Brachial Plexus Disorders

Learn more about the nerve entrapment and irritations of the brachial plexus.

The nerves that supply the skin and muscles of the shoulder, arm, and hand emerge from the spine and form the brachial plexus. This complex collection of nerves is arrayed between the spine and the shoulder joint. Along the way, it is subject to various types of injuries and entrapments.
Among the milder injuries causing pain and weakness is a group of conditions collectively called Thoracic Outlet Syndrome (TOS) — these involve entrapment or irritation of the nerves. More severe trauma can injure the nerves, stretch them severely, or even break or tear them. The most common causes of severe injuries to the brachial plexus are motor vehicle injuries – particularly motorcycle injuries – and severe blows to the shoulder. An entirely different cause affects infants at the moment of their birth as the shoulder becomes caught in the birth canal in a difficult delivery.
When the brachial plexus is injured so severely as to cause a paralysis of the arm, it is important for the physician to try to determine whether the problem will resolve on its own or whether in will require surgery to repair or reconstuct the nerves. Often, MR Neurography can provide definitive information about the precise location and severity of the injury. In general, in the case of complete paralysis requiring surgical nerve repair, the surgery should be undertaken within six months of the date of the injury.

Tumors and Schwannomas

Localization of Schwannomas Within the Brachial Plexus for Planning of Tumor Resection
Slideshow: Position of schwannoma in brachial plexus in patient with asymptomatic palpable neck mass.
The oblique coronal view (A) allows counting and identification of the cervical spinal nerves and establishes that only the C5 root is involved with this Schwannoma. “Nerve perpendicular” image slices can be obtained by using the image from the oblique coronal view to depict the direction of travel of the nerve trunks near the tumor
The resulting oblique sagittal (B) view demonstrates each of the cervical spinal nerves in cross section and demonstrates their relationship to the tumor.
(C) Relationship of nerve trunks to tumor. The surgical approach and risks of nerve injury can be greatly influenced by the relative position of nerve and tumor. In many cases, MR Neurography allows the position of the traversing nerve elements relative to the tumor can be clearly established in advance of surgery. This is a “nerve perpendicular” image in which a double oblique image orientation is prescribed so that the image plane crosses most of the plexus elements at right angles in the region of interest.

Nerve Root Avulsions

Pseudorneningocoele after Brachial Plexus Nerve Root Avulsion
Animation: Demonstration of traumatic pseudorneningocoeles.
The MR Neurography imaging technique also provides a useful MR myelogram capable of efficient demonstrations of traumatic pseudomeningocoeles. This term refers to the residual nerve lining left behind when the nerve elements are literally pulled out of the spinal cord by a severe injury
Although, these images are still not always definitive in the confirmation of true nerve root avul-sion they are more reliable for making this diagnosis than the other available imaging techniques.

Post-Irradiation Plexopathy

Plexopathy and Plexitis After irradiation for Breast Cancer
Animation: Late plexopathy after mastectomy and irradiation for breast cancer.
(A) This patient had a bright irregular nerves of normal caliber suggestive of a radiation neuritis treatable with steroids.
(B) Hyperintense brachial plexus elements of extremely narrow caliber suggest encircling mechanical entrapment associated with post-irradiation fibrosis. Surgical neurolysis may be helpful.
(C) Grossly swollen nerve roots and hydrothorax associated with aggressive tumor recurrence and nerve invasion by tumor.

Brachial Plexitis

Plexitis and other inflammatory Conditions Affecting the Brachial Plexus
Animation: image findings in patients with painless pure motor weakness of hand intrinsics.
(A), (B), (C) Image findings in patients with painless pure motor weakness of hand intrinsics with no sensory findings (Gilliatt-Sumner Hand) there is hyperintensity and swelling in the elements of the lower trunk without mechanical deformation or other evidence of mechanical entrapment. Surgical treatment is unlikely to be effective and an inflammatory or vascular

Brachial Plexus Trauma

Diagnosis of Traumatic Discontinuities in Brachial Plexus Elements
Animation: Confirmation of total nerve disruption in trauma.
(A) The right brachial plexus of a 15-year-old with flail arm – lacking any movement or sensation, two months after a motorcycle accident. The image demonstrates gross discontinuities or disruptions in the upper plexus elements (ue), meningocoeles proximally (me), and bright swollen nerve trunks (st).
(B) Disconnected and retracted lower trunk (It) in traumatic injury of brachial plexus.
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