Yang et al. described a modified pathological classification (PC) of brachial plexus injury (BPI) and its magnetic resonance (MR) imaging characteristics. The reliability and diagnostic accuracy of MR imaging for detecting nerve injury was discussed. Between 2006 and 2010, 86 patients with BPI were managed surgically in our department. Their preoperative MR images and surgical findings were analyzed retrospectively. The PC of BPI was classified into five types: (I) nerve root injury in continuity (including Sunderland grade I-IV injury); (II) postganglionic spinal nerve rupture with or without proximal stump; (III) preganglionic root injury (visible); (IV) preganglionic nerve root injury and postganglionic spinal nerves injury; (V) preganglionic root injury (invisible). The main MR imaging characteristics of BPI included traumatic meningocele, displacement of spinal cord, the absence of nerve root, “Black line” sign, nerve root/trunk injury in continuity, and thickening and edema of nerve root. The accuracy of MR imaging for detecting C5, C6, C7, C8, and T1 nerve roots injury were 93.3, 95.2, 92.3, 84, and 74.4%, respectively. The modified PC provides a detailed description of nerve root injury in BPI, and MR imaging technique is a reliable method for detecting nerve root injury 1).
see also Bilateral brachial plexus injury.
Initial exam seeks to differentiate preganglionic injury (proximal to dorsal root ganglion) which cannot be repaired surgically, from postganglionic injuries.
see Clues to preganglionic injury.
Treatment options that include neurolysis, nerve grafting, or neurotization (nerve transfer) has become an important procedure in the restoration of function in patients with irreparable preganglionic lesions. Restoration of elbow flexion is the primary goal in treating patients with severe brachial plexus injuries. Nerve transfers are used when spinal roots are avulsed, and proximal stumps are not available.
Nerve transfers using ulnar and/or median nerve fascicles to restore elbow flexion have been widely used following traumatic brachial plexus injury, but their utility following neonatal brachial plexus palsy remains unclear.