Abstract
Introduction
Image interpretation during ultrasound guided interscalene nerve blocks might be difficult and misleading due to rare anatomical variations of the sternocleidomastoid muscle.
Case report
During a routine dissection, we found a cleidoatlanticus muscle, which originated lateral to the regular cleidomastoid portion of the sternocleidomastoid muscle. This muscle separated from the sternocleidomastoid muscle at level of the dorsally crossing omohyoid muscle to fuse with the levator scapulae muscle’s origin at the transverse process of the atlas.
Conclusion
As this muscle crosses at a level, where ultrasound guided interscalene blocks are performed, this unusual structure might lead to misinterpretation of the confusing ultrasound image, resulting in misguided needle positioning and consecutive inefficiency of the block technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bergmann RA, Afifi AK, Miyauchi R (1988) In: Bergmann (ed) Compendium of human antomic variations. Urban und Schwarzenberg, Baltimore, pp 32–33
Chan VW (2003) Applying ultrasound imaging to interscalene brachial plexus blocks. Reg Anesth Pain Med 28(4):340–343
Eisler P (1912) Muskeln des Stammes. In: Bardeleben (ed) Handbuch der Anatomie des Menschen; von Bardeleben K. Gustav Fischer Verlag, Jena, pp 234–241
Fasel J, Gailloud P, Terrier F (1994) Three-dimensional reconstruction of a levator claviculae muscle. Surg Radiol Anat 16:303–305
Feigl GC, Dreu M (2010) Important structures to be known during ultrasound guided supraclavicular brachial plexus block. Reg Anesth Pain Med 35(3):317–318
Gruber W (1876) Ein Musculus cleidocervicalis sive tracheo-clavicularis imus. Arch Anat Physiol Wissen Med: 757–758
Hafferl A (1939) Die Muskulatur. In: Hafferl A (ed) Die Anatomie der Pleurakuppel. Julius Springer Verlag, Berlin
Henle DJ (1858) Muskellehre. In: Henle (ed) Handbuch der systematischen Anatomie. Vol 1, 3rd part. Friedrich Viehweg und Sohn, Braunschweig
Manickam BP, Oosthuysen SA, Prikh KM (2009) Supraclavicular brachial plexus block-variant relation of brachial plexus to subclavian artery in the first rib. Reg Anesth Pain Med 34(4):383–384
Rodríguez-Vásquez JF, Mérida-Velaso JR, Verdugo-López S, de la Cuadra-Blanco C, Snz-Casado JV (2009) Anatomical relationships of the cleidoatlanticus muscle. Interpretation about its origin. Anat Sci Int 84:47–52
Terminologia anatomica (1998) federative committee on anatomical terminology (ed) Thieme, Stuttgart, pp 35–36
Testut L (1894) Muscles cléido-atloidien et cléido-axoidien. In: Masson G (ed) Les anomalies musculaires chez l′homme, expliquées par l′anatomie comparée. Leur importance en anthropologie, Masson, pp 224–226
Thiel W (1969) Faszien und Räume des Halses. In: Haffel A (ed) Lehrbuch der topographischen Anatomie, vol 3. Springer, Berlin, pp 225–231
Thiel W (1992) The preservation of the whole corpse with natural color. Ann Anat 174:185–195
Acknowledgments
This work has not been funded by any foundation or other non-governmental source.
Conflict of interest
No conflict is declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Feigl, G.C., Pixner, T. The cleidoatlanticus muscle: a potential pitfall for the practice of ultrasound guided interscalene brachial plexus block. Surg Radiol Anat 33, 823–825 (2011). https://doi.org/10.1007/s00276-011-0820-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-011-0820-z