Keywords:
Neuroradiology peripheral nerve, Musculoskeletal system, Trauma, Ultrasound, Diagnostic procedure
Authors:
O. K. Nwawka, Y. Endo, T. Miller; New York City, NY/US
DOI:
10.1594/essr2017/P-0279
Imaging findings OR Procedure Details
ULTRASOUND IMAGING TECHNIQUE
For successful imaging of the post-ganglionic brachial plexus,
high-resolution transducers are recommended.
At our institution,
12-18 MHz transducers are routinely employed.
Both still and cine imaging of the brachial plexus are useful.
NORMAL SONOGRAPHIC APPEARANCE OF THE BRACHIAL PLEXUS
The postganglionic brachial plexus is evaluated in four main locations in the neck and chest: paravertebral,
interscalene,
supraclavicular and infraclavicular (Figure 1).
In the paravertebral region,
the C5-C8 brachial plexus roots can be visualized immediately after they exit the spine,
adjacent to the transverse processes (Figure 2).
Note that the T1 nerve root is poorly visualized in the paravertebral region due to the overlying first rib.
Scanning distally,
the plexus roots and trunks are imaged in the interscalene triangle,
between the anterior and middle scalene muscles (Figures 3,
4).
Note that the suprascapular nerve can be seen originating from the superior trunk as the superior-most fascicle (Figure 5).
As tracked distally,
the plexus divisions are imaged in the immediate supraclavicular region,
taking a triangular configuration (Figure 6).
Below the clavicle,
the brachial plexus cords are visualized around the axillary artery (Figure 7).
CASE ONE (Figures 8-11):
32 y/o man with right upper extremity weakness following a motor vehicle accident.
CASE TWO (Figure 12):
35 y/o man with marked upper extremity weakness following motorcycle accident 6 months prior.
CASE THREE (Figure 13):
25 y/o man with upper extremity weakness following football injury.
CASE FOUR (Figure 14):
30 y/o man with upper extremity weakness following motor vehicle accident.
CASE FIVE (Figure 15):
22 y/o man with poor elbow strength and severe left hand weakness and numbness following a gunshot injury to the axilla.
CASE SIX (Figure 16):
38 y/o man with upper extremity weakness following motor vehicle accident.