Supraclavicular Nerves

The supraclavicular nerves is a name referred to a group of cutaneous nerves originating via cervical nerves C3 and C4 that travel downwards and stimulate the skin over the clavicle and shoulder inferiorly till the second rib after arising under the posterior margin of the sternocleidomastoid muscle.

Origin

The supraclavicular nerves start from the third and fourth cervical vertebral levels and arise as a common trunk below the coat of the sternocleidomastoid muscle. The trunk splits into anterior, middle, and posterior supraclavicular nerves, which supply skin over the shoulder forwardly till the median plane and travel downwards under the enclosure of the platysma in the posterior triangle, superficially through the clavicle.

Supraclavicular Nerves

Insertion

• Below the sternocleidomastoid muscle at the punctum nervosum (Erb’s point) the supraclavicular nerves emerge as a common trunk.
• In the posterior triangle of the neck, the supraclavicular nerve goes downwards travelling below the platysma muscle.
• The common trunk of the supraclavicular nerves divides into three groups of descending branches as it goes to the clavicle:
  •  Medial supraclavicular nerve
  •  Intermediate supraclavicular nerve
  •  Lateral supraclavicular nerve

Branches

They pierce the fascia and platysma near the clavicle in order to become cutaneous and are arranged, into three groups in relation to their position.

• Anterior
• Middle
• Posterior

Medial supraclavicular nerve

Supraclavicular Nerves

The medial supraclavicular nerves or anterior supraclavicular nerves a.k.a. Supraclaviculares anteriores, suprasternal nerves, along with the clavicular and sternal heads of the sternocleidomastoid cross obliquely over the external jugular veins and stimulate the skin as far as the middle line. They supply one or two filaments towards the sternoclavicular joint.

Intermedial supraclavicular nerve

The intermedial supraclavicular nerve middle supraclavicular nerves a.k.a. supraclaviculares medii, supraclavicular nerves goes through the clavicle and stimulate the skin over the pectoralis major and deltoideus, connecting with the cutaneous branches of the upper intercostal nerves.

Lateral supraclavicular nerve

The lateral supraclavicular nerve or posterior supraclavicular nerves a.k.a. Supraclaviculares posteriors, supra-acromial nerves, travel obliquely via the outer surface of the trapezius as well as the acromion, and supply the skin of the superior and posterior parts of the shoulder.

Connections

It travels superficially above the external jugular vein as the medial supraclavicular nerve descends in the chest. Along with the other cutaneous branches of the cervical plexus at the punctum nervosum roughly midway in the middle of the origin and insertion of the muscle the lesser occipital nerve passes posterior towards the sternocleidomastoid muscle.

Clinical Significance

Supraclavicular Nerve Entrapment

• The neuropathy may occur as a result of a stretch injury to the neck, possibly incurred during sports activity.
• When there is tunneling of the nerve through the clavicle, it is conceivable that direct trauma to this area would result in symptoms.
• It is unlikely that manifestations would occur if the nerve does not tunnel through the clavicle, since under normal circumstances, there is sufficient laxity to allow for even excessive head-neck positioning.

Supraclavicular Nerve Block

The block is best executed as an ultrasound-guided block. It has been performed blindly, with a nerve stimulator and ultrasound/nerve stimulator together with a doppler used to guide the needle around the subclavian artery. Due to the high risk of a pneumothorax, the supraclavicular block was no longer performed by most anesthesiologists until the resurrection of the ultrasound as a guide to regional anesthesia.