/thumbnails/104.jpg)