Glute Injection

Glute (buttock) injection is a universal procedure that is commonly used around the world. Selecting the proper site that avoids injury to the neurovascular structures is important. The sciatic nerve could be at risk for injury during a buttock injection.  The buttocks is divided into quadrants. Divide the buttock halfway down the middle and halfway across.  Injection is given in the center of the upper outer quadrant. Avoid the other quadrants. Injection into the other quadrants may cause injury to the neurovascular structures and damage the sciatic nerve.  Another helpful method that could confirm a safe site for injection is to draw a line from the posterior superior edge of the iliac spine to the greater trochanter. This area above the line is considered to be the safe zone for intramuscular injection.

Corachobrachialis Muscle Anatomy

The coracobrachialis muscle arises from the tip of the coracoid process. The coracobrachialis muscle may have a conjoint tendon with the short head of the biceps muscle.  The coracobrachialis lies lateral to the pectoralis minor muscle. Close to the origin of the coracobrachialis is the origin of the coraco-clavicular ligaments. The conoid ligament is medial and the trapezoid ligament is lateral. The coracobrachialis muscle inserts into the middle third of the medial border of the humeral shaft.  The innervation of the coracobrachialis, biceps brachii, and brachialis muscle comes from the musculocutaneous nerve.  The brachialis has dual innervation. The medial part of the muscle innervation is from the musculocutaneous nerve and the lateral part of the muscle gets innervation from the radial nerve. The musculocutaneous nerve will also give the lateral antebrachial nerve with its anterior and posterior divisions. It is the primary nerve supply of the muscles of the anterior compartment of the upper arm it supplies sensation to the lateral half of the forearm. The coracobrachialis muscle flexes and adducts the arm at the shoulder joint.  The coracobrachialis muscle originates from the coracoid, and the musculocutaneous nerve is close to the muscle. The musculocutaneous nerve pierces the coracobrachialis about 3-8 cm distal to the coracoid where it then gives a branch to the coracobrachialis muscle. Some studies show that the nerve may be 1-5 cm from the coracoid. The nerve runs between the biceps and the brachialis muscles on the anterior compartment of the arm. The musculocutaneous nerve is close to approaches of the anterior shoulder especially with retraction of the conjoint tendon of the coracobrachialis and short head of the biceps. When the musculocutaneous nerve is injured, we may not be able to measure the deficit except for decreased sensation on the area supplied by the lateral antebrachial cutaneous nerve, which is a terminal branch that will give sensation to the forearm. The lateral antebrachial cutaneous nerve could be injured during distal biceps repair. Be careful when retracting the conjoint tendon during anterior shoulder surgery (avoid injury to the musculocutaneous nerve). Occasional, coracoid osteotomy is done to enhance exposure to the shoulder joint and the conjoint tendon will be easily retracted without compromising the musculocutaneous nerve.

Simple Acts of Kindness to Relieve Patient Pain

In general, doctors treat patients for pain due to injury or surgery. Pain intensity varies from person to person and it can be related to stress, distress, coping strategies, and physiological factors. The physician should work with the patient for better pain control and for safer prescribing of medications.  The best pain relief is self-efficacy and resilience. We have found that giving the patient a teddy bear helps to relieve their pain and anxiety, giving the patient comfort and confidence in the system.