2024 Workshop Handout Bundle-W84A Advanced US of the Brachial Krzesniak-Swinarska

W84A Advanced US of the Brachial Krzesniak-Swinarska

Pdf Summary

The document is an invited review on neuromuscular ultrasound of the brachial plexus, detailing a standardized approach for its assessment. It acknowledges the challenges posed by the complex anatomy and varying pathologies of the brachial plexus, where traditional electrodiagnostic testing might be inconclusive or uncomfortable for patients. As a high-resolution, point-of-care diagnostic tool, ultrasound is proposed to complement clinical assessments, electrodiagnostic testing, and other imaging modalities for improved localization and diagnosis.<br /><br />The manuscript, contributed by a team of specialists in neurology, physiatry, anesthesiology, and orthopedic surgery from the Wake Forest School of Medicine and The Ohio State University, outlines a systematic method for performing brachial plexus ultrasound. It describes four standard views and supplemental views to assess the anatomy and potential pathologies.<br /><br />### Key Points Discussed:<br />- **Brachial Plexus Anatomy**: The document provides an overview of the brachial plexus originating from C5 through T1 nerve roots, and describes its journey through trunks, divisions, cords, and branches.<br />- **Ultrasonographic Approach**: Recommendations for patient positioning, optimal use of a high-frequency transducer, and a technique for imaging the brachial plexus from the neck (interscalene perspective) to the axilla (cord and branch perspectives) are provided.<br />- **Representative Case Study**: A detailed case study of a 13-year-old girl with right hand weakness and numbness post-injury demonstrates the utility of ultrasound in diagnosing a cervical rib causing lower trunk brachial plexopathy, which was later confirmed through surgical exploration.<br /><br />### Practical Applications:<br />- **Educational Material**: The document serves as a background for hands-on workshops, offering step-by-step guidance to ensure accurate and reproducible ultrasound techniques are employed.<br />- **Standard Views**: Four key ultrasound views (interscalene, supraclavicular, infraclavicular, and axillary) are explained, providing a framework to systematically evaluate the brachial plexus.<br /><br />The study asserts the importance of integrating neuromuscular ultrasound with other diagnostic modalities to enhance patient outcomes and proposes this standardized method to aid in the diagnosis of complex brachial plexus pathologies.

Keywords

neuromuscular ultrasound

brachial plexus

standardized assessment

anatomy

high-frequency transducer

diagnostic tool

electrodiagnostic testing

clinical assessments

imaging modalities

Wake Forest School of Medicine