2023 Workshop Handout Bundle-Advanced US of Brachial Plexus

Advanced US of Brachial Plexus

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The document reviews a strategy for using neuromuscular ultrasound to diagnose issues in the brachial plexus, a complex network of nerves originating from the C5 to T1 nerve roots. Electrodiagnostic tests, while commonly used for diagnoses, can be uncomfortable and sometimes inconclusive due to the anatomy's intricacies and the wide range of potential pathologies.<br /><br />Ultrasound serves as a high-resolution, point-of-care imaging tool that assists in diagnosing structural issues in the brachial plexus. A standardized technique, developed by a multidisciplinary team of medical specialists, employs four primary and several supplementary views for the ultrasound evaluation. This systematic approach can greatly complement electrodiagnostic testing and improve patient outcomes.<br /><br />The brachial plexus is anatomically complex, given its progression from nerve roots to trunks, divisions, cords, and ultimately branches. Detailed knowledge of this anatomy and associated vascular structures is critical for accurate localization using ultrasound.<br /><br />Specific segments of the brachial plexus are viewed using different strategic positions of the ultrasound probe and patient, each aimed at maximizing the visibility of the nerve structures and surrounding areas:<br />1. <strong>Interscalene/Supraclavicular View</strong>: Visualizes the roots and trunks between the anterior and middle scalene muscles.<br />2. <strong>Infraclavicular View</strong>: Focuses on the cords around the sub-pectoral axillary artery.<br />3. <strong>Axillary View</strong>: Looks at the terminal branches surrounding the axillary artery and vein.<br /><br />A representative case of a young girl with right hand weakness and numbness post-fall illustrates the efficacy of this ultrasound approach. Ultrasound analysis revealed a cervical rib compressing the brachial plexus, confirmed and treated surgically.<br /><br />This standardized approach aims to systematize the diagnostic process, making it reproducible and accurate in identifying a variety of brachial plexus pathologies, ultimately aiding in better clinical outcomes.

Keywords

neuromuscular ultrasound

brachial plexus

C5 to T1 nerve roots

electrodiagnostic tests

high-resolution imaging

standardized technique

anatomical complexity

interscalene view

infraclavicular view

axillary view