Diagnosis of root avulsion in brachial plexus injury before surgery

Česká verzia

Authors: Š. Brušáková ^1,2; I. Holečková ²; J. Lodin ³; J. Ceé ¹; H. Zítek ³; V. Skálová ⁴; I. Humhej ³
Authors place of work: Neurologické oddělení, Krajská, zdravotní, a. s., Masarykova nemocnice, v Ústí nad Labem, o. z. ¹; Neurochirurgická klinika, LF UK a FN Plzeň ²; Neurochirurgická klinika Fakulty zdravotnických, studií Univerzity, J. E. Purkyně v Ústí nad Labem, a Krajské zdravotní a. s. – Masarykovy, nemocnice v Ústí nad Labem, o. z. ³; Radiologická klinika Fakulty zdravotnických, studií Univerzity J. E. Purkyně, v Ústí nad Labem a Krajské zdravotní, a. s. – Masarykovy nemocnice v Ústí, nad Labem, o. z. ⁴
Published in the journal: Cesk Slov Neurol N 2023; 86(4): 231-238
Category: Review Article
doi: https://doi.org/10.48095/cccsnn2023231

Summary

The complex structure and lesion variety of the brachial plexus, together with the frequent presence of concurrent tissue trauma, necessitates a multidisciplinary diagnostic approach including clinical, radiological, and electrophysiological examinations. Neither examination is individually sensitive or specific enough to diagnose radicular avulsion. Misinterpretation can result in an incorrect preoperative diagnosis of the present lesion. False positive results can lead to unnecessary or wrongly planned surgery; false negative results result in permanent morbidity. Careful clinical examination of the patient forms the cornerstone of a correct diagnosis. Preoperative neurophysiological methods evaluate individual portions of the brachial plexus and include electroneurography, needle electromyography and evoked potentials. Radiological examinations analyze the brachial plexus structure and include most often used CT perimyelography, magnetic resonance imaging or their combination. The article summarizes current combinations of diagnostic strategies, which increase the sensitivity and specificity of the preoperative diagnosis. This allows accurate identification of optimal surgical candidates for early surgery in a timely and efficient manner.

Keywords:

Electrophysiology – magnetic resonance imaging – Regeneration – brachial plexus – avulsion – nerve root – neurotransfer – CT myelography

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