2025 Workshop Handout Bundle-W84 Adv US Brachial Plexus

W84 Adv US Brachial Plexus - Krezesniak-Swinarska

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This article presents a standardized, systematic approach to neuromuscular ultrasound (NMUS) evaluation of the brachial plexus, a complex nerve network arising from C5 to T1 nerve roots. Brachial plexus disorders, both traumatic and nontraumatic (including neoplastic, autoimmune, inflammatory, and compressive etiologies), pose diagnostic challenges due to anatomical complexity and variability. Traditional electrodiagnostic testing aids diagnosis but can be uncomfortable and inconclusive. NMUS offers a high-resolution, noninvasive point-of-care imaging adjunct that can improve localization and characterization of brachial plexus pathology.<br /><br />The authors, a multidisciplinary team of neurologists, physiatrists, anesthesiologists, and surgeons, reviewed the literature and described reproducible standard ultrasound views for assessment. They emphasize the importance of understanding the brachial plexus anatomy, including roots, trunks, divisions, cords, and branches, as well as adjacent vascular landmarks like the subclavian and axillary arteries and veins, and muscles (e.g., anterior and middle scalenes, pectoralis major and minor).<br /><br />Four standard ultrasound views are detailed:<br /><br />1. Interscalene/Supraclavicular view (roots, trunks, divisions) – Identifies nerve roots based on characteristic transverse processes and visualizes trunks between scalene muscles, including surrounding vascular and muscular anatomy.<br /><br />2. Supraclavicular transverse view – The "bundle of grapes" appearance of divisions lateral to the subclavian artery.<br /><br />3. Infraclavicular view (cords) – Visualizes cords surrounding the axillary artery in a triangular distribution with reference to a clock-face orientation beneath the pectoralis muscles.<br /><br />4. Axillary view (branches) – Assesses terminal branches (median, ulnar, radial, musculocutaneous nerves) around the brachial artery in the axilla.<br /><br />An illustrative case of a 13-year-old girl with neurogenic thoracic outlet syndrome highlights NMUS utility: ultrasound detected a cervical rib causing compression of lower plexus trunks, not fully visualized by other methods, leading to surgical decompression.<br /><br />The authors conclude that brachial plexus NMUS is a valuable adjunct to clinical and electrodiagnostic evaluation, providing real-time, high-resolution structural assessment. Standardized imaging protocols enhance diagnostic reliability and can inform management for complex brachial plexopathies.

Keywords

neuromuscular ultrasound

brachial plexus

nerve roots C5-T1

brachial plexus disorders

electrodiagnostic testing

ultrasound imaging views

interscalene supraclavicular view

infraclavicular view

axillary view

neurogenic thoracic outlet syndrome