Upper Extremity Blocks

Upper Extremity Blocks

Multiple Choice

Beginning at the Nerve Roots, order the components of the brachial plexus from medial to lateral

• Divisions

  Branches

  Trunks

  Cords

• Cords

  Branches

  Trunks

  Divisions

• Divisions

  Cords

  Branches

  Trunks

• Trunks

  Divisions

  Cords

  Branches

​Brachial Plexus Overview

Multiple Choice

Which terminal branches of the brachial plexus originate from nerve roots C5-T1?

• Median and Radial

• Radial and Musculocutaneous

• Ulnar and Median

• Brachial and Axillary

Multiple Choice

Which terminal nerve branch receives innervation from the lateral and medial cords?

• Median nerve
• Musculocutaneous nerve
• Radial nerve
• Ulnar nerve

Multiple Choice

Which of the following nerves provides sensory innervation to the "cape of the shoulder"?

• Dorsal Scapular nerve

• Supraclavicular nerve

• Intercostobrachial nerve

• Acromial Scapular nerve

Additional Nerves of Relevance

Phrenic Nerve

Draw

Circle the nerve that innervates the serratus anterior muscle

Multiple Select

Which peripheral nerves are purely sensory? (select 2)

• Medial antebrachial cutaneous

• Musculocutaneous

• Axillary

• Medial Brachial Cutaneous

​​Dermatomes

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Fill in the Blanks

Which peripheral nerve is responsible for triceps contraction?

Multiple Choice

Which peripheral nerve is responsible for adductor pollicis contraction?

• Median nerve
• Radial nerve
• Musculocutaneous nerve
• Ulnar nerve

Multiple Choice

What nerve provides SENSORY innervation to the light blue dermatome?

• Radial nerve
• Musculocutaneous nerve
• Ulnar nerve
• Median nerve

Multiple Choice

What nerve roots provide SENSORY innervation to the purple dermatome?

• C5-C7

• C5-C6

• C5-T1

• C6-C8

Multiple Choice

What CORDS provide(s) SENSORY innervation to the pink dermatome?

• Lateral

• Posterior and Medial

• Medial and Lateral

• Medial

Multiple Choice

An interscalene block would be most effective for which of the following procedures?

• Knee arthroscopy
• open reduction and internal fixation of an ulnar fracture

• Wrist fracture repair
• Arthroscopic rotator cuff repair

Interscalene Block Technique

Next: Slide the transducer cephalad until you can identify the hypoechoic roots of the plexus between the anterior and middle scalene muscles

Identify 3 things:
- Cricoid Cartilage
- Clavicle
- Lateral border of the clavicular head of the SCM

​

Landmark
Technique

Multiple Choice

Landmarks for the interscalene block (no US) include: (select two)

• Cricoid Cartilage

• Medial border of clavicular head of SCM

• Thyroid Cartilage

• Lateral Border of Sternal border of SCM

• Lateral Border of clavicular head of SCM

Multiple Choice

How many mL of LA do you inject for an interscalene block under US guidance?

• 20-30 mL

• 3-5 mL

• 100 mL
• 7-15 mL

Multiple Choice

How many mL of LA do you inject for an interscalene block WITHOUT US guidance?

• 7-15 mL

• 25-30 mL

• 30-50 mL

• 5-10 mL

Multiple Choice

What length of needle should you use for an interscalene block?

• 5 in

• 5 cm

• 2 in

• 2 cm

Multiple Select

What muscle movements are acceptable when using a nerve stimulator for interscalene block? (Select all that apply)

• shoulder abduction

• shoulder shrug

• scapular winging

• hand twitching

• arm internal rotation

Complications of IS Block

Complications of IS Block

Complications of IS Block

Multiple Choice

What percentage of time does ipsilateral diaphragmatic paresis occur following IS block?

• ~70%

• ~50%

• ~100%

• ~20%

• ~25%

Multiple Select

Symptoms of Horner's Syndrome include: (select three)

• Ptosis

• Mydriasis

• Miosis

• Hyperhydrosis

• Anhidrosis

Multiple Choice

What is my dog's name?

• Mocha

• Mookie

• Mochi

• Munch

Multiple Choice

What type of chickens did I just acquire?

• Rhode island reds

• Silkies

• Buff Orpingtons

• Jersey Giants

Multiple Choice

What artery is at risk of puncture during IS block?

• Vertebral a.

• Basilar a.

• Subclavian a.

• Innominate a.

Multiple Choice

The supraclavicular block targets the ___ of the brachial plexus.

• Roots/Trunks

• Trunks/Divisions

• Divisions/Cords

• Cords/Branches

Supraclavicular Block

Supraclavicular Block

Supraclavicular Block

Multiple Choice

Describe the transducer orientation for Supraclavicular block with US

• Transverse w/ Cephalad Tilt

• Sagittal w/ Lateral Tilt

• Sagittal w/ Medial Tilt

• Transverse w/ Caudal Tilt

Multiple Choice

What is an acceptable motor response when doing landmark technique for supraclavicular block?

• Arm adduction

• Shoulder abduction

• Bicep flexion

• Finger twitch

Multiple Choice

Which artery is most likely to be injected during supraclavicular block?

• Supraclavian

• Supclavian

• Interclavian

• Subclavian

Supraclavicular Block Complications

Supraclavicular Block Complications

Multiple Choice

The pleura is immediately inferior to what bone when correctly visualzing on US for a supraclavicular block?

• 2nd rib

• 1st rib

• Clavicle

• Manubrium

Infraclavicular Block

Infraclavicular Block

Infraclavicular Block

Infraclavicular Block

Infraclavicular Block

Infraclavicular Block- Nerve Stim.

Multiple Select

What are the three most common errors that increase the risk of pneumothorax in infraclavicular block?

• Needle insertion is too medial

• Needle direction is too medial

• Needle direction is too lateral

• Needle insertion depth exceeds 6 cm

• Needle insertion depth exceeds 9 cm

Multiple Select

When compared to the supraclavicular approach to the brachial plexus, the infraclavicular approach has a higher risk of: (select 2)

• intravascular injection

• patient discomfort

• pneumothorax

• respiratory compromise

Complications of Inf. Block

Complications of Inf. Block

Multiple Choice

Which region is MOST likely to be inadequately anesthetized following an axillary block with a transarterial technique?

• Lateral forearm

• Medial forearm

• First Digit

• Fifth Digit

Axillary Block Technique

Axillary Block Technique

Axillary Block Technique

Axillary Block Technique

Axillary Block Technique

Axillary Block Landmark Technique

Axillary Block Landmark Technique

Axillary Block Landmark Technique

Multiple Choice

Describe the orientation of the MEDIAN nerve relative to the axillary artery in the anatomic position:

• Anterior + Lateral

• Anterior + Medial

• Posterior + Lateral

• Posterior + Medial

Multiple Choice

Describe the orientation of the RADIAL nerve relative to the axillary artery in the anatomic position:

• Anterior + Medial

• Posterior + Medial

• Anterior + Lateral

• Posterior + Lateral

Multiple Choice

Describe the orientation of the ULNAR nerve relative to the axillary artery in the anatomic position:

• Anterior + Lateral

• Anterior + Medial

• Posterior + Lateral

• Posterior + Medial

Multiple Choice

Describe the orientation of the MUSCULOCUTANEOUS nerve relative to the axillary artery in the anatomic position:

• Anterior + Lateral

• Anterior + Medial

• Posterior + Lateral

• Posterior + Medial

Distal Nerve Blocks

Axillary Block Complications

Distal Nerve Blocks

Distal Nerve Blocks

Distal Nerve Blocks

Distal Nerve Blocks

Distal Nerve Blocks

Distal Nerve Blocks

Multiple Select

List the anatomic landmarks for the MEDIAN nerve block at the WRIST: (select two)

• flexor carpi ulnaris tendon

• flexor carpi radialis tendon

• flexor palmaris longus tendon

• flexor dongus longus tendon

Procedure steps

​

Bier Block

Procedure steps

​

Bier Block

Procedure steps

​

Bier Block

Avoiding LAST
Tourniquet Deflation

​

Bier Block

IV Regional
Anesthesia

​

Bier Block

Multiple Select

Best procedures to perform Bier block include: (select 2)

• Dupuytren's contracture release

• Carpal Tunnel release

• ORIF 1st digit

• external fixation of 5th digit

Multiple Choice

What is the minimum amount of time the tourniquet must remain inflated after injecting local anesthetic for Bier Block?

• 30 minutes

• 20 minutes

• 60 minutes

• 10 minutes