Ultrasonography for Depiction of Brachial Plexus Injury

Abstract

Recent development of ultrasonographic equipment has allowed improved spatial resolution for visualizing normal and pathologic conditions of peripheral nerves. Regarding the brachial plexus, only ultrasonographic studies that have described the normal appearance have been reported. To the best of our knowledge, no case report regarding the ultrasonographic description of a brachial plexus lesion has been published. We report the ultrasonographic findings of a brachial plexus injury after extirpation of a suspected enlarged supraclavicular lymph node.

High-resolution ultrasound of peripheral neurogenic tumors

“…b: A chain of neuromatous nodules (black arrowheads) along the fibular nerve after traumatic amputation. In such a "neuroma in continuity" most neuromas are of the lateral excentric type with usually one neuroma of the terminal type at the blind end of the nerve Usually the outer border of a neuroma is sharp but it may be distorted by scar formation in the surrounding soft tissues [3,16,18,21]. Duplex HR-US usually does not show any perfusion [16,[21][22][23].…”

Differential Diagnosis between Pre- and Postganglionic Adult Traumatic Brachial Plexus Lesions by Ultrasonography

“…Many efforts have been put into depicting the anatomy of the brachial plexus and diagnosing brachial plexus lesions by ultrasonography. Ultrasonographic manifestations of brachial plexopathy, such as trauma, tumor and inflammation infiltration, have been studied (Sheppard et al 1998;Yang et al 1998;Apan et al 2001;Retzl et al 2001;Martinoli et al 2002;Demondion et al 2003;Mallouhi et al 2003;Shafighi et al 2003;Graif et al 2004;Gruber et al 2007;Poyhia et al 2010). The present study confirmed the high feasibility of visualizing brachial plexus by ultrasonography in normal control subjects and in patients with suspected brachial plexus lesions.…”

“…On the contrary, the integration of continuity and textures of the nerve roots of the brachial plexus were normal in subjects with postganglionic lesions. In this study, preoperative diagnosis mainly relied on ultrasonographic imaging and MRI that depicted disruption of nerve continuity or neural gaps located at different levels of the brachial plexus, swelling stumps or traumatic neuroma (Shafighi et al 2003;Graif et al 2004;Gruber et al 2007). All 23 patients underwent surgery, which included exploration, microsurgical external and internal neurolysis and neurolization with various grafts.…”

“…Therapeutic decisions are presently based on a combination of clinical history, physical examination, neurologic tests and imaging tests. With the development of advanced ultrasound techniques, ultrasonography has already been used to determine the site, extent and severity of brachial plexus lesions (Apan et al 2001;Retzl et al 2001;Martinoli et al 2002;Shafighi et al 2003;Graif et al 2004;Gruber et al 2007). This study investigated the feasibility of differentiation between pre-and postganglionic brachial plexus lesions by preoperative ultrasonography.…”

High-resolution ultrasound of the supraclavicular brachial plexus—can it improve therapeutic decisions in patients with plexus trauma?

“…Most clinical HR-US studies on the brachial plexus, however, solely focus on the value of sonography for the guidance of anesthesiologic procedures [16][17][18][19][20], while studies on the value of HR-US for the diagnosis of plexus pathologies are scarce [21][22][23]. As a the plexus topography is evident [24][25][26][27] and also subtile neural pathologies are proven to be detectable by means of HR-US [28][29][30][31], assessments of suspected brachial plexus injuries by HR-US are consequential.…”