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Semin Musculoskelet Radiol 2010; 14(5): 523-546
DOI: 10.1055/s-0030-1268072
© Thieme Medical Publishers

Brachial Plexus and Nerves about the Shoulder

Carlo Martinoli1 , Nicola Gandolfo2 , Maribel Miguel Perez3 , Andrea Klauser4 , Federigo Palmieri1 , Luca Padua5 , 6 , Alberto Tagliafico1
  • 1Cattedra di Radiologia–DISC, Università di Genova, Genova, Italy
  • 2IM2S–Institut Monégasque de Médecine and chirurgie Sportive, Montecarlo, Monaco
  • 3Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapy, Faculty of Medicine (C Bellvitge), University of Barcelona, Barcelona, Spain
  • 4Department of Diagnostic Radiology, Medical University Innsbruck, Innsbruck, Austria
  • 5Fondazione Don Gnocchi Onlus
  • 6Department of Neurology, Policlinico “A. Gemelli,” Università Cattolica del Sacro Cuore, Rome, Italy
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Publikationsdatum:
11. November 2010 (online)

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ABSTRACT

Ultrasound (US) and MR imaging have been shown able to detect in-depth features of brachial plexus anatomy and to localize pathological lesions in disorders where electrophysiology and physical findings are nonspecific or nonlocalizing. High-end gradient technology, phased array coils, and selection of an appropriate protocol of pulse sequences are the main requirements to evaluate the brachial plexus nerves with MR imaging and to distinguish between intrinsic and extrinsic pathological changes. A careful scanning technique based on anatomical landmarks is required to image the brachial plexus nerves with US. In traumatic injuries, MR imaging and myelographic techniques can exclude nerve lesions at the level of neural foramina and at intradural location. Outside the spinal canal, US is an excellent alternative to MR imaging to determine the presence of a lesion, to establish the site and the level of nerve involvement, as well as to confirm or exclude major nerve injuries.

In addition to brachial plexus injuries, MR imaging and US can be contributory in a variety of nontraumatic brachial plexopathies of a compressive, neoplastic, and inflammatory nature. In the thoracic outlet syndrome, imaging performed in association with postural maneuvers can help diagnose dynamic compressions. MR imaging and US are also effective to recognize neuropathies about the shoulder girdle involving the suprascapular, axillary, long thoracic, and spinal accessory nerves that may mimic brachial plexopathy. In this article, the clinical entities just listed are discussed independently, providing an overview of the current status of knowledge regarding imaging assessment.

KEYWORDS

Brachial plexus - Parsonage-Turner syndrome - brachial plexopathies - thoracic outlet syndrome - magnetic resonance imaging - ultrasound - MR myelography