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DOI: 10.1055/s-0044-1791664
Brachial and Lumbosacral Plexopathies

Abstract
The brachial and lumbosacral plexuses are complex neural structures that transmit sensory, motor, and autonomic information between the spinal cord and the extremities. Plexus disorders can be particularly disabling because lesions in the plexus usually affect large groups of nerve fibers originating from several spinal levels. Electrodiagnostic studies are often required to confirm a plexus lesion and determine the extent of injury and prognosis. Magnetic resonance is the imaging modality of choice for detecting intrinsic nerve abnormalities; recently, high-resolution ultrasound has emerged as an alternative method for dynamic evaluation and visualization of internal nerve architecture. Once a plexopathy is confirmed, the list of possible etiologies is relatively limited and includes traumatic and nontraumatic causes. Treatment relies on symptom management and physical rehabilitation unless a treatable underlying condition is found. Surgical approaches, including nerve grafts or tendon transfers, may improve limb function when spontaneous recovery is suboptimal.
Keywords
plexopathies - brachial plexus - lumbosacral plexus - radiculoplexus neuropathy - electrodiagnostic studiesPublication History
Article published online:
17 October 2024
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References
- 1 Collins MP, Hadden RD. The nonsystemic vasculitic neuropathies. Nat Rev Neurol 2017; 13 (05) 302-316
- 2 Dyck PJ, Thaisetthawatkul P. Lumbosacral plexopathy. Continuum (Minneap Minn) 2014; 20 (5 Peripheral Nervous System Disorders): 1343-1358
- 3 Staff NP, Engelstad J, Klein CJ. et al. Post-surgical inflammatory neuropathy. Brain 2010; 133 (10) 2866-2880
- 4 Chahin N, Temesgen Z, Kurtin PJ, Spinner RJ, Dyck PJ. HIV lumbosacral radiculoplexus neuropathy mimicking lymphoma: diffuse infiltrative lymphocytosis syndrome (DILS) restricted to nerve?. Muscle Nerve 2010; 41 (02) 276-282
- 5 Rubin DI. Brachial and lumbosacral plexopathies: a review. Clin Neurophysiol Pract 2020; 5: 173-193
- 6 Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve 1990; 13 (09) 771-784
- 7 van Alfen N. The trouble with neuralgic amyotrophy. Pract Neurol 2006; 6: 298-307
- 8 Ferrante MA, Wilbourn AJ. Electrodiagnostic approach to the patient with suspected brachial plexopathy. Neurol Clin 2002; 20 (02) 423-450
- 9 Oishi T, Ryan CS, Vazquez Do Campo R, Laughlin RS, Rubin DI. Quantitative analysis of myokymic discharges in radiation versus nonradiation cases. Muscle Nerve 2021; 63 (06) 861-867
- 10 Massie R, Mauermann ML, Staff NP. et al. Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies. Brain 2012; 135 (Pt 10): 3074-3088
- 11 Panther EJ, Reintgen CD, Cueto RJ, Hao KA, Chim H, King JJ. Thoracic outlet syndrome: a review. J Shoulder Elbow Surg 2022; 31 (11) e545-e561
- 12 Davis GA, Knight SR. Pancoast tumors. Neurosurg Clin N Am 2008; 19 (04) 545-557 , v–vi
- 13 Rehman I, Chokshi FH, Khosa F. MR imaging of the brachial plexus. Clin Neuroradiol 2014; 24 (03) 207-216
- 14 Gasparotti R, Shah L. Brachial and lumbosacral plexus and peripheral nerves. In: Hodler J, Kubik-Huch RA. , von Schulthess GK, eds. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. . Chapter 20
- 15 Jung JY, Lin Y, Carrino JA. An updated review of magnetic resonance neurography for plexus imaging. Korean J Radiol 2023; 24 (11) 1114-1130
- 16 Griffith JF. Ultrasound of the brachial plexus. Semin Musculoskelet Radiol 2018; 22 (03) 323-333
- 17 Chen DZ, Cong R, Zheng MJ. et al. Differential diagnosis between pre- and postganglionic adult traumatic brachial plexus lesions by ultrasonography. Ultrasound Med Biol 2011; 37 (08) 1196-1203
- 18 van Alfen N, Malessy MJ. Diagnosis of brachial and lumbosacral plexus lesions. Handb Clin Neurol 2013; 115: 293-310
- 19 Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014; 38 (04) 210-218
- 20 Van der Looven R, Le Roy L, Tanghe E. et al. Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2020; 62 (06) 673-683
- 21 Osorio M, Lewis S, Tse RW. Promoting recovery following birth brachial plexus palsy. Pediatr Clin North Am 2023; 70 (03) 517-529
- 22 Tharin BD, Kini JA, York GE, Ritter JL. Brachial plexopathy: a review of traumatic and nontraumatic causes. AJR Am J Roentgenol 2014; 202 (01) W67-75
- 23 Wade RG, Takwoingi Y, Wormald JCR. et al. Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy. Syst Rev 2018; 7 (01) 76
- 24 Noland SS, Bishop AT, Spinner RJ, Shin AY. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg 2019; 27 (19) 705-716
- 25 Feinberg JH. Burners and stingers. Phys Med Rehabil Clin N Am 2000; 11 (04) 771-784
- 26 Fraiman PHA, Papa IMD, Fernandes BM, Santos FTAD, Godeiro-Junior C. Rucksack palsy after military boot camp. Arq Neuropsiquiatr 2022; 80 (06) 658
- 27 Cralle LE, Harris LM, Lum YW, Deery SE, Humphries MD. Thoracic outlet syndrome in females: a systematic review. Semin Vasc Surg 2023; 36 (04) 487-491
- 28 Levine NA, Rigby BR. Thoracic outlet syndrome: biomechanical and exercise considerations. Healthcare (Basel) 2018; 6 (02) 68
- 29 Charon JP, Milne W, Sheppard DG, Houston JG. Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol 2004; 59 (07) 588-595
- 30 Nwawka OK. Ultrasound imaging of the brachial plexus and nerves about the neck. Ultrasound Q 2019; 35 (02) 110-119
- 31 Sanders RJ, Haug CE, Pearce WH. Recurrent thoracic outlet syndrome. J Vasc Surg 1990; 12 (04) 390-398 , discussion 398–400
- 32 Atasoy E. Recurrent thoracic outlet syndrome. Hand Clin 2004; 20 (01) 99-105
- 33 Kim TU, Chang MC. Neuralgic amyotrophy: an underrecognized entity. J Int Med Res 2021; 49 (04) 3000605211006542
- 34 Meiling JB, Boon AJ, Niu Z. et al. Parsonage-Turner syndrome and hereditary brachial plexus neuropathy. Mayo Clin Proc 2024; 99 (01) 124-140
- 35 Ferrante MA. The distribution of neuralgic amyotrophy lesions is overwhelmingly extraplexal. Muscle Nerve 2018; 58 (03) 325-326
- 36 Ferrante MA. Brachial plexopathies: classification, causes, and consequences. Muscle Nerve 2004; 30 (05) 547-568
- 37 Granata G, Tomasello F, Sciarrone MA, Stifano V, Lauretti L, Luigetti M. Neuralgic amyotrophy and hourglass nerve constriction/nerve torsion: two sides of the same coin? A clinical review. Brain Sci 2024; 14 (01) 67
- 38 van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain 2006; 129 (Pt 2): 438-450
- 39 van Alfen N, van Engelen BG, Hughes RA. Treatment for idiopathic and hereditary neuralgic amyotrophy (brachial neuritis). Cochrane Database Syst Rev 2009; 2009 (03) CD006976
- 40 Yamanaka R, Hayano A. Radiation-induced malignant peripheral nerve sheath tumors: a systematic review. World Neurosurg 2017; 105: 961-970.e8
- 41 Rawal A, Yin Q, Roebuck M. et al. Atypical and malignant peripheral nerve-sheath tumors of the brachial plexus: report of three cases and review of the literature. Microsurgery 2006; 26 (02) 80-86
- 42 Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer: 100 cases. Neurology 1981; 31 (01) 45-50
- 43 Patel DK, Gwathmey KG. Neoplastic nerve lesions. Neurol Sci 2022; 43 (05) 3019-3038
- 44 Jaeckle KA. Neurologic manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol 2010; 30 (03) 254-262
- 45 Yan M, Kong W, Kerr A, Brundage M. The radiation dose tolerance of the brachial plexus: a systematic review and meta-analysis. Clin Transl Radiat Oncol 2019; 18: 23-31
- 46 Lutz AM, Gold G, Beaulieu C. MR imaging of the brachial plexus. Neuroimaging Clin N Am 2014; 24 (01) 91-108
- 47 Weiler-Sagie M, Bushelev O, Epelbaum R. et al. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med 2010; 51 (01) 25-30
- 48 Ng PS, Dyck PJ, Laughlin RS, Thapa P, Pinto MV, Dyck PJB. Lumbosacral radiculoplexus neuropathy: incidence and the association with diabetes mellitus. Neurology 2019; 92 (11) e1188-e1194
- 49 Laughlin RS, Dyck PJ. Electrodiagnostic testing in lumbosacral plexopathies. Phys Med Rehabil Clin N Am 2013; 24 (01) 93-105
- 50 Dhawan PS. Electrodiagnostic assessment of plexopathies. Neurol Clin 2021; 39 (04) 997-1014
- 51 Collins MP, Periquet-Collins I. Nonsystemic vasculitic neuropathy: update on diagnosis, classification, pathogenesis, and treatment. Front Neurol Neurosci 2009; 26: 26-66
- 52 Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies: new insights into pathophysiology and treatment. Muscle Nerve 2002; 25 (04) 477-491
- 53 Neufeld EA, Shen PY, Nidecker AE. et al. MR imaging of the lumbosacral plexus: a review of techniques and pathologies. J Neuroimaging 2015; 25 (05) 691-703
- 54 Chiou-Tan FY, Kemp Jr K, Elfenbaum M, Chan KT, Song J. Lumbosacral plexopathy in gunshot wounds and motor vehicle accidents: comparison of electrophysiologic findings. Am J Phys Med Rehabil 2001; 80 (04) 280-285 , quiz 286–288
- 55 Stoehr M. Traumatic and postoperative lesions of the lumbosacral plexus. Arch Neurol 1978; 35 (11) 757-760
- 56 Pinto MV, Ng PS, Laughlin RS. et al. Risk factors for lumbosacral radiculoplexus neuropathy. Muscle Nerve 2022; 65 (05) 593-598
- 57 Baum P, Koj S, Klöting N. et al. Treatment-induced neuropathy in diabetes (TIND)-developing a disease model in type 1 diabetic rats. Int J Mol Sci 2021; 22 (04) 1571
- 58 Laughlin RS, Dyck PJ. Diabetic radiculoplexus neuropathies. Handb Clin Neurol 2014; 126: 45-52
- 59 Pinto MV, Ng PS, Howe BM. et al. Lumbosacral radiculoplexus neuropathy: neurologic outcomes and survival in a population-based study. Neurology 2021; 96 (16) e2098-e2108
- 60 Filosto M, Pari E, Cotelli M. et al. MR neurography in diagnosing nondiabetic lumbosacral radiculoplexus neuropathy. J Neuroimaging 2013; 23 (04) 543-544
- 61 Chan YC, Lo YL, Chan ES. Immunotherapy for diabetic amyotrophy. Cochrane Database Syst Rev 2017; 7 (07) CD006521
- 62 Lee EQ. Nervous system metastases from systemic cancer. Continuum (Minneap Minn) 2015; 21 (2 Neuro-oncology): 415-428
- 63 Harish Bindiganavile S, Prabhu A. Neoplastic Lumbosacral Plexopathy. In: StatPearls. Treasure Island, FL: StatPearls Publishing;; November 7, 2022
- 64 Lee BC, Kim SW, Kim DH, Yoon YC, Kim CK, Sung DH. Lumbosacral plexopathy caused by the perineural spread of pelvic malignancies: clinical aspects and imaging patterns. Acta Neurochir (Wien) 2022; 164 (06) 1509-1519
- 65 Bourque PR, Sampaio ML, Warman-Chardon J, Samaan S, Torres C. Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review. BMC Cancer 2019; 19 (01) 1149
- 66 Jaeckle KA, Young DF, Foley KM. The natural history of lumbosacral plexopathy in cancer. Neurology 1985; 35 (01) 8-15
- 67 Capek S, Amrami KK, Dyck PJ, Spinner RJ. Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique. Neurosurg Focus 2015; 39 (03) E12
- 68 Almeida LR, Faustino D, Esteves LR. et al. Radiation-induced lumbosacral plexopathy. Cureus 2023; 15 (03) e36842
- 69 Griffith JF, Lalam RK. Top-ten tips for imaging the brachial plexus with ultrasound and MRI. Semin Musculoskelet Radiol 2019; 23 (04) 405-418
- 70 Jaeckle KA. Neurologic manifestations of neoplastic and radiation-induced plexopathies. Semin Neurol 2010; 30 (03) 254-262
- 71 Lower Extremity Nerves. In: Saremi F. , ed. Imaging Anatomy: Text and Atlas Volume 3: Bones, Joints, Muscles, Vessels, and Nerves. 1st ed. New York: Thieme; 2023