
3D/AR Probe Placement ©
Interactive 3D Model Control: Simply use your cursor to rotate the 3D model and explore probe positioning from every angle.
Immersive AR Experience: For an even more immersive experience, click the AR icon in the top right corner of the image. A QR code will appear—open your phone’s camera and scan it. This will take you to our secure AR platform, 'learn.arira.us'.
Bring the 3D Model to Your Room: When prompted, tap “Allow” to view the 3D model. Then, point your phone at a clear surface to project the model and explore it from any perspective.
The Best Seat in the Course: You’re always in the front row, and nothing beats this view!
Interscalene Brachial Plexus Block
Probe Placement
Position: Place the high-frequency linear ultrasound probe transversely over the lateral aspect of the neck, above the clavicle at the level of the cricoid cartilage (C6 vertebra). This corresponds to the interscalene groove.
Landmarks: Identify the anterior and middle scalene muscles with the brachial plexus located between them in the interscalene groove.
Orientation: Align the probe perpendicularly to the skin, ensuring it is placed in the transverse plane of the neck.
Medial to Lateral Movement: If the landmarks are not immediately visible, move the probe medially to locate the carotid artery and internal jugular vein. Then, scan laterally, past these structures, into the interscalene region where the brachial plexus lies between the scalene muscles.
Adjustment: Once the interscalene groove is visualised, slide the probe slightly cranially or caudally along the neck to locate the optimal view of the brachial plexus. Fine-tune the angle to capture a clear view of the nerve roots.
Optimisation Manoeuvres
Adjust the probe angle: Tilting the probe slightly cranially or caudally can help better align with the nerve roots.
Apply adequate gel: Ensuring sufficient gel is applied helps improve skin contact and reduces artefacts, especially in muscular necks.
Optimise depth: Set the depth between 2–3 cm to focus on the superficial nerve roots of the brachial plexus.
Optimise gain settings: Increase the gain to enhance the contrast between muscles, nerves, and fascia for a better definition of the brachial plexus.
Compression: Applying light compression may help reduce superficial artefacts and improve the visibility of the deeper nerve structures.
Tracing the Brachial Plexus
Proximal to Distal Movement: Trace the brachial plexus proximally towards the cervical spine to identify the individual C5 and C6 nerve roots. Following these roots helps confirm their position before targeting the block.
Avoiding Vascular Structures
Colour Doppler: Use colour Doppler to identify and avoid the transverse cervical artery or other vascular structures near the brachial plexus. This helps prevent inadvertent vascular puncture during needle insertion.
Avoiding Vascular Structures: When performing an interscalene brachial plexus block, it's crucial to avoid vascular structures that may be located near the nerve roots. This can be challenging, as the brachial plexus trunks, which are hypoechoic on ultrasound, can resemble small blood vessels. Key vascular structures, such as the ascending cervical artery, transverse cervical artery and suprascapular artery, can cross the brachial plexus, potentially causing confusion and increasing the risk of inadvertent vascular puncture. Colour-flow Doppler and pulse-wave Doppler should be routinely used to differentiate these vessels from the nerve trunks. Doppler helps identify vascular structures by showing blood flow, preventing the needle from accidentally puncturing a vessel during injection. Proper Doppler imaging not only enhances safety but also optimises the precision of the block by ensuring that only the intended nerves are targeted while avoiding nearby vessels. This approach significantly reduces complications such as bleeding or inadvertent vascular injection.