this is Rachel she suffers from shoulder pain and trigger points of the thoracic spine and cervical spine today I evaluated her and performed trigger point injections I just want to go over her Anatomy what we're looking at here is a supinatus muscle under the deltoid the two muscle layers you can also do a 90° turn and visualize this in the short axis and as we go more distal that I run out of space to image because we have the chromium up top that bone and the spine of the scapular protruding so it's a more narrow space so I have to go 90° to visualize the region and of course our friend the super scapular nerve block comes into play at the bottom right aspect of the screen under the transverse scapular ligament scanning inferior to the spine of the scapula we could see the actual infraspinatus muscle tapering as we go laterally to the humoris where the tendon inserts right right here and you also have the glener humeral joint when I scan the humoris the bone itself I can see the deltoid muscle as well as the head of the humorus and the shaft I see the hyperlucency next to the shaft and that's actually the axillary nerve inserting and this is a target for peripheral neurom modulation for chronic shoulder pain sometimes if we go immediately we could actually see the blood vessels that run with the nerve the circumflex vessels color mode okay and we see blood vessels here as we go more laterally they're a little tortuous so they're not going to look completely circular or linear and the nerves run with the blood vessels and here they are the hyperlucency around the blood vessel is the axillary nerve and this would be a Target it typically will run between Terry's minor and major as they go laterally towards the humoris under the deltoid and if I was to do a nerve block here I would come in plain and go longitudinally above my probe first I would do a diagnostic and then I would do peripheral nerve stimulation body of the Terry's minor muscle over here and that's the shoulder thank you
