2024 Workshop Handout Bundle-W45B Cervical Radiculopathy Brachial Plexopathy

W45B Cervical Radiculopathy Brachial Plexopathy

Pdf Summary

The document by Mark A. Ferrante, MD, and Ghazala Hayat, MD, focuses on the electrodiagnostic (EDX) assessment of cervical radiculopathies and brachial plexopathies. The EDX examination evaluates peripheral sensory and motor neurons, nerve fibers, neuromuscular junctions, and muscle fibers using nerve conduction studies (NCS) and needle electrode examination (NEE). Each part provides specific insights: sensory NCS for lesion localization, motor NCS for lesion severity and pathology (axon vs. myelin disruption), and NEE for further lesion characterization and location refinement.<br /><br />The anatomy reviewed emphasizes the peripheral nervous system (PNS) as a bridge between the central nervous system (CNS) and the environment. It details the structure from anterior horn cells (AHCs) and sensory neurons to the brachial plexus, which comprises roots (C5-T1), trunks, divisions, cords, and terminal nerves. Specific muscles and sensory domains are mapped to their nerve roots, aiding diagnostic accuracy in identifying the source of neuropathies.<br /><br />The EDX approach is regional, focusing first on sensory NCS for their high sensitivity, followed by motor NCS for assessing lesion severity and pathology, and concluding with NEE to locate and characterize the lesion. Specific nerve pathways are assessed to determine the lesion's impact on sensory and motor functions. NCS packages are tailored to capture data from sensory responses and muscle activity to guide diagnosis.<br /><br />Cervical radiculopathies, often due to root compression, are common and primarily affect the C7 root, followed by C6, C8, and C5. Brachial plexopathies are classified into supraclavicular (roots and trunks), retroclavicular (divisions), and infraclavicular (cords and terminal nerves) regions, with supraclavicular plexopathies being more common and severe due to the greater force required for injury and higher incidence of closed traction injuries.<br /><br />Key disorders associated with the various plexus regions are listed, emphasizing distinct diagnostic and clinical challenges. The document underscores the importance of regional EDX assessment to confirm lesion localization and differentiate between neuropathies and radiculopathies, summarizing that comprehensive EDX studies are crucial for accurate diagnosis and management direction.

Keywords

electrodiagnostic

cervical radiculopathies

brachial plexopathies

nerve conduction studies

ncs

needle electrode examination

peripheral nervous system

anterior horn cells

sensory neurons

motor neurons

neuropathy diagnosis

nerve conduction studies

nerve conduction study

ncs