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Anterior shoulder dislocation (ASD) is the most common type of dislocation presented to the emergency department (ED) with severe pain and limitation of range of movement. Procedural sedation and analgesia are commonly used for ASD, but regional techniques are gaining popularity. Interscalene brachial plexus block is effective but has several limitations. Suprascapular nerve block (SSNB) has been explored for this indication. The SSNB is commonly performed using the posterior approach in a sitting position and can be technically difficult in dislocated patients. Recently, anterior subomohyoid approach performed in the lower neck has been described but has not yet been reported in the ED. We, hereby, report our experience of using low-volume ultrasound-guided anterior SSNB for procedural analgesia in 10 patients with ASD.

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This case report aims to encourage teams to readjust the operating table during prolonged robotic cases, especially in those patients with a high body mass index. We present the case of a 59-year-old male who developed neuropathic pain involving the suprascapular nerve distribution following a prolonged robotic-assisted radical prostatectomy.

Blocking the suprascapular nerve under the inferior belly of the omohyoid muscle is a novel regional anesthesia technique that has been proposed for shoulder analgesia. We describe the use of and our experience with bilateral indwelling suprascapular catheters for pain management via continuous infusions in a patient undergoing bilateral shoulder surgery.
Bilateral subomohyoid suprascapular catheters were inserted prior to surgery for postoperative analgesia in a patient undergoing bilateral rotator cuff tear repair. The catheters were placed 0.5-1 cm beyond the needle tip, and low local anesthetic infusion rates (ropivacaine 0.2% at 5 mL·hr-1 on each side) were used.
Judicious use of preoperatively placed bilateral suprascapular catheters added to a comprehensive multimodal analgesic regimen provided excellent analgesia without respiratory compromise throughout the perioperative course.
RéSUMé: OBJECTIF: Une nouvelle technique d’anesthésie régionale proposée pour l’analgésie de l’épaule consiste à bloquer le nerf suprascapulaire sous la partie inférieure du muscle omohyoïdien. Nous décrivons l’utilisation et notre expérience avec des cathéters suprascapulaires bilatéraux pour la prise en charge de la douleur par l’intermédiaire de perfusions continues chez un patient subissant une chirurgie bilatérale des épaules. ÉLéMENTS CLINIQUES: Des cathéters suprascapulaires sous-omohyoïdiens bilatéraux ont été insérés avant la chirurgie pour l’analgésie postopératoire d’un patient subissant une réparation bilatérale de rupture de la coiffe des rotateurs. Les cathéters ont été positionnés 0,5-1 cm au-delà de l’extrémité de l’aiguille, et de faibles quantités d’anesthésique local (ropivacaine 0,2 % à 5 mL·h−1 de chaque côté) ont été utilisées. CONCLUSION: L’utilisation judicieuse de cathéters suprascapulaires bilatéraux installés en période préopératoire, ajoutée à un régime analgésique multimodal exhaustif, a procuré une excellente analgésie sans atteinte respiratoire tout au long de la période périopératoire.

BACKGROUND: Well-established human anatomy labs with access to expert faculty are exceedingly valuable tools to medical student education. In this manuscript, we detail an infero-lateral subclavicular lipoma which was discovered as a result of the utilization of both those labs and expert faculty. This lipoma may have caused brachial plexopathy or may serve as an unusual cause of neurologic thoracic outlet syndrome (NTOS) due to the location of the mass.
UNASSIGNED: During prosection of a donor in the human anatomy lab, a mass was discovered by a medical student. This medical student utilized the human anatomy lab faculty members and resources to identify the mass as a lipoma. The lipoma compressed the lateral cord of the brachial plexus and the suprascapular nerve, but no diagnosis of NTOS or brachial plexopathy was made during the life of the donor, nor was any surgical intervention indicated. Removal of the lipoma immediately relieved stress upon the nerves. Histochemical analysis confirmed the diagnosis of a lipoma and demonstrated almost only mature adipocytes.
CONCLUSIONS: The authors concluded that the lipoma of this patient was not identifiable with computerized tomography imaging modalities, despite ultrasound demonstrating a hyperechoic outline of the mass in the cadaver of the patient. It is very likely that this lipoma had not been diagnosed previously due to the atypical location of the tumor. Equally, typical surgical methods associated with brachial plexopathy or NTOS treatment would be difficult or more complicated, due to the lateral and inferior location of the lipoma. Physicians treating thoracic outlet syndrome-type symptoms without resolution should consider potential non-malignant obstruction located outside the thoracic outlet, toward the extremity. Deep palpatory methods and physical therapy should be considered until diagnosis is certain, as ultrasound would be difficult and typical transaxillary surgical methods would be nonhelpful. Medical students and early-career residents and physicians should be aware of the resources provided to them via campus human anatomy laboratories which they may utilize to further their understanding and knowledge of specific pathologies.

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Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series.
Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength.
The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade ≥ 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer.
The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.

Complex brachial plexus and peripheral nerve injuries can be challenging to evaluate and treat, especially in the face of novel pathology.
To describe the diagnosis of bilateral suprascapular nerve injury, the unique surgical anatomy, and the novel use of a distal nerve transfer to re-establish external rotation. To the best of our knowledge, bilateral suprascapular nerve injury has not previously been reported.
The authors describe the physical examination and electrodiagnostic and imaging work-up for elucidating complex injury patterns and present a procedure for reinnervating the infraspinatus muscle.
A 48-yr-old man presented with profound, right-sided, partial brachial plexus injury incurred 5 mo earlier in a motorcycle accident. Imaging demonstrated atrophy and severe edema within the bilateral supraspinatus and infraspinatus muscles. Needle electromyography depicted no motor units and insertional activities in bilateral infraspinatus muscles, consistent with bilateral suprascapular nerve injury. Along with brachial plexus repair, the patient underwent transfer of a distal branch of the spinal accessory nerve to the inferolateral branch of the suprascapular nerve to the infraspinatus muscle. At 16 mo, he had recovered strong restoration of shoulder external rotation.
Systematic evaluation can assist in defining complex pathology, particularly with previously unreported types. In this case, predominant injury was inflicted upon the branch innervating the infraspinatus. Highly focal nerve transfers can achieve substantial restoration of external rotation.