Top Tweets for #ParasternalBlocks

about 1 year ago

"Innermost Intercostal Muscle: One Muscle, Three Faces!" #Anatomy #ThoracicWall #MedicalEducation #ChestWallBlocks #ParasternalBlocks #MyRATips Tip of the Day: Deep inside your thoracic wall 🫁 lies the Innermost Intercostal Muscle, but it doesn't always stay whole — it detaches beautifully into: 🛡️ Innermost Intercostal: Between ribs, deepest layer 🧭 Sternocostalis (Transversus Thoracis): Anteriorly near the sternum 🧩 Subcostalis: Posteriorly, spanning multiple ribs Key Facts: ✅ All arise from the same muscular plane ✅ Share the same nerve supply (intercostal nerves) ✅ Share the same function (depress ribs during expiration) ✅ Differ only by location and fiber arrangement They are not truly separate muscles — they are regional adaptations of a single deep muscle layer! 🦴✨ Nature’s engineering at its finest!

KartikBSonawane's tweet photo. "Innermost Intercostal Muscle: One Muscle, Three Faces!"

#Anatomy #ThoracicWall #MedicalEducation
#ChestWallBlocks
#ParasternalBlocks
#MyRATips

Tip of the Day:

Deep inside your thoracic wall 🫁 lies the Innermost Intercostal Muscle, but it doesn't always stay whole — it detaches beautifully into:

🛡️ Innermost Intercostal:
Between ribs, deepest layer

🧭 Sternocostalis (Transversus Thoracis):
Anteriorly near the sternum

🧩 Subcostalis:
Posteriorly, spanning multiple ribs

Key Facts:

✅ All arise from the same muscular plane

✅ Share the same nerve supply (intercostal nerves)

✅ Share the same function (depress ribs during expiration)

✅ Differ only by location and fiber arrangement

They are not truly separate muscles — they are regional adaptations of a single deep muscle layer!

🦴✨ Nature’s engineering at its finest!

912

Dr.Kartik Sonawane

@KartikBSonawane

over 2 years ago

" THORACIC WALL BLOCKS: An Art of Looking Between the Lines" #Thoracicwallblocks #Chestwallblocks #Parasternalblocks #PECSblocks #SAPblocks #PVB #ESPblock #RISSblock #ITPblock My 10 points between 6 LINES: ANTERIOR CHEST WALL BLOCKS: (A) Medial to the Midclavicular line: PMM covers ribs & ICMs in the parasternal region. External ICM becomes the Anterior Intercostal Membrane anteriorly (Posterior Intercostal Membrane is formed by Internal ICM posteriorly). 1. Parasternal blocks: Probe placed sagitally over the parasternal region. LA deposition- Between PMM and ICM for Superficial parasternal block OR between internal ICM and transversus thoracic muscle for Deep parasternal (Transversus Thoracic Plane) block. Coverage- Anterior cutaneous nerve T2-T6. Vascular landmark- Internal mammary A. in TTP block. (B) Between Midclavicular - Anterior axillary lines: Muscles from superficial to deep include PMM, PMnM, and SAM above ribs & ICMs. 2. PEC ZERO (Modified Clavipectoral Fascial Plane) block:* Probe placed vertically between the clavicle (proximally) and 2nd Rib (distally). LA deposition- Above and below PMnM. Vascular landmark- Acromial branch of TAA. 3. PEC 1 (InterPectoral plane) block: Probe over 2nd Rib. LA deposition- Between PMM and PMnM. Vascular landmark- Pectoral branch of TAA. Coverage- LPN & MPN. 4. PEC 2 (Pecto-Serattus Plane) Block: Probe over 3rd Rib. LA depostion (2 injections)- Between PMM-PMnM & PMnM-SAM. Coverage- LPN & MPN, ICNs T2-T6. (C) Between Anterior - Posterior Axillary lines: Muscles include SAM (anterior to midaxillary line). LDM & SAM (posterior to midaxillary line) above the ribs. 5. BRILMA (on 4/5th ribs) and modified BRILMA (on 7/8th ribs): Probe placed at midaxillary. LA depostion- Between SAM and Ribs. Coverage- Lateral cutaneous nerves T2-T7 (BRILMA) and T5-T12 (modified BRILMA). 6. SAP 1 (superficial SAP): Probe between Midaxillary- Posterior axillary lines. LA deposition- Between SAP muscle and LDM at 4/5 th ribs level. Coverage-Intercostobrachial N., T3-T9, LTN, and TDN. SAP 2 (Deep SAP): LA deposition below SAM at 4/5 th ribs level. Vascular landmark- Thoracodoral A above SAM. Coverage- Intercostobrachial N. and T3-T9. POSTERIOR CHEST WALL BLOCKS: (D) Probe kept parasagittal 2.5 cm lateral to the midline: 7. Thoracic PVB: LA deposition above pleura by piercing superior costotransverse ligament. 8. Inter Transverse Process (ITP) Block: LA deposition anterior to C-T ligament in the retro CT space. (E) Probe kept parasagittal 4 cm lateral to the midline: 9. Thoracic ESP Block: LA deposition below ESPM by hitting the tip of the TP. (F) Probe between TP and Scapula: 10. RISS (Rhomboids Intercostal Sub-Serratus plane) Block: LA deposition between RHM-ICM along the Medial border and below SAM at the inferior angle of the Scapula. Coverage- T2-T11 dermatomes.

KartikBSonawane's tweet photo. " THORACIC WALL BLOCKS:
An Art of Looking Between the Lines"

#Thoracicwallblocks
#Chestwallblocks
#Parasternalblocks
#PECSblocks
#SAPblocks #PVB #ESPblock #RISSblock #ITPblock

My 10 points between 6 LINES:

ANTERIOR CHEST WALL BLOCKS:

(A) Medial to the Midclavicular line:

PMM covers ribs & ICMs in the parasternal region. External ICM becomes the Anterior Intercostal Membrane anteriorly (Posterior Intercostal Membrane is formed by Internal ICM posteriorly).

1. Parasternal blocks: Probe placed sagitally over the parasternal region. LA deposition- Between PMM and ICM for Superficial parasternal block OR between internal ICM and transversus thoracic muscle for Deep parasternal (Transversus Thoracic Plane) block. Coverage- Anterior cutaneous nerve T2-T6. Vascular landmark- Internal mammary A. in TTP block.

(B) Between Midclavicular - Anterior axillary lines:

Muscles from superficial to deep include PMM, PMnM, and SAM above ribs & ICMs.

2. PEC ZERO (Modified Clavipectoral Fascial Plane) block:* Probe placed vertically between the clavicle (proximally) and 2nd Rib (distally). LA deposition- Above and below PMnM. Vascular landmark- Acromial branch of TAA.

3. PEC 1 (InterPectoral plane) block: Probe over 2nd Rib. LA deposition- Between PMM and PMnM. Vascular landmark- Pectoral branch of TAA. Coverage- LPN & MPN.

4. PEC 2 (Pecto-Serattus Plane) Block: Probe over 3rd Rib. LA depostion (2 injections)- Between PMM-PMnM & PMnM-SAM. Coverage- LPN & MPN, ICNs T2-T6.

(C) Between Anterior - Posterior Axillary lines:

Muscles include SAM (anterior to midaxillary line). LDM & SAM (posterior to midaxillary line) above the ribs.

5. BRILMA (on 4/5th ribs) and modified BRILMA (on 7/8th ribs): Probe placed at midaxillary. LA depostion- Between SAM and Ribs. Coverage- Lateral cutaneous nerves T2-T7 (BRILMA) and T5-T12 (modified BRILMA).

6. SAP 1 (superficial SAP): Probe between Midaxillary- Posterior axillary lines. LA deposition- Between SAP muscle and LDM at 4/5 th ribs level. Coverage-Intercostobrachial N., T3-T9, LTN, and TDN.

SAP 2 (Deep SAP): LA deposition below SAM at 4/5 th ribs level. Vascular landmark- Thoracodoral A above SAM. Coverage- Intercostobrachial N. and T3-T9.

POSTERIOR CHEST WALL BLOCKS:

(D) Probe kept parasagittal 2.5 cm lateral to the midline:

7. Thoracic PVB: LA deposition above pleura by piercing superior costotransverse ligament.

8. Inter Transverse Process (ITP) Block: LA deposition anterior to C-T ligament in the retro CT space.

(E) Probe kept parasagittal 4 cm lateral to the midline:

9. Thoracic ESP Block: LA deposition below ESPM by hitting the tip of the TP.

(F) Probe between TP and Scapula:

10. RISS (Rhomboids Intercostal Sub-Serratus plane) Block: LA deposition between RHM-ICM along the Medial border and below SAM at the inferior angle of the Scapula. Coverage- T2-T11 dermatomes.

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