"Imaging plays a role in pre-operative planning and patient counselling; surgical exploration is the gold standard for diagnosis of traumatic brachial plexus injuries 8. Imaging of suspected preganglionic injuries is optimal at 3-4 weeks post-injury to allow any blood products to be resorbed and pseudomeningocele formation to occur 8, but can be performed earlier if early surgery is being considered."
"Advantages include high spatial resolution and the absence of CSF flow artifacts. Disadvantages include improper filling of the meningocele sac in the presence of a dural scar, and intra- and post-procedural complications, e.g., haematoma, infection, allergic reaction, and headache."
"Advantages include the ability to detect partial root avulsion, excellent visualisation of bony structures, no CSF flow artifacts and multiplanar reconstruction. Disadvantages include radiation dose, potential contrast media reaction, poor visualisation of the lower brachial plexus due to bony artifacts, and pre- and post-procedural complications 8."
"Advantages include the ability to detect partial root avulsion, excellent visualisation of bony structures, no CSF flow artifacts and multiplanar reconstruction. Disadvantages include radiation dose, potential contrast media reaction, poor visualisation of the lower brachial plexus due to bony artifacts, and pre- and post-procedural complications 8."
"Postganglionic injuries can be seen as nerve discontinuity distal to the neural foramen (best seen on axial or coronal sequences) or increased T2 signal (close to fluid signal) of the affected peripheral nerve(s), maximal at the site of injury, with asymmetry a useful finding 6,8,9. Injured peripheral nerves can also show disrupted fascicular pattern, deviated course, change in calibre (e.g. bulging, hourglass constriction), neuroma formation, and/or perineural fibrosis 6,8. Denervation changes in the supplied musculature can also be seen 8,9."
"occurs proximal to the dorsal root ganglion with avulsion of the nerve root from the spinal cord"
"occurs distal to the dorsal root ganglion, affecting the peripheral nerve system, e.g. nerve rupture, neuroma-in-continuity, or end-bulb neuroma"
"occurs distal to the dorsal root ganglion, affecting the peripheral nerve system, e.g. nerve rupture, neuroma-in-continuity, or end-bulb neuroma"
"Advantages include high spatial resolution and the absence of CSF flow artifacts. Disadvantages include improper filling of the meningocele sac in the presence of a dural scar, and intra- and post-procedural complications, e.g., haematoma, infection, allergic reaction, and headache."
"MR myelography"
"MR neurography"
Expected headings
"Fluoroscopy"
"MR myelography"
"MR neurography"
"This article is focused on non-obstetric brachial plexus injuries; see the article obstetric plexus injuries for details on this injury type."
"In the simplest form, brachial plexus injuries can be preganglionic or postganglionic; however, in clinical practice, they can be mixed 1. The most common pattern is complete (C5-T1) root avulsion (~75%), followed by upper plexus (C5-6) injury (~20%), and then lower plexus (C8-T1) 9."
"Imaging plays a role in pre-operative planning and patient counselling; surgical exploration is the gold standard for diagnosis of traumatic brachial plexus injuries 8. Imaging of suspected preganglionic injuries is optimal at 3-4 weeks post-injury to allow any blood products to be resorbed and pseudomeningocele formation to occur 8, but can be performed earlier if early surgery is being considered."
"In preganglionic injury, nerve root discontinuity near the spinal cord is a key finding. There is usually (~75% of cases) a pseudomeningocele present, although it may not be a reliable indicator of root avulsion 8,9. Other signs include nerve root sleeve deformity, cord oedema, syrinx, and cord lateralisation 8,9. Denervation changes of the ipsilateral paraspinal muscles are an indirect sign of root avulsion; post-contrast enhancement may be seen in the first 4 weeks after injury 8,9."
"preganglionic injury: repaired by nerve transfer to the denervated muscles, as there is no chance of spontaneous neural repair; functioning free muscle transplantation; or palliative reconstruction"
"preganglionic injury: repaired by nerve transfer to the denervated muscles, as there is no chance of spontaneous neural repair; functioning free muscle transplantation; or palliative reconstruction"
"a common mechanism of root avulsion is overhead arm abduction, with force applied to the arm/body (e.g. grabbing overhead when falling)"
"Advantages include high spatial resolution and the absence of CSF flow artifacts. Disadvantages include improper filling of the meningocele sac in the presence of a dural scar, and intra- and post-procedural complications, e.g., haematoma, infection, allergic reaction, and headache."
"Postganglionic injuries can be seen as nerve discontinuity distal to the neural foramen (best seen on axial or coronal sequences) or increased T2 signal (close to fluid signal) of the affected peripheral nerve(s), maximal at the site of injury, with asymmetry a useful finding 6,8,9. Injured peripheral nerves can also show disrupted fascicular pattern, deviated course, change in calibre (e.g. bulging, hourglass constriction), neuroma formation, and/or perineural fibrosis 6,8. Denervation changes in the supplied musculature can also be seen 8,9."
"In preganglionic injury, nerve root discontinuity near the spinal cord is a key finding. There is usually (~75% of cases) a pseudomeningocele present, although it may not be a reliable indicator of root avulsion 8,9. Other signs include nerve root sleeve deformity, cord oedema, syrinx, and cord lateralisation 8,9. Denervation changes of the ipsilateral paraspinal muscles are an indirect sign of root avulsion; post-contrast enhancement may be seen in the first 4 weeks after injury 8,9."
"Postganglionic injuries can be seen as nerve discontinuity distal to the neural foramen (best seen on axial or coronal sequences) or increased T2 signal (close to fluid signal) of the affected peripheral nerve(s), maximal at the site of injury, with asymmetry a useful finding 6,8,9. Injured peripheral nerves can also show disrupted fascicular pattern, deviated course, change in calibre (e.g. bulging, hourglass constriction), neuroma formation, and/or perineural fibrosis 6,8. Denervation changes in the supplied musculature can also be seen 8,9."