Brachial plexopathy as a consequence of nerve root swelling after shoulder trauma in a patient following an acute seizure

Object Treatment of spinal and peripheral nerve lesions relies on localization of the pathology by the use of neurological examination, spinal MR imaging and electromyography (EMG)/nerve conduction studies (NCSs). Magnetic resonance neurography (MRN) is a novel imaging technique recently developed for direct imaging of spinal and peripheral nerves. In this study, the authors analyzed the role of MRN in the evaluation of spinal and peripheral nerve lesions. Methods Imaging studies, medical records, and EMG/NCS results were analyzed retrospectively in a consecutive series of 191 patients who underwent MRN for spinal and peripheral nerve disorders at the University of California, San Francisco between March 1999 and February 2005. Ninety-one (47.6%) of these patients also underwent EMG/NCS studies. Results In those who underwent both MRN and EMG/NCS, MRN provided the same or additional diagnostic information 32 and 45% of patients, respectively. Magnetic resonance neurograms were obtained at a median of 12 months after the onset of symptoms. The utility of MRN correlated with the interval between the onset of symptoms to MRN. Twelve patients underwent repeated MRN for serial evaluation. The decrease in abnormal signal detected on subsequent MRN correlated with time from onset of symptoms and the time interval between MRN, but not with resolution of symptoms. Twenty-one patients underwent MRN postoperatively to assess persistent, recurrent, or new symptoms; of these 3 (14.3%) required a subsequent surgery. Conclusions Magnetic resonance neurography is a valuable adjunct to conventional MR imaging and EMG/NCS in the evaluation and localization of nerve root, brachial plexus, and peripheral nerve lesions. The authors found that MRN is indicated in patients: 1) in whom EMG and traditional MR imaging are inconclusive; 2) who present with brachial plexopathy who have previously received radiation therapy to the brachial plexus region; 3) who present with brachial plexopathy and have systemic tumors; and 4) in patients under consideration for surgery for peripheral nerve lesions or after trauma. Magnetic resonance neurography is limited by the size of the nerve trunk imaged and the timing of the study.

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Coaptation of the anterior rami of C-3 and C-4 to the upper trunk of the brachial plexus for cervical nerve root avulsion

Journal of Neurosurgery ◽

10.3171/jns.1991.74.2.0171 ◽

1991 ◽

Vol 74 (2) ◽

pp. 171-177 ◽

Cited By ~ 33

Author(s):

Shokei Yamada ◽

Gordon W. Peterson ◽

Donald S. Soloniuk ◽

A. Douglas Will

Keyword(s):

Brachial Plexus ◽

Nerve Root ◽

Shoulder Girdle ◽

Brachial Plexopathy ◽

Root Avulsion ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Content Type ◽

Nerve Root Avulsion ◽

Shoulder Girdle Muscles

✓ No surgical procedure has been available to repair cervical nerve root avulsion inside the spinal canal. Results with peripheral neurotization of denervated muscles have been discouraging. The authors have performed bridge-graft coaptation in three patients with C-5 and C-6 nerve root avulsion. The components of the coaptation included the anterior primary rami of C-3 and C-4 as the donor material, the entire upper trunk as the recipient, and the sural nerve graft as the bridge. This procedure resulted in restoration of motor function in the biceps and shoulder-girdle muscles and produced improved sensation. Stimulation of the C-3 and C-4 nerve roots elicited electrical responses in the biceps and deltoid muscles that indicated nerve growth through the graft and the brachial plexus into these muscles. This reconstructive procedure is effective and should stimulate development of new approaches to treatment of cervical nerve root avulsion and proximal brachial plexopathy.

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Brachial plexopathy: aberrant fifth cervical nerve root in conjunction with traction injury

Sonography ◽

10.1002/sono.12004 ◽

2014 ◽

Vol 1 (1) ◽

pp. 25-29 ◽

Cited By ~ 1

Author(s):

Claire Flavel

Keyword(s):

Nerve Root ◽

Brachial Plexopathy ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Traction Injury

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Spinal Nerve Root Swelling Mimicking Intervertebral Disc Herniation in Magnetic Resonance Imaging -A Case Report-

The Korean Journal of Pain ◽

10.3344/kjp.2010.23.1.51 ◽

2010 ◽

Vol 23 (1) ◽

pp. 51 ◽

Cited By ~ 3

Author(s):

Yu Yil Kim ◽

Jun Hak Lee ◽

Young Eun Kwon ◽

Tae Jun Gim

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Magnetic Resonance ◽

Intervertebral Disc ◽

Nerve Root ◽

Spinal Nerve ◽

Intervertebral Disc Herniation ◽

Spinal Nerve Root ◽

Resonance Imaging ◽

Root Swelling

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Imaging and electrodiagnostic work-up of acute adult brachial plexus injuries

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411422313 ◽

2011 ◽

Vol 36 (9) ◽

pp. 747-759 ◽

Cited By ~ 28

Author(s):

K. O'Shea ◽

J. H. Feinberg ◽

S. W. Wolfe

Keyword(s):

Nerve Root ◽

Imaging Modality ◽

Sensory Nerve ◽

Critical Factor ◽

Primary Objective ◽

Surgical Reconstruction ◽

Brachial Plexopathy ◽

Root Avulsion ◽

Potential Donor ◽

Nerve Root Avulsion

Imaging and electrodiagnostic studies form an essential part of the evaluation of the patient with traumatic brachial plexopathy, enabling clarification of surgical options, prognostication of outcome and formulation of postoperative management. The primary objective of imaging is to identify pre-ganglionic injury indicative of nerve root avulsion. The presence of one or more nerve root avulsion injuries is a critical factor in surgical decision-making and the prognosis of surgical reconstruction. CT myelography is the current imaging modality of choice for this purpose. Initial electrodiagnostic (EDX) testing is ideally performed no sooner than 4 weeks following injury unless otherwise clinically indicated. Follow-up testing can be helpful at approximately 6 week intervals. The sensory nerve amplitudes are the most important component of nerve conduction testing in distinguishing between pre- and post-ganglionic injuries. Electromyographic studies will also assist in the determination of a pre- from post-ganglionic injury, the level of plexus involvement and identify potential donor nerves that may be suitable for use as transfers.

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Additive value of magnetic resonance neurography in diagnosis of brachial plexopathy: a cross-section descriptive study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00555-5 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Sara Mohamed Mahmoud Mabrouk ◽

Hossam Abd El Hafiz Zaytoon ◽

Ashraf Mohamed Farid ◽

Rania Sobhy Abou Khadrah

Keyword(s):

Magnetic Resonance ◽

Brachial Plexus ◽

Nerve Injury ◽

Clinical Examination ◽

Nerve Root ◽

Nerve Conduction ◽

Brachial Plexopathy ◽

Root Avulsion ◽

Magnetic Resonance Neurography ◽

Nerve Root Avulsion

Abstract Background Management of brachial plexopathy requires proper localization of the site and nature of nerve injury. Nerve conduction studies and electrophysiological studies (ED) are crucial when diagnosing brachial neuropathy but these do not determine the actual site of the lesion. Conventional MRI has been used to evaluate the brachial plexus. Still, it carried the disadvantage of the inability to provide multi-planar images that depict the entire length of the neural plexus .It might be difficult to differentiate the brachial plexus nerves from adjacent vascular structures. Magnetic resonance neurography (MRN) is an innovative imaging technique for direct imaging of the spinal nerves. Our study aims to detect the additive role of MRN in the diagnosis of brachial plexopathy over ED. Forty cases of clinically suspected and proved by clinical examination and ED—traumatic (N = 30) and non-traumatic (N = 10)—were included in our study. We compared MRN finding with results of clinical examination and ED. Results MRN findings showed that the root was involved in 80% of cases, trunks in 70% of cases affecting the middle trunk in 40% of cases, the middle and posterior cord in 25%, lateral cord in 50%, and terminal branches on 10% of cases. Ten percent of cases were normal according to MRN, and 90% had abnormal findings in the form of preganglionic nerve root avulsion in 30% of cases, mild perineural edema surrounding C6/7 nerve roots in 20%, lower brachial trunk high signal in 10%, complicated with pseudo meningocele in 20%, and with increased shoulder muscle T2 signal intensity with muscle atrophy in 10%. There were minimal differences between clinical examination finding and MRN findings, with very good agreement between electromyography and nerve conduction (p value < 0.05, with sensitivity and specificity values of 94.44% and 100%, respectively). Conclusion MRN is important in differentiating different types of nerve injuries, nerve root avulsion, and nerve edema, playing an important role in differentiating the site of nerve injury, both preganglionic or postganglionic and planning for treatment of the cause of nerve injury, either medical or surgical.

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Rating Spinal Nerve Extremity Impairment Using the Sixth Edition

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.julaug01 ◽

2009 ◽

Vol 14 (4) ◽

pp. 1-6

Author(s):

Christopher R. Brigham

Keyword(s):

Nerve Root ◽

Spinal Nerve ◽

Upper Extremities ◽

Motor Deficits ◽

Nerve Injuries ◽

Sixth Edition ◽

Federal Employee ◽

Nerve Root Injury ◽

Root Injury ◽

Rating Process

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.

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