Acetabular revision for iliopsoas impingement: a study of 55 cases at 3 years of follow-up. Does the procedure achieve the Minimal Clinically Important Difference (MCID) in the Oxford-12 score in more than 80% of cases?

INTRODUCTION: Several surgical options can be offered to manage iliopsoas impingement. Research published on cup replacements often concerns a small population size or multicentre studies, suggesting a variety of indications. We conducted a retrospective single centre study screening according to a specific protocol of a population of patients who had a cup replacement for iliopsoas impingement. The objectives were: 1) to specify the functional outcomes and the achievement of the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) according to the Oxford-12 score, and 2) to assess the complication rate. HYPOTHESIS: Our hypothesis was that acetabular replacements achieve a Minimal Clinically Important Difference (MCID) in more than 80% of cases. PATIENTS AND METHODS: Fifty-five hips underwent acetabular revision between 2011 and 2020. Forty-three were performed as first-line surgery, eight after failed tenotomy and four after failed anterior hip capsule thickening plasty. A CT scan of all the hips revealed a median overhang of 9 mm (7; 12) and a 7 ° cup anteversion (2; 19). Follow-up included assessment of the Oxford-12 score using MCID and PASS, the Merle d'Aubigné score, an assessment of hip flexion muscle strength using the Medical Research Council scale, and an assessment of satisfaction and complications. RESULTS: At a mean follow-up of 3 years (2-10), the difference in the Oxford score before and at follow-up was 18 points (15; 27) (p < 0.001), the median Medical Research Council score was 4.5 (4; 5) and patients were satisfied or very satisfied in 73% of cases (40/55). The MCID was achieved for 87% of the hips (48/55), and the PASS was achieved in 67% of cases (33/55). The rate of complications involving surgical revision was 10.9% (6/55) with respectively: two anterior dislocations, one early infection on day 10 resolved after wound irrigation and appropriate antibiotic therapy, one intraoperative fracture of the trochanter requiring osteosynthesis and one arthroscopic revision to remove a free cement fragment. CONCLUSION: Due to a good functional outcome but a high complication rate, a cup replacement can be offered for iliopsoas impingement associated with acetabular malposition or significant overhang. LEVEL OF EVIDENCE: IV.

Corona mortis and pelvic dissection: Understanding the relationship between anatomical structures and bone areas.

Pelvic fractures are becoming increasingly frequent. The gold standard for surgical managements remains open procedures. Despite its excellent biomechanically results, it can lead to many complications. Minimally invasive surgery could reduce these complications. For complex pelvic trauma, extraperitoneal endoscopic technique has never been described. The aim of this study is to determine anatomical landmarks which are useful for endoscopic pelvic ring surgery using an extraperitoneal approach. The second objective is to compare this minimally invasive procedure to expose the bone versus a traditional open approach. After preparing the vessels with latex injections, 10 specimens are dissected alternately, using an endoscopic method (MIS) on one side and an open method on the other side. Both procedures are performed on the same subject. The visualized bone areas are drilled with burr holes. The marked surfaces are measured with photogrammetry. Finally, the data are processed (surface analysis). An extraperitoneal endoscopic dissection that follows anatomical landmarks can be performed. Bone area (mm2 ) visualized by endoscopy was 74 ± 14 (59-94) compared to 71 ± 16 (48-94) by open method. Paired t-test was performed with no significant difference between the two methods. Skin and muscular incisions were significantly lower in the MIS group (5.1, IC95% [4.1; 6.1], p < 0.001). An extraperitoneal endoscopic dissection of the pelvis can be performed. We also find no significant difference between our method and an open traditional approach concerning bone exposure. We offer a holistic approach to treat pelvic fractures by identifying key anatomical structures.

What happens in the medium-term to capsule-thickening plasties for iliopsoas impingement after total hip arthroplasty? Evaluation of 14 procedures at 4years' follow-up.

INTRODUCTION: In 2015, we described a capsule-thickening technique via an anterior approach for iliopsoas cup impingement. To our knowledge, medium-term results have not been reported. We therefore retrospectively analyzed all cases in the initial series and those since 2015, to assess this original technique over a longer follow-up: (1) to analyze complications, and (2) to assess functional outcome. HYPOTHESIS: The study hypothesis was that this surgical solution has a success rate sufficient for it to be included in the therapeutic armamentarium for iliopsoas impingement. MATERIAL AND METHOD: Fourteen patients were included. Nine plasties were in first line, 3 after tenotomy, and 2 after cup exchange. The anterior Hueter approach was used, visualizing anterior cup overhang, sometimes associated with penetration of the anterior capsule, and enabling capsule-thickening by a folded Vicryl™ mesh. Functional results were analyzed. RESULTS: At a median 4years' follow-up (IQR: 2-5; range: 1-9), change over baseline in Oxford score was 7 points (p=0.004), median Medical Research Council thigh flexion strength score was 5 (IQR: 5-5), and 50% of patients (7/14) were satisfied or very satisfied. The major complications rate was 7% (1/14), for 1 irrigation of infected hematoma, cured without recurrence; there was also 1 minor case of injury to the lateral cutaneous nerve of the thigh. Forty-three percent of patients (6/14) exhibited a minimal clinically important difference (MCID) and 64% (9/14) a patient-acceptable symptom state (PASS). Median anatomic overhang on anatomic CT transverse slice was 7mm (IQR: 3-8; range: 0-13). Four patients underwent secondary acetabular component exchange; their median overhang was 7.5mm (IQR: 7-8) compared to 5mm (IQR: 2-8) for the other patients (p-value non-calculable). CONCLUSION: This surgical option seems interesting when acetabular overhang is not too great, especially as it does not affect flexion strength. LEVEL OF EVIDENCE: IV.

Metaphyseal and Diaphyseal Contours: Variants and Pitfalls.

We discuss several variants of the metaphyseal and diaphyseal bone surfaces that may be misleading in clinical practice. They include metaphyseal stripes, spiculated metaphyseal cortex, cortical desmoid, laminated lateral supracondylar ridge, cortical vascular canals, variations in shape or lucency of normal tuberosities, cortical thickening of normal ridges, and well-organized undulated hyperostosis at the proximal phalanges.

Anatomical study of the dorsal capsulo-scapholunate septum using high frequency ultrasonography.

INTRODUCTION: The dorsal capsulo-scapholunate septum (DCSS) is a recently described capsuloligamentous structure between the dorsal bundle of the scapholunate ligament (SLL) and the joint capsule of the wrist. It acts a secondary stabilizer of the scapholunate joint. The aim of this study was to evaluate the visibility and normal appearance of DCSS on high frequency ultrasound. HYPOTHESIS: The DCSS can be analyzed using high frequency ultrasound. MATERIALS AND METHODS: Three cadaveric wrists were dissected in order to study the DCSS; one without labeling and the other two after labeling under ultrasound guidance. On two other wrists, a correlation between the structure considered to be the DCSS on ultrasound and the corresponding CT arthrography and anatomical sections was carried out. Finally, sagittal ultrasound sections of the DCSS region on 42 healthy wrists were analyzed retrospectively. RESULTS: During dissection, the DCSS corresponded to a fibrous structure extending to the dorsal surface of the scaphoid and lunate, with certain fibers converging towards the SLL. On high-frequency ultrasound, a hyperechoic fibrillar structure was visualized at the theoretical position of the DCSS. The dissections performed after ultrasound-guided transfixion showed that its limits corresponded to the limits of the DCSS. The anatomical, CT arthrography and ultrasound sections in the DCSS region were concordant. The DCSS was retrospectively visible on at least one reference ultrasound slice in 90.5% of healthy wrists, and was always hyperechoic. Its average thickness was 1.38±0.24mm. DISCUSSION: Our study describes the normal sonographic characteristics of the DCSS, visible in a majority of healthy patients on high-frequency ultrasound. The analysis of the sonographic characteristics of the DCSS in the context of acute wrist trauma should be evaluated, and a diagnostic decision tree has been proposed. LEVEL OF EVIDENCE: IV.

Anatomical study of the sternoclavicular joint using high-frequency ultrasound.

OBJECTIVES: The purpose of the present study was to determine whether ultrasound enables assessment of sternoclavicular structures. METHODS: A preliminary study in 3 cadavers was followed by an ultrasound study, performed by 2 musculoskeletal radiologists working in consensus, in 59 patients without history of trauma, surgery or pain in the sternoclavicular joint. The visibility, echogenicity and thickness of the sternoclavicular structures were assessed. RESULTS: The anterior sternoclavicular ligament and the interclavicular ligament could be seen in all patients (mean thickness: 1.4 mm and 1.3 mm, respectively). The articular disc was clearly seen in 66.1% of cases, and shoulder antepulsion enabled analysis in an additional 20.3%. Intra-articular joint gas was frequent (33.89% of cases), preventing analysis of the disc in 2 patients. Only the superficial anterior aspect of the clavicular and sternal articular cartilages could be assessed. Joint effusion was seen in 6.8% of cases. Clavicular osteophytes, sternal osteophytes and bone irregularities at the anterior sternoclavicular ligament insertion were detected in 33.9%, 16.9% and 16.9% of cases, respectively. CONCLUSION: The anterior sternoclavicular ligament, interclavicular ligament and anterior intra-articular structures can be visualized by ultrasound. This means of assessment may have clinical applications, particularly in patients with trauma or microtrauma.

Impact of introducing extremity cone-beam CT in an emergency radiology department: A population-based study.

BACKGROUND: Musculoskeletal cone-beam CT (CBCT) recently appeared on the market, with image quality comparable to that of high-resolution CT. It was previously implemented mainly in craniofacial surgery and in orthopedic limb surgery for weight-bearing imaging, but without large-scale assessment in emergency settings. We therefore conducted a retrospective comparative study in an emergency radiology department: 1) to assess whether introduction of CBCT dedicated to extremity traumatology reduced radiation dose delivered to the patient undergoing cross-sectional imaging, 2) to assess whether it increased turnover, and 3) to study the feasibility and practical consequences. Study hypothesis Introducing CBCT dedicated to traumatology in an emergency radiology department reduces radiation dose related to cross-sectional imaging in extremity trauma. PATIENTS AND METHODS: Two periods were distinguished: in May-November 2016, the only cross-sectional imaging available in our emergency radiology department was multi-detector CT (MDCT); in May-November 2017, both MDCT and CBCT were available. Thus, the population in period 1 (n=165) had undergone only MDCT extremity imaging, while patients in period 2 underwent either CBCT (n=139) or MDCT (n=85). Study parameters notably included dose-length product (DLP) and length of patient stay in the radiology department (turnover). RESULTS: Mean DLP was significantly reduced with the introduction of CBCT: 210.3±133.6 mGy.cm (range, 20-595) in period 1, versus 138.4±92.7 mGy.cm (range, 32-623) in period 2 (p<0.0001). Taking both periods together, mean DLP was 50.7% lower with CBCT (n=139) than MDCT (n=249): respectively, 101.6±14.9 mGy.cm (range, 50.6-126.9) versus 206.5±131.8 mGy.cm (range, 20-623) (p<0.0001). Turnover accelerated with the introduction of CBCT, with mean stay of 84.9minutes in period 1 versus 72.1minutes in period 2 (p=0.011). In period 2, turnover was 23.6% faster with CBCT than MDCT: respectively, 64.9minutes versus 85.0minutes (p=0.0004). DISCUSSION: Introducing CBCT dedicated to the extremities in an emergency radiology department was feasible. It reduced overall radiation dose and accelerated turnover. LEVEL OF EVIDENCE: III; comparative case-control study.

Anatomical study of the proximal tibiofibular ligaments using ultrasound.

OBJECTIVES: No description of the proximal tibiofibular (PTF) ligaments by means of high ultrasound has yet been reported in the literature. The purpose of this study was to assess whether ultrasound may allow the assessment of these ligaments. METHODS: This study was initially undertaken in three cadaveric knees, followed by an ultrasound study performed by two musculoskeletal radiologists working in consensus of 52 patients without history of trauma or surgery of the knee, and without lateral knee pain. The visibility, echogenicity, length and thickness of the PTF ligaments were assessed. RESULTS: Regarding the anterior PTF ligament, the superior bundle and the upper and lower middle bundles were clearly seen in 42.3%, 100% and 75% of the knees, respectively. Regarding the posterior PTF ligament, the superior and middle bundles were clearly seen in 88.4% and 51.9% of the knees, respectively. The echo-anatomy of these ligaments and the probe positioning allowing their best depiction were described in this study. CONCLUSION: Most of the PTF ligaments can be visualized by means of ultrasound. This possible assessment may have clinical applications, particularly in patients with lateral knee pain.

Styloidogenic compression of the internal jugular vein, a new venous entrapment syndrome?

Internal jugular vein (IJV) thrombosis is mainly related to central venous catheter, malignancy, and ovarian hyperstimulation syndrome. We report a case of IJV thrombosis possibly related to IJV compression between the styloid process and the first cervical vertebra (C1) transverse process. To support this hypothesis, we perform radiological assessment of the IJV and examine its relationship with the styloid process and C1 transverse process in 34 controls. Our results showed a strong correlation between IJV diameter and styloid process-C1 transverse process distance. Compared to control subjects, our patient had a short styloid process-C1 transverse process distance, which suggests its involvement in IJV thrombosis.

Thoracic Outlet Syndrome: Diagnostic Accuracy of MRI.

BACKGROUND: Thoracic outlet syndrome (TOS) is challenging to diagnose, as the physical findings and investigations lack sensitivity and/or specificity. Magnetic resonance imaging (MRI) with dynamic manoeuvres can rule out a tumour and detect anatomical abnormalities potentially responsible for compression. The objective of this study was to assess the sensitivity and specificity of MRI for identifying anatomical structures responsible for compression in TOS, using intra-operative findings as the diagnostic reference standard. HYPOTHESIS: MRI is effective in diagnosing the source of compression in TOS, notably within the scalene triangle and at the pleural apex. METHODS: We retrospectively included 48 patients who underwent surgery for TOS after a work-up that included MRI (1.5-T, n=29 and 3-T, n=19). The MRI scans were reviewed for the study by a specialised radiologist who was unaware of the intra-operative findings. The sensitivity and specificity of MRI for diagnosing TOS were estimated using the intra-operative findings as the reference standard. RESULTS: MRI identified a structure potentially responsible for TOS in 34 (71%) patients; thus, the false-negative rate was 14/48 (29%). The sensitivity of MRI was 28% for compression at the suspensory ligament of the pleural dome, 81% for hypertrophy of the anterior scalene muscle, and 50% for an accessory scalene muscle. For diagnosing a cervical rib, MRI had 100% sensitivity and 100% specificity. CONCLUSION: MRI can contribute to the diagnosis of TOS. Specificity is sufficiently high to provide guidance for planning the surgical procedure. Sensitivity, however, is too low for MRI to be useful as a screening test. MRI should be used in combination with the clinical assessment and other investigations to assist in the diagnosis of TOS. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Trapezius perforator flaps: anatomical basis using 58 dissections.

INTRODUCTION: The trapezius muscle is a good option for soft tissue defects in the cervical and thoracic regions. However, pedicled flaps raised from perforators in the trapezius are rare. Through a series of cadaver dissections, the authors aim to map the perforating arteries in the trapezius muscle. MATERIALS AND METHODS: Dissection of 58 anatomical regions in 32 cadavers was carried out. The perforating arteries of the trapezius were inventoried based on their location, dimensions and frequency using the scapular spine and spinous process line as landmarks. RESULTS: In 78% of cases, the main perforators of the trapezius were located along two vertical lines parallel to the spinous process line, 5-6 cm on either side of it, between the scapular spine laterally, the tip of the scapula caudally and the superior margin of the trapezius cranially. On each side of the spinous process line, we found an average of 16 perforators (range 5-27) with an average diameter of 0.6 mm (range 0.1-2.6 mm). CONCLUSION: Our study shows that surgeons can use fixed landmarks when developing trapezius perforator flaps.

Prospective study of the reproducibility of X-rays and CT scans for assessing trochanteric fracture comminution in the elderly: a series of 110 cases.

BACKGROUND: Trochanteric fractures are common but difficult to analyse in the elderly on plain X-rays. Fixation failures are related to the severity of the comminution, but comminution and the degree of instability are not easy to determine on standard X-rays. Use of computed tomography (CT) improves assessment of complex fractures, but this finding has not been confirmed versus intraoperative data. The primary objective of this prospective study was to determine the error rate when evaluating comminution on X-rays and CT scans. The secondary objectives were to determine whether CT data on comminution and stability were consistent with intraoperative findings and to define the fracture characteristics. HYPOTHESIS: Standard X-ray assessment underestimates the complexity of trochanteric fractures and is not very reproducible. METHODS: Between January and December 2013, all proximal femur fractures in the trochanter area of patients aged 75 years or older (mean age 85) were analysed prospectively with standard X-rays and computed tomography (CT). One hundred and ten patients (88 women and 22 men) with trochanteric fractures were included in the study. Fracture stability was evaluated using the Müller AO classification; the other fracture characteristics were evaluated independently. A senior surgeon evaluated the anonymised X-rays. A radiologist specialised in musculoskeletal imaging interpreted the CT scan images. All patients underwent total hip arthroplasty (110 patients) and 104 fixations of the greater trochanter. The X-ray and CT findings were compared to the intraoperative findings (gold standard) to evaluate their reproducibility. RESULTS: The reproducibility of the X-ray evaluation was poor for comminution, with a kappa of 0.4, sensitivity of 44 % and a negative predictive value of 29 % but a positive predictive value and specificity of 100 %. The CT evaluation had a kappa of 0.94, sensitivity of 95 % and negative predictive value of 79 %. According to the AO classification, unstable fractures were found in 65 patients based on X-rays, 80 patients based on CT scan and 83 patients based on intraoperative findings. Comminution was mainly identified during surgery; it was medial in 34 % of cases, posterior in 22 % and posteromedial in 21.8 %. DISCUSSION AND CONCLUSION: In the current study, 75.4 % of fractures were complex and unstable, with medial and/or posterior comminution present in three-quarters of these fractures. X-ray assessment underestimates posterior comminution and the complexity of the fracture line and was not very reproducible. The current results of this study suggest that comminution contributes to instability and that this finding is not taken into account in the AO classification, which is not well suited for this type of fracture and raises the question of how to best evaluate and treat these fractures. LEVEL OF EVIDENCE: Prospective diagnostic study, Level III.

Ultrasound and magnetic resonance imaging of the peripheral nerves: current techniques, promising directions, and open issues.

High-resolution ultrasound (US) and magnetic resonance (MR) imaging are the two imaging methods of choice for the study of peripheral nerves. The many advances that have been made in recent years, either by US or MR imaging, including diffusion tensor imaging and tractography, offer new perspectives for the assessment of many pathological processes affecting peripheral nerves such as entrapment syndromes, tumors and tumor-like lesions, and traumatic disorders. Most of these improvements have especially increased the spatial resolution of nerve imaging. US and MR imaging are complementary, each having advantages and disadvantages. Tractography is still emerging in the musculoskeletal field, particularly for the analysis of peripheral nerves, but this technique seems promising.

Adrenal gland hypertrophy in a case of homolateral renal agenesis: case report with special emphasis on adrenal blood supply.

Hypertrophic suprarenal gland is an anomaly which can lead to serious complications during adrenalectomy under endoscopy because of abnormal veins of the retroperitoneum. The authors report a rare dissection of a male which presented with this anomaly in a case of homolateral renal agenesis, highlighting this left pseudorenal vein. No abnormality of the genital tract was found. The anatomic features, associated syndromes, implications for endoscopic surgery are outlined and embryologic considerations and discussed.

Sonographic assessment of the lateral femoral cutaneous nerve.

PURPOSE: To evaluate the ability of high-frequency sonography to evaluate the lateral femoral cutaneous nerve (LFCN). METHODS: A cadaveric study was performed on 5 cadavers to outline the normal course of the LFCN. Next, 37 LFCNs in 21 volunteers were evaluated via sonography with a 5-13-MHz linear-array transducer. RESULTS: The LFCN was easily identified in our dissections. It always entered the thigh under the inguinal ligament and coursed superficially to the sartorius muscle. In 2/10 (20%) cases, anatomical variants were observed. Sonography revealed the LFCN in 26/37 (70%) cases. The relationships of the nerve with the deep circumflex iliac artery, the anterior superior iliac spine, and the sartorius were visualized. Neuromas were observed bilaterally in 1 volunteer. CONCLUSION: The LFCN can be seen in the groin with the aid of sonography.

Early rheumatoid arthritis: a review of MRI and sonographic findings.

OBJECTIVE: The introduction of anti-tumor necrosis factor alpha agents has opened new prospects in therapeutic management of patients with early rheumatoid arthritis, thereby creating new demands on radiologists to identify patients with aggressive disease at an early stage. As a result, imaging techniques such as MRI and sonography have developed during the past few years. CONCLUSION: This article illustrates the imaging findings that may be encountered with these techniques in patients with early rheumatoid arthritis.

Imaging of the hip in patients with rheumatic disorders.

Hip joint abnormalities are commonly encountered in patients with rheumatic disorders. Although conventional radiography remains the mainstay for diagnosis of joint damage and subsequent follow-up, magnetic resonance imaging and, to a lesser extent, ultrasound have afforded the ability to detect early signs of articular involvement (i.e., synovitis and bone erosions), and to assess disease activity in treated patients. In more advanced stages of rheumatic disorders, magnetic resonance imaging and ultrasound are both useful in assessing paraarticular involvement (i.e., bursitis and synovial cysts).

Subchondral fractures of the femoral head: a review of seven cases.

OBJECTIVE: To describe the main characteristics of subchondral fractures of the femoral head. CASE-REPORTS: The seven patients, five women and two men, with a mean age of 50 years (37-76 years), presented with mechanical pain in the groin. Bone loss was the main risk factor. Two patients had postmenopausal osteoporosis (including one with a history of ovariectomy at 30 years of age), two had osteoporosis induced by glucocorticoid therapy given after transplantation (liver and allogeneic bone marrow, respectively), one had an ACTH-producing adenoma, and one had femoral osteopenia at a site of topical glucocorticoid therapy for atopic dermatitis. The remaining patient had osteopenia and a history of smoking. Phosphate and calcium levels were normal in five patients. One patient had isolated hypocalciuria and another had moderate proximal tubular disease with phosphate wasting and hypercalciuria. Magnetic resonance imaging (MRI) disclosed a subcapital line of low signal on T1- and T2-weighted sequences surrounded by an area of variable size generating low signal on T1 images and high signal on T2 images, with postgadolinium enhancement, denoting marrow edema. Complete elimination of weight bearing for 6 weeks, symptomatic agents, and treatment of the underlying causes of bone insufficiency were used in all seven patients. Mean follow-up was 2.4 years (range, 11-39 years). No cases of osteonecrosis were recorded. CONCLUSION: Several cases of subchondral fracture have been reported in the literature. Bone insufficiency was the main risk factor in all the patients.

Bone structure of the calcaneus: analysis with magnetic resonance imaging and correlation with histomorphometric study.

The purpose of this study was to compare structural measurements obtained from MR images of the calcaneus with those obtained from conventional histomorphometry. Sagittal magnetic resonance (MR) images of the calcaneus of 24 fresh human cadaveric feet were obtained at a spatial resolution achievable in vivo. A three-dimensional gradient echo-sequence was used with a slice thickness of 700 microm and in plane resolution of 172 x 172 microm. Structural analysis (four histomorphometric parameters; seven connectivity parameters) was performed in the superior region of the calcaneus. Bone biopsy specimens were obtained in the same area and were sectioned for histomorphometric study. Most of the MR histomorphometric parameters were overestimated (by a factor ranging from 0.8 to 3), as compared with histomorphometry. However, significant ( P<0.05) correlations were found between MR imaging and histomorphometric measurements for bone volume/tissue volume, trabecular separation, trabecular number, star volume of the marrow space, node count and terminus count. MR histomorphometric parameters correlated much better with histomorphometry than connectivity parameters. This study suggests that structural parameters characterizing cancellous bone in the calcaneus can be derived from MR images in the limited spatial resolution regime applicable in vivo.

Sonographic mapping of the normal brachial plexus.

BACKGROUND AND PURPOSE: Mapping of the brachial plexus with MR imaging has been reported and may have potential clinical applications (eg, precise localization of traumatic or tumoral nerve lesions, selective anesthesia of the brachial plexus). We sought to demonstrate that mapping of the brachial plexus may be performed by means of sonography. METHODS: Twelve healthy adult volunteers (seven women and five men; age range, 24-38 years; mean, 31 years) underwent bilateral sonographic examination for the assessment of the nerve structures of the brachial plexus from the extraforaminal part to the axillary part. Four formolated cadavers (two male and two female; age range, 66-84 years; mean, 77.5 years) were frozen and sawed into 3-mm-thick contiguous sections in the same plane as that used for the sonographic exploration. RESULTS: A satisfactory sonographic examination was performed in 10 of 12 volunteers, leading to a good association with anatomic sections. Two volunteers were excluded from the study because a clear depiction of the brachial plexus was difficult owing to a short neck and low echogenicity at examination. The association between sonographic images and anatomic sections allowed us to map the brachial plexus. The subclavian and deep cervical arteries were useful landmarks for this mapping. The eighth cervical nerve root and the first thoracic nerve root were the most difficult part of the brachial plexus to depict because of their deep location. CONCLUSION: The brachial plexus can be mapped with sonography. However, this technique requires a good grounding in anatomy and may be impossible in short-necked individuals.