2026 Workshop Handout Bundle-W84B - Advanced US of the Brachial Plexus

W84B - Advanced US of the Brachial Plexus - Krzesniak-Swinarska

Pdf Summary

The review presents a standardized approach to neuromuscular ultrasound of the brachial plexus, intended to complement clinical examination, electrodiagnostic testing, and other imaging. Ultrasound is a painless, point-of-care method for assessing structural abnormalities, while electrodiagnostic results may be limited by factors such as injury timing, patchy nerve involvement, or coexisting disorders.<br /><br />Using a high-frequency linear transducer, clinicians examine the plexus systematically from medial to lateral, adapting the starting point to the patient’s symptoms and other test results. Four standard views are described: (1) the interscalene/supraclavicular region, showing roots and trunks; (2) the supraclavicular divisions; (3) the infraclavicular cords around the axillary artery; and (4) the axillary terminal branches around the brachial artery. Vessels and surrounding muscles provide landmarks for identifying nerve structures. Longitudinal views can help assess nerve roots, and dynamic maneuvers, including shoulder abduction and external rotation, may reveal compression, particularly in suspected thoracic outlet syndrome.<br /><br />A case illustrates the technique’s clinical value: ultrasound in a teenager with severe lower-trunk plexopathy identified a cervical rib adjacent to and constricting the plexus. Surgery revealed fibrous bands and an anomalous muscle contributing to compression; the patient’s sensory symptoms improved after intervention.<br /><br />The authors conclude that careful, reproducible ultrasound technique can help localize and characterize brachial plexus pathology and reduce diagnostic uncertainty, especially when used alongside electrodiagnostic testing.

Keywords

brachial plexus

neuromuscular ultrasound

electrodiagnostic testing

high-frequency linear transducer

interscalene region

supraclavicular view

infraclavicular cords

axillary terminal branches

thoracic outlet syndrome

cervical rib