Diagnosis Of Brachial Plexus Injury Research Articles

Diagnostic Performance of 3D-NERVE as an Adjunct to Electromyography for the Assessment of Brachial Plexus Injury in Infants.

Objective: This study aimed to explore diagnostic performance of 3D-NERVE as an adjunct to electromyography for the assessment of brachial plexus injury in infants. Methods: Imaging of infants with brachial plexus injury using 3D-NERVE and/or 3D-STIR from 2019 to 2022 were reviewed. Images were evaluated between the 2 sequences for nerve-to-fat ratio, nerve-to-muscle ratio, muscle-to-fat ratio, fat suppression homogeneity, and display rate of brachial plexus branches. Results: This study included 37 infants who were referred for a clinical diagnosis of brachial plexus injury. A total of 21 infants accepted 3D-NERVE sequence scanning, and 16 infants accepted 3D-NERVE and 3D-STIR sequences scanning. The results of examination were generally consistent with electromyography. The 2 sequences were compared, yielding the following results. There were no pulsation artifacts (0/16), and 1 case with heterogeneous fat saturation (1/16) was seen on 3D-NERVE. There were no pulsation artifacts (0/16), and 5 cases with heterogeneous fat saturation (5/16) were seen on 3D-STIR. 3D-NERVE performed better (P < .05) for nerve-to-fat and nerve-to-muscle ratios compared with 3D-STIR, and no significant difference in the muscle-to-fat ratio (P > .05). The 3D-NERVE and STIR helped depict 100% (16/16) of the brachial roots and brachial plexus trunk. Brachial plexus bundles and brachial plexus branches were observed in 93.75% (15/16) and 68.75% (11/16) of the 3D-NERVE and 93.75% (15/16) and 62.5% (10/16) of the 3D-STIR, respectively. The differences were not statistically significant (P > .05). Conclusion: Nerve trauma was better visualized with the 3D-NERVE, which is an effective adjunct to electromyography for doctors to assess brachial plexus injury and consequently helps in better treatment planning.

Value of High-Resolution MRI in the Diagnosis of Brachial Plexus Injury in Infants and Young Children.

PurposeTo investigate the value of high-resolution MRI based on 3D-short inversion time inversion recovery sampling perfection with application-optimized contrasts (3D-STIR SPACE) sequence for the diagnosis of brachial plexus injury in infants and young children.MethodsPhysical examination, electromyography (EMG) and MRI data of 26 children with brachial plexus injury were retrospectively analyzed. Sensitivity, specificity, and accuracy were calculated for the three tests. The agreement among these examinations was analyzed with the Kappa test. P<0.05 was considered statistically significant.ResultsOf the 26 children, 3 cases had normal MRIs, 23 cases had unilateral brachial plexus injury diagnosed with MRI, and a total of 73 nerve roots and/or sheaths were involved. Among the 23 cases with aberrant MRI findings, there were 19 cases of nerve root thickening (42 nerve roots), 4 cases of nerve root sleeve expansion (5 nerve roots), 17 cases of pseudomeningeal cysts (34 nerve roots), 2 cases of nerve root loosening (2 nerve roots), 8 cases of nerve root dissection (11 nerve roots), 19 cases with increased nerve signal (43 nerve roots), and 9 cases with an increased signal of the muscles on the affected side. As for the diagnosis of brachial plexus injury, the sensitivity and the accuracy of physical examination, EMG and MRI were 0.92, 0.86, and 0.88, respectively. The agreement between MRI and physical examination was substantial (κ=0.780, P=0.000), as did the agreement between MRI and EMG (κ=0.611, P=0.005).ConclusionHigh-resolution MRI based on 3D-STIR SPACE sequence plays a role in the diagnosis and evaluation of brachial plexus injury in infants and young children. It can accurately identify the injured nerve and characterize related pathological alterations. Besides EMG and physical examination, it can be used as a valuable tool for screening and monitoring of brachial plexus injury in infants and children.

Management of Physiotherapy In Brachial Plexus Injury Post Neurotization SAN To SSN : Case Report

Brachial plexus injury (BPI) is an injury to the brachial plexus that can cause muscle paralysis in the upper extremities. Based on the data, the proportion of brachial plexus injuries with total lesions (C5–T1) was 54%, partial lesions (C5-6) 24%, (C5-C7) 19%, and (C8-Th1) 3%. This case report aims to present the physiotherapy management of brachial plexus injury.&#x0D; A 23-year-old man with a medical diagnosis of brachial plexus injury. Previously the patient fell from the bathroom and suffered a blow to the shoulder and fractures in the proximal 1/3 of the ulna &amp; radial. The patient received the first medical treatment for fracture with ORIF (plate and screw), while the shoulder injury received medical treatment after 6 months. The medical procedure is SAN to SSN neurotization surgery.&#x0D; The physiotherapy program provided include ROM exercise, strengthening, stretching, and release. The results of the evaluation for 3 times of therapy showed that there was a change in passive ROM, pain, edema and spasm in the shoulder region. there has been no change in muscle strength and sensory function. In addition, in the wrist and elbow region there is an increase in muscle strength.&#x0D; The process of nerve recovery takes a long time, so there have not been many changes that have occurred in the patient. The process of nerve growth only occurs at 1 mm / day. Physiotherapy program given for 3 days postoperative conditions only aim to reduce problems such as muscle spasm, edema, postoperative pain, muscle tightness, and prevent potential problems that will occur.&#x0D; The physiotherapy program given can reduce secondary problems that occur in the condition 3 days after brachial plexus injury.

Physical therapeutic treatment for traumatic brachial plexus injury in adults: A scoping review.

Traumatic brachial plexus injury (BPI) is one of the most disabling injuries of the upper extremity, often requiring specialized treatment and a prolonged rehabilitation period. This scoping review was carried out to identify and describe the physical therapy modalities applied in the rehabilitation of adult individuals with BPI. Electronic databases, gray literature, and reference lists were searched, and studies meeting the following eligibility criteria were included: (a) interventions including any physical therapy modality; (b) individuals age ≥18 years old; and (c) a clinical diagnosis of BPI. The literature search yielded 681 articles of which 49 met the inclusion criteria and had their outcomes, treatment parameters, and the differences between conservative and pre- and postoperative treatment phases analyzed. The most commonly used physical therapy interventions were in the subfields of kinesiotherapy (ie, involving range of motion exercises, muscle stretching, and strengthening), electrothermal and phototherapy, manual therapy, and sensory re-education strategies. Although several physical therapy modalities were identified for the treatment of BPI in this scoping review, the combination of low levels of evidence and the identified gaps regarding the treatment parameters challenge the reproducibility of such treatments in clinical practice. Therefore, future controlled clinical trials with clearer treatment protocols for individuals with BPI are needed.

Diagnostic Function of 3-Tesla Magnetic Resonance Imaging for the Assessment of Brachial Plexus Injury.

Background:This study aimed to evaluate the diagnostic function of 3-Tesla (T) magnetic resonance imaging (MRI) during the assessment of brachial plexus injury (BPI), in comparison with intraoperative findings.Methods:A retrospective study was performed on 60 patients (47 men and 13 women), who had clinical manifestations of BPI, underwent 3T MRI of the brachial plexus, and were surgically treated at the Viet Duc and Vinmec Times City hospitals, in Hanoi, Vietnam, from March 2016 to December 2019. Preganglionic and postganglionic lesion features were identified on MRI. The diagnostic function of MRI features for the determination of BPI was evaluated and correlated with intraoperative findings.Results:The root avulsion and pseudomeningocele preganglionic injuries were observed in 57% and 43% of MRIs, respectively, and were commonly observed at the C7 and C8 roots. Nerve disruption and never edema were observed in 47.56% and 33.53% of MRIs, respectively, and were commonly observed at the C5 and C6 roots. The sensitivity, specificity, accuracy, positive prognostic value, and negative prognostic value of 3T MRI were 64.12%, 92.90%, 80.33%, 87.50%, and 76.96%, respectively, for the diagnosis of total avulsion, and 68.52%, 83.33%, 80.67%, 47.44%, and 92.34%, respectively, for the diagnosis of nerve disruption.Conclusion:MRI offers valuable details regarding the location, morphology, and severity of both preganglionic and postganglionic injuries during the preoperative diagnosis of BPI. However, this modality played a moderate diagnostic role. Therefore, 3T MRI should be used as a supplemental evaluation, coupled with clinical tests and electromyography, to determine the most appropriate treatment strategies for BPI patients.

Role of Magnetic Resonance Imaging in Localization of Acute Brachial Plexus Injury

Brachial plexus imaging is challenging due to its anatomical complexity. Multiple sequences of MRI may be performed pre-operatively for an accurate radiological diagnosis of brachial plexus injury. This image shows the useful role of MRI in localization of acute brachial plexus injury.

Application of electromyography combined with magnetic resonance imaging in the diagnosis of brachial plexus injury in newborns

Objective To investigate the characteristics of electromyography(EMG) and MRI in the diagnosis of brachial plexus injury in newborns. Methods First, the EMG examination was conducted in 30 newborns with brachial plexus injury, where the brachial plexus of the five major nerve conduction and muscle EMG activity were measured.Second, the brachial plexus MRI was conducted to compare with the first examination. Results EMG revealed that 25 cases of upper and middle trunk palsy(83.3%), 4 cases of total plexus palsy(13.3%) and 1 case of lower trunk palsy(3.3%) in the 30 cases, as well as 6 cases of plexus pre-ganglionic injury(20.0%), 7 cases of complete injury(23.3%), 23 cases of incomplete injury(76.7%). MRI showed that 5 cases of upper and middle trunk palsy(16.7%), 1 case of total plexus palsy(3.3%), 1 case of lower trunk palsy(3.3%), and 7 cases of plexus pre-ganglionic injury(23.3%)in the whole 30 cases. Conclusion EMG and MRI are both helpful to localize the brachial plexus injury.But EMG performs better compared with MRI towards the slight incomplete injury.Therefore, the combination of both methods can provide an accurate guidance for diagnosis. Key words: Newborn; Brachial plexus injury; Electromyography; Magnetic resonance imaging

The optimal visualization of brachial plexus with utilization of nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation imaging MR neurography and initial dignostic application

Objective To assess the optimal visiualization capacity of brachial plexus with three-dimensional nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation imaging (3D SHINKEI), exploring the feasibility of preliminary diagnostic value on brachial plexus diseases. Methods MRI scans were performed on 24 healthy volunteers with no history of brachial plexus injury, and 46 patients whose outcomes of lesions had been verified as post-ganglionic brachial plexus injuries by surgery or clinical follows-up . The scan series consist 3D SHINKEI, STIR in the coronal plane as well as DW-MRN in the axial plane using a 3.0 T MR system. The source and post-processed images of 3D SHINKEI and DW-MRN were scored according to the optimal visibility on brachial plexus, in the meanwhile, contrast-to-noise ratio of the original images in the 3D SHINKEI and STIR sequences were calculated separately. Two radiologists blindly compared the detection rate of positive brachial plexus injuries between 3D SHINKEI and STIR in 46 patients. And then analyze the outcomes by means of Kappa test, Mann-Whitney test , independent sample t test, and Chi-square test. Results Post-ganglionic brachial plexus showed high intensity in the 3D SHINKEI sequence. In the 24 healthy volunteers, the scores by the two radiologists were 3.6 ± 0.6, 3.5 ± 0.6, 3.0 ± 0.2, 2.9 ± 0.1, respectively. There was statistical difference between the two sequences (Z=2.667,P=0.008,P<0.05). And the Kappa was 0.8 and 0.6 with favorable consistency. The CNR of 3D SHINKEI and STIR were 0.61±0.07, 0.42±0.03 (t=12.78, P=0.001, P<0.05). The positive detection rates of post-ganglionic brachial plexus injuries on 3D SKINKEI and STIR were, 78.3%, 52.2% (χ2=9.421, P<0.05). Conclusions 3D SHINKEI sequence demonstrates robust visibility consistently and can clearly display the structures and signals of post-ganglionic abnormality, compared with DW-MRN and STIR. This technique can be helpful to provide more complementary information to further confirm the diagnosis of brachial plexus injuries. Key words: Brachial plexus neuropathies; Magnetic resonance imaging

Diagnostic Value and Surgical Implications of the 3D DW-SSFP MRI On the Management of Patients with Brachial Plexus Injuries.

Three-dimensional diffusion-weighted steady-state free precession (3D DW-SSFP) of high-resolution magnetic resonance has emerged as a promising method to visualize the peripheral nerves. In this study, the application value of 3D DW-SSFP brachial plexus imaging in the diagnosis of brachial plexus injury (BPI) was investigated. 33 patients with BPI were prospectively examined using 3D DW-SSFP MR neurography (MRN) of brachial plexus. Results of 3D DW-SSFP MRN were compared with intraoperative findings and measurements of electromyogram (EMG) or somatosensory evoked potentials (SEP) for each injured nerve root. 3D DW-SSFP MRN of brachial plexus has enabled good visualization of the small components of the brachial plexus. The postganglionic section of the brachial plexus was clearly visible in 26 patients, while the preganglionic section of the brachial plexus was clearly visible in 22 patients. Pseudomeningoceles were commonly observed in 23 patients. Others finding of MRN of brachial plexus included spinal cord offset (in 16 patients) and spinal cord deformation (in 6 patients). As for the 3D DW-SSFP MRN diagnosis of preganglionic BPI, the sensitivity, the specificity and the accuracy were respectively 96.8%, 90.29%, and 94.18%. 3D DW-SSFP MRN of brachial plexus improve visualization of brachial plexus and benefit to determine the extent of injury.

Incidence and prognosis of neonatal brachial plexus palsy with and without clavicle fractures.

To report the incidence of neonatal brachial plexus palsy with and without ipsilateral clavicle fracture in a population of newborns and to compare the prognosis between these subgroups. This was a retrospective review of 3,739 clavicle fractures and 1,291 brachial plexus palsies in neonates over a 24-year period from a geographically defined health care system with reference to county-wide population data. A referral clinic for children with brachial plexus palsies evaluated 1,383 neonates, of whom 320 also had ipsilateral clavicular fracture. As a result of referral patterns within the region, it is likely that this represents nearly all infants from the area with persistent brachial plexus injury after 2 months of age. Among the children evaluated without concomitant clavicular fracture, 72% resolved spontaneously (154/214); among those with concomitant clavicular fracture, 74% healed spontaneously (55/74). Limiting the analysis to neonates delivered at Parkland Memorial Hospital and assuming that those neonates with a discharge diagnosis of brachial plexus injury with or without clavicular fracture who did not present to the referral brachial plexus injury clinic had complete resolution, 94.4% without clavicular fracture resolved and 98.1% with clavicular fracture resolved (P=.005). The risk of persistent neurologic deficit from a birth-related brachial plexus palsy is lower than what has been reported, and the presence of a clavicle fracture may improve the likelihood of recovery. III.

Brachial Plexus Injury Associated With Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary support system. We present 2 patients of ECMO-related brachial plexus injury. Patients were selected from a registry of 154 patients treated with ECMO from January 2002 to September 2011. Five patients had unilateral arm weakness after the initiation of ECMO therapy. There was no neurological examination or electrophysiological testing data available for 3 patients. Diagnosis of brachial plexus injury was confirmed in 2 patients, one based on neurological examination and one based on electrophysiological testing. Axillary artery cannulation resulting in hematoma formation was identified as a probable risk factor for brachial plexus injury in our 2 patients.

Diagnosis of brachial plexus injury by MR-myelography

Objective To evaluate the application of magnetic resonance myelography using 3D Fast Imaging Employing Steady-state Acquisition (3D-FIESTA) sequence in the diagnosis of brachial plexus preganghonic injury. Methods Ten cases with brachial plexus injury underwent MR scanning before the operation, lmages of MRM were reviewed and compared with surgical findings and electrophysiologic diagnosis. Results The sensitivity , specificity and accuracy of MRM in diagnosing brachial plexus preganglionic injury were 86.1% , 100% and 90.0% , respectively. The positive predictive value and negative predictive value were 100% and 73.7% , respectively. Conclusion The MRM images of injured brachial plexus by using 3D-FIESTA sequence are satisfactory. This technique is helpful in early diagnosis of preganglionic injury. Key words: Brachial plexus; Wound and injuries; MRI; Diagnosis

Ultrasound diagnosis of traumatic brachial plexus injury combined with rotator cuff tear and injury of long head of the biceps

目的 了解创伤性臂丛神经损伤合并肩袖及肱二头肌长头腱损伤的发病情况.方法以50例诊断明确的臂丛神经损伤患者为研究对象,其中臂丛上干损伤35例,全臂丛损伤15例;用超声检测的方法,探查其是否合并有肩袖及肱二头肌长头腱的损伤.结果肩袖及肱二头肌长头腱完全损伤5例(5/50),部分损伤17例(17/50);臂丛神经上干损伤合并肩袖及肱二头肌长头腱损伤有21例,占21/35;全臂丛神经损伤有1例,占1/15.结论臂丛神经上干损伤合并肩袖及肱二头肌长头腱损伤有非常高的发生率(21/35).在制订臂丛神经上干损伤治疗方案的同时,需兼顾对损伤的肩袖及肱二头肌长头腱的治疗,尤其是对完全损伤肩袖的修复。

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury.

The purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the brachial plexus. We assessed 25 spinal roots in 19 patients. The results of the two investigations were consistent in all except two roots. Although assessment of ESCPs is easy and quick, it mainly records the nerve potentials along the sensory pathway. Although measurement of CAT activity needs a specimen of the nerve and the availability of a radioisotope laboratory, it gives direct information regarding the motor function of ventral spinal roots. These two techniques should be complementary to each other in order to achieve a more accurate diagnosis.

Choline acetyltransferase activity and evoked spinal cord potentials for diagnosis of brachial plexus injury

The purpose of this study is to investigate the diagnostic value of evoked spinal cord potentials (ESCPs) and choline acetyltransferase (CAT) activity during exploration of injuries to the brachial plexus. We assessed 25 spinal roots in 19 patients. The results of the two investigations were consistent in all except two roots. Although assessment of ESCPs is easy and quick, it mainly records the nerve potentials along the sensory pathway. Although measurement of CAT activity needs a specimen of the nerve and the availability of a radioisotope laboratory, it gives direct information regarding the motor function of ventral spinal roots. These two techniques should be complementary to each other in order to achieve a more accurate diagnosis.

The absence of brachial plexus injury in stroke.

Brachial plexus injury and proximal mononeuropathy have been reported as a potential complications in the hemiplegic shoulder after a stroke. The diagnosis of brachial plexus injury and proximal mononeuropathy in the hemiplegic extremity is complicated by the upper motor neuron findings on physical examination and by the diffusely abnormal electrodiagnostic test results frequently seen in hemiplegic limbs. This study investigated the incidence of brachial plexus injury and proximal mononeuropathy after a thromboembolic stroke. Hemiplegic patients (n = 50) underwent physical examination, needle electromyography of the hemiplegic extremities and nerve conduction studies across the brachial plexus within 4 months after a stroke. Combining the physical examination and electromyographic findings we were unable to make a diagnosis of brachial plexus injury or proximal mononeuropathy in any hemiplegic patient. Spontaneous electromyographic activity was observed in 68% of the arms and 70% of the legs examined on the hemiplegic side. The severity and incidence of spontaneous activity was evenly distributed in upper and lower trunk muscles. Mean central latencies across the lower brachial plexus were slightly delayed (12.5 +/- 2 v 11.6 +/- 2.2 ms, P < 0.01) compared with the contralateral normal limb, but in no case was the F wave unilaterally unelicitable. The mean hypothenar compound muscle action potential amplitude was diminished (7 +/- 2.7 v 9.2 +/- 4.1 mV, P < 0.01) in the hemiplegic hand compared with the normal side and the degree of amplitude loss inversely corresponded (r = -0.6, P < 0.01) to the amount of spontaneous electromyographic activity observed in the first dorsal interosseus muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Somatosensory evoked potentials from musculocutaneous nerve in the diagnosis of brachial plexus injuries

A technique for recording somatosensory evoked potentials using stimulation of musculocutaneous sensory nerve fibers proximal to the wrist has been used in 10 normal subjects and in 8 patients with traumatic lesions of proximal parts of the brachial plexus. The technique gave satisfactory evoked potentials in all normal subjects and provided useful information in patients with avulsion of the 5th and 6th cervical roots. The results were similar to those obtained by radial nerve stimulation. The results in 3 patients with upper trunk injuries and in 1 patient with avulsion of the 5th cervical root were unhelpful. In 2 patients with multiple cervical root avulsions the evoked potentials from cervical cord and contralateral scalp were absent and were attenuated at Erb's point. This is the first report where musculocutaneous nerve evoked potentials have been applied to a group of patients.