Ultrasonographic visualization of anatomical variations of the supraclavicular nerves

Typical anatomy of the supraclavicular nerve (SCN) is described as originating from the cervical plexus and dividing into medial, intermediate, and lateral branches. The SCN is vulnerable to injury during clavicular surgery, leading to altered sensation post-operatively. There is also increasing interest in anesthetizing the SCN in shoulder or clavicular surgery. Utilizing a high-frequency (20 MHz) ultrasound probe, 20 healthy volunteers were scanned, giving data for 40 SCNs. For each nerve, anatomical course and branches were graphically plotted using a custom Python 3.8.12 program and Microsoft Excel. Of 40 nerves, only 19 (47.5%) demonstrated a typical course, with the rest showing considerable variability of branching patterns. Crossing branches (CBs) were found in 24 (60%) with a total of 54. Just over half (29, 54.7%) of these crossed the clavicle lateral to its midpoint, with 32 (59.6%) CBs having a diameter of ≥25% compared to that of the SCN main trunk. The distance from the mid-clavicular point at which the branches crossed the clavicle was recorded. This study demonstrated that over half the SCNs had atypical branching patterns with intra-volunteer variability. Preoperative mapping may be useful in preventing injury and subsequent numbness.