Brachial Plexus Hand Surgery Workup

Updated: Nov 22, 2021
  • Author: Alan Bienstock, MD; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Workup

Imaging Studies

Initial management

  • After brachial plexus injury is initially diagnosed, an immediate neurologic evaluation is performed.

  • Digital imaging and video may be beneficial to document function in children.

  • Radiographic studies in the neonatal period are used to evaluate any concomitant injuries. These studies include chest radiographs to depict an elevated hemidiaphragm secondary to phrenic nerve injury and shoulder and arm radiographs to identify fractures and dislocations.

Additional study

  • Computed tomography (CT) myelography is the best method to visualize the nerve roots and detect avulsions and ruptures. CT has a sensitivity of 95% and specificity of 98%.

  • Magnetic resonance imaging (MRI) may be used to diagnose large pseudomeningoceles, and studies have shown its promise in diagnosing nerve root avulsion. [1]

  • MRI is reportedly superior to CT because of its multiplanar capability, which allows clinicians to view the components of the brachial plexus in their own optimal planes (axial plane for roots, oblique coronal for trunks, sagittal plane for cords). However, controversy surrounds the superiority of MRI versus CT myelography. Some suggest that MRI is not as sensitive as CT and that it reduces visualization of rootlets, whereas MRI proponents claim that it has great promise in diagnosing nerve root avulsion.

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Other Tests

Terzis et al have suggested that electromyelography (EMG) is one of the most valid techniques for assessing a brachial plexus lesion. [2, 3]

  • When experts perform the study and analyzed the results, EMG can help in determining the location and extent of the injury and the likelihood of recovery. This ability is exemplified in supraganglionic lesions, in which sensory perception is lost but sensory potentials remain intact.

  • In practice, EMG has several limitations related to difficulties in administering this test in infants, in localizing the lesion along the length of the nerve, and in interpreting the results and correlating them with clinical findings. For these reasons, EMG has largely been abandoned as a first-line study for diagnosis, but remains useful during and after surgery.

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