2023 Workshop Handout Bundle-Cervical Radiculopathy Brachial Plexopathy (Dr. Ferrante)

Cervical Radiculopathy Brachial Plexopathy (Dr. Ferrante)

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Dr. Mark A. Ferrante presented an extensive overview of the electrodiagnostic (EDX) assessment of cervical radiculopathies and brachial plexopathies at the 2023 AANEM Annual Meeting. EDX exams evaluate peripheral sensory and motor neurons, neuromuscular junctions, and muscle fibers. They include nerve conduction studies (NCS), both sensory and motor, and needle electrode examinations (NEE). <br /><br />NCS helps locate lesions and assess their severity and underlying pathology, while NEE refines lesion location and characterizes them further, including their progression. The assessments in Ferrante's studies are regional, requiring a deep understanding of both sensory and motor neuron anatomy.<br /><br />The peripheral nervous system (PNS) connects the central nervous system (CNS) to the environment, allowing for environmental perception and action. Motor and sensory neurons within the PNS span from the spinal column to distal sensory receptors and muscles. The C5 through T1 motor and sensory neurons form the basis of upper extremity and shoulder innervations, exiting the spinal cord to create the brachial plexus.<br /><br />Ferrante detailed the intricate structure of the brachial plexus—from roots, trunks, divisions, cords, to terminal nerves—and its clinical relevance. He elaborated on how specific roots and trunks are more susceptible to injury and their associated clinical conditions, such as true neurogenic thoracic outlet syndrome, Pancoast syndrome, and various forms of paralysis and plexopathy.<br /><br />Cervical radiculopathies generally result from root compression, with varying assessment difficulties due to preganglionic fiber involvement, minimal nerve disruption, and reinnervation via collateral sprouting. While sensory NCS are often normal, motor NCS might show abnormalities depending on the severity and number of affected roots.<br /><br />When diagnosing radiculopathies or plexopathies, a regional EDX approach is recommended. Sensory and motor NCS, combined with NEE, provide critical insights for accurate diagnosis, localization, and characterization of these conditions. A regional approach to diagnosis is particularly advocated for its efficiency in localizing the lesion within the complex structure of the brachial plexus and directing appropriate management and treatment.<br /><br />In conclusion, Dr. Ferrante emphasizes the importance of thorough EDX examination for accurate diagnosis and effective management of cervical radiculopathies and brachial plexopathies.

Keywords

cervical radiculopathies

brachial plexopathies

electrodiagnostic assessment

nerve conduction studies

ncs

needle electrode examinations

peripheral nervous system

motor neurons

sensory neurons

brachial plexus

EDX exams

nerve conduction studies

nerve conduction study

ncs