Abstract
For ultrasound (US), a transverse in plane with long-axis confirmation technique at the level of the Chassaignac’s tubercle of C6 is described. By utilizing a hybrid fluoroscopic approach, US is used to carefully position the needle away from critical structures in the soft tissue of the anterolateral neck, guiding the safest injection possible. After US-guided (USG) needle placement, injected contrast under fluoroscopy (hybrid technique) verifies unilateral and nonvascular contrast flow. Vital structures identified and avoided under USG injection include the trachea, esophagus, thyroid, inferior thyroid artery, recurrent laryngeal nerve, common carotid artery, internal jugular vein, and vertebral artery.
Keywords
causalgia, CRPS, PTSD, RSD, sympathetic chain, sympathetic pain
Note: Please see pages ii , iii for a list of anatomic terms/abbreviations used throughout this book.
For ultrasound (US), a transverse in-plane with long-axis confirmation technique at the level of the Chassaignac’s tubercle of C6 is described. By utilizing a hybrid fluoroscopic approach, US- guidance is used to carefully position the needle away from critical structures in the soft tissue of the anterolateral neck, guiding the safest injection possible. After US-guided (USG) needle placement, injected contrast under fluoroscopy (hybrid technique) verifies unilateral and nonvascular contrast flow. Vital structures identified and avoided under USG injection include the trachea, esophagus, thyroid, inferior thyroid artery, recurrent laryngeal nerve, common carotid artery, internal jugular vein, and vertebral artery.
In-Plane Technique
- ▪
The patient is placed in a supine position. The patient’s head is slightly rotated contralateral to the approached side with minimal cervical extension.
- ▪
Place the linear transducer in transverse position over the midline at the cricoid cartilage and scan inferiorly until the inferior aspect of the thyroid is visualized.
- ▪
Move the transducer laterally toward the desired side until the anterior aspect of the Chassaignac’s tubercle of C6 is identified ( Fig. 28B.1B ). In this position, visualize the lateral aspect of the thyroid, carotid artery, internal jugular vein, longus colli, and longus capitus muscles. Color or power Doppler may further clarify the positions of vessels. Structures of interest are noted in Figs. 28B.1C, D, E .
Related posts:
Introduction: How to Use This Atlas
Caudal Epidural Steroid Injection: Ultrasound Guidance
Lumbar Transforaminal Epidural Steroid Injection—Infraneural Approach: Fluoroscopic Guidance
Thoracic Zygapophysial Joint Intraarticular Injection—Posterior Approach: Fluoroscopic Guidance
Cervical Zygapophysial Joint Nerve (Medial Branch) Radiofrequency Neurotomy and Nerve Injection, Posterior Approach: Fluoroscopic Guidance
Lateral Femoral Cutaneous Nerve Injection: Ultrasound Guidance
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
