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Spine
Diagnosis
Peripheral Nerve and Plexus
Plexus and Peripheral Nerve Lesions
Brachial Plexus Traction Injury
Brachial Plexus Traction Injury
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Brachial plexus stretch injury, brachial plexus avulsion, avulsion pseudomeningocele

              • Definitions

                • Stretch injury or avulsion of ≥ 1 cervical roots, brachial plexus

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Clifton WE et al: Delayed myelopathy in patients with traumatic preganglionic brachial plexus avulsion injuries. World Neurosurg. 122:e1562-9, 2019
                                              2. Gunes A et al: Brachial plexus ultrasound and MRI in children with brachial plexus birth injury. AJNR Am J Neuroradiol. 39(9):1745-50, 2018
                                              3. Kachramanoglou C et al: Long-term outcome of brachial plexus reimplantation after complete brachial plexus avulsion injury. World Neurosurg. 103:28-36, 2017
                                              4. Lutz AM et al: MR imaging of the brachial plexus. Neuroimaging Clin N Am. 24(1):91-108, 2014
                                              5. Chhabra A et al: High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. AJNR Am J Neuroradiol. 34(3):486-97, 2013
                                              6. Rhee PC et al: Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. J Bone Joint Surg Am. 93(24):2271-7, 2011
                                              7. Aralasmak A et al: MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol. 31(3):410-7, 2010
                                              8. Doumouchtsis SK et al: Are all brachial plexus injuries caused by shoulder dystocia? Obstet Gynecol Surv. 64(9):615-23, 2009
                                              9. Malessy MJ et al: Obstetric brachial plexus injuries. Neurosurg Clin N Am. 20(1):1-14, v, 2009
                                              10. Pearl ML: Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg. 17(4):242-54, 2009
                                              11. Hof JJ et al: What's new in MRI of peripheral nerve entrapment? Neurosurg Clin N Am. 19(4):583-95, vi, 2008
                                              12. Schwartzman RJ et al: Brachial plexus traction injury: quantification of sensory abnormalities. Pain Med. 9(7):950-7, 2008
                                              13. Smith AB et al: Magnetic resonance neurography in children with birth-related brachial plexus injury. Pediatr Radiol. 38(2):159-63, 2008
                                              14. Haber HP et al: Sonography of brachial plexus traction injuries. AJR Am J Roentgenol. 186(6):1787-91, 2006
                                              15. Medina LS et al: Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Pediatr Radiol. 36(12):1295-9, 2006
                                              16. Yoshikawa T et al: Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics. 26 Suppl 1:S133-43, 2006
                                              17. Benjamin K: Part 1. Injuries to the brachial plexus: mechanisms of injury and identification of risk factors. Adv Neonatal Care. 5(4):181-9, 2005
                                              18. Waters PM: Update on management of pediatric brachial plexus palsy. J Pediatr Orthop. 25(1):116-26, 2005
                                              19. Bowen BC et al: The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am. 14(1):59-85, vii-viii, 2004
                                              20. Carlstedt T et al: Restoration of hand function and so called "breathing arm" after intraspinal repair of C5-T1 brachial plexus avulsion injury. Case report. Neurosurg Focus. 16(5):E7, 2004
                                              21. Chappell KE et al: Magic angle effects in MR neurography. AJNR Am J Neuroradiol. 25(3):431-40, 2004
                                              22. Ferraresi S et al: Reinnervation of the biceps in C5-7 brachial plexus avulsion injuries: results after distal bypass surgery. Neurosurg Focus. 16(5):E6, 2004
                                              23. Filler AG et al: MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin. 22(3):643-82, 2004
                                              24. Haerle M et al: Management of complete obstetric brachial plexus lesions. J Pediatr Orthop. 24(2):194-200, 2004
                                              25. Kim DH et al: Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus. 16(5):E2, 2004
                                              26. Todd M et al: MR imaging of brachial plexus. Top Magn Reson Imaging. 15(2):113-25, 2004
                                              27. Bertelli JA et al: Brachial plexus avulsion injury repairs with nerve transfers and nerve grafts directly implanted into the spinal cord yield partial recovery of shoulder and elbow movements. Neurosurgery. 52(6):1385-9; discussion 1389-90, 2003
                                              28. Chen HJ et al: Combined dorsal root entry zone lesions and neural reconstruction for early rehabilitation of brachial plexus avulsion injury. Acta Neurochir Suppl. 87:95-7, 2003
                                              29. DaSilva VR et al: Upper thoracic spinal cord herniation after traumatic nerve root avulsion. Case report and review of the literature. J Neurosurg. 99(3 Suppl):306-9, 2003
                                              30. Gei AF et al: Brachial plexus paresis associated with fetal neck compression from forceps. Am J Perinatol. 20(6):289-91, 2003
                                              31. Doi K et al: Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg. 96(3 Suppl):277-84, 2002
                                              32. Dubuisson AS et al: Brachial plexus injury: a survey of 100 consecutive cases from a single service. Neurosurgery. 51(3):673-82; discussion 682-3, 2002
                                              33. Birch R: Injuries to the brachial plexus: controversies and possibilities. Neurosurg Clin N Am. 12(2):285-94, 2001
                                              34. Tavakkolizadeh A et al: Imaging of adult brachial plexus traction injuries. J Hand Surg Br. 26(3):183-91, 2001
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Synonyms

                                                            • Brachial plexus stretch injury, brachial plexus avulsion, avulsion pseudomeningocele

                                                          • Definitions

                                                            • Stretch injury or avulsion of ≥ 1 cervical roots, brachial plexus

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nonvascular Interventions

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Clifton WE et al: Delayed myelopathy in patients with traumatic preganglionic brachial plexus avulsion injuries. World Neurosurg. 122:e1562-9, 2019
                                                                                          2. Gunes A et al: Brachial plexus ultrasound and MRI in children with brachial plexus birth injury. AJNR Am J Neuroradiol. 39(9):1745-50, 2018
                                                                                          3. Kachramanoglou C et al: Long-term outcome of brachial plexus reimplantation after complete brachial plexus avulsion injury. World Neurosurg. 103:28-36, 2017
                                                                                          4. Lutz AM et al: MR imaging of the brachial plexus. Neuroimaging Clin N Am. 24(1):91-108, 2014
                                                                                          5. Chhabra A et al: High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. AJNR Am J Neuroradiol. 34(3):486-97, 2013
                                                                                          6. Rhee PC et al: Concomitant traumatic spinal cord and brachial plexus injuries in adult patients. J Bone Joint Surg Am. 93(24):2271-7, 2011
                                                                                          7. Aralasmak A et al: MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol. 31(3):410-7, 2010
                                                                                          8. Doumouchtsis SK et al: Are all brachial plexus injuries caused by shoulder dystocia? Obstet Gynecol Surv. 64(9):615-23, 2009
                                                                                          9. Malessy MJ et al: Obstetric brachial plexus injuries. Neurosurg Clin N Am. 20(1):1-14, v, 2009
                                                                                          10. Pearl ML: Shoulder problems in children with brachial plexus birth palsy: evaluation and management. J Am Acad Orthop Surg. 17(4):242-54, 2009
                                                                                          11. Hof JJ et al: What's new in MRI of peripheral nerve entrapment? Neurosurg Clin N Am. 19(4):583-95, vi, 2008
                                                                                          12. Schwartzman RJ et al: Brachial plexus traction injury: quantification of sensory abnormalities. Pain Med. 9(7):950-7, 2008
                                                                                          13. Smith AB et al: Magnetic resonance neurography in children with birth-related brachial plexus injury. Pediatr Radiol. 38(2):159-63, 2008
                                                                                          14. Haber HP et al: Sonography of brachial plexus traction injuries. AJR Am J Roentgenol. 186(6):1787-91, 2006
                                                                                          15. Medina LS et al: Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Pediatr Radiol. 36(12):1295-9, 2006
                                                                                          16. Yoshikawa T et al: Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics. 26 Suppl 1:S133-43, 2006
                                                                                          17. Benjamin K: Part 1. Injuries to the brachial plexus: mechanisms of injury and identification of risk factors. Adv Neonatal Care. 5(4):181-9, 2005
                                                                                          18. Waters PM: Update on management of pediatric brachial plexus palsy. J Pediatr Orthop. 25(1):116-26, 2005
                                                                                          19. Bowen BC et al: The brachial plexus: normal anatomy, pathology, and MR imaging. Neuroimaging Clin N Am. 14(1):59-85, vii-viii, 2004
                                                                                          20. Carlstedt T et al: Restoration of hand function and so called "breathing arm" after intraspinal repair of C5-T1 brachial plexus avulsion injury. Case report. Neurosurg Focus. 16(5):E7, 2004
                                                                                          21. Chappell KE et al: Magic angle effects in MR neurography. AJNR Am J Neuroradiol. 25(3):431-40, 2004
                                                                                          22. Ferraresi S et al: Reinnervation of the biceps in C5-7 brachial plexus avulsion injuries: results after distal bypass surgery. Neurosurg Focus. 16(5):E6, 2004
                                                                                          23. Filler AG et al: MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin. 22(3):643-82, 2004
                                                                                          24. Haerle M et al: Management of complete obstetric brachial plexus lesions. J Pediatr Orthop. 24(2):194-200, 2004
                                                                                          25. Kim DH et al: Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus. 16(5):E2, 2004
                                                                                          26. Todd M et al: MR imaging of brachial plexus. Top Magn Reson Imaging. 15(2):113-25, 2004
                                                                                          27. Bertelli JA et al: Brachial plexus avulsion injury repairs with nerve transfers and nerve grafts directly implanted into the spinal cord yield partial recovery of shoulder and elbow movements. Neurosurgery. 52(6):1385-9; discussion 1389-90, 2003
                                                                                          28. Chen HJ et al: Combined dorsal root entry zone lesions and neural reconstruction for early rehabilitation of brachial plexus avulsion injury. Acta Neurochir Suppl. 87:95-7, 2003
                                                                                          29. DaSilva VR et al: Upper thoracic spinal cord herniation after traumatic nerve root avulsion. Case report and review of the literature. J Neurosurg. 99(3 Suppl):306-9, 2003
                                                                                          30. Gei AF et al: Brachial plexus paresis associated with fetal neck compression from forceps. Am J Perinatol. 20(6):289-91, 2003
                                                                                          31. Doi K et al: Cervical nerve root avulsion in brachial plexus injuries: magnetic resonance imaging classification and comparison with myelography and computerized tomography myelography. J Neurosurg. 96(3 Suppl):277-84, 2002
                                                                                          32. Dubuisson AS et al: Brachial plexus injury: a survey of 100 consecutive cases from a single service. Neurosurgery. 51(3):673-82; discussion 682-3, 2002
                                                                                          33. Birch R: Injuries to the brachial plexus: controversies and possibilities. Neurosurg Clin N Am. 12(2):285-94, 2001
                                                                                          34. Tavakkolizadeh A et al: Imaging of adult brachial plexus traction injuries. J Hand Surg Br. 26(3):183-91, 2001