US of Brachial plexus

[Linh]

Dear Steve,

I had a referral US of brachial plexus for any adhesions. The patient also has MRI booked in.

When scanning the cervical chains, I can see the neurovascular bundle of the brachial plexus. But what do you look for exactly?

Best regards,
Linh

[Stephen Bird]

Hi Linh,

I agree, the roots are easy to observe and follow through the neck from their origins passing between the anterior and middle scalene muscles and towards the axilla.
I have never been able to demonstrate adhesions reliably with ultrasound so I would think the referral is not ideal with the MRI being more useful.
I have seen nerve sheath tumours, post radiotherapy fibrosis and post trauma changes in the brachial plexus but adhesions I have not.
The problem I have with brachial plexus ultrasound in my hands is that the process of following the anatomy is fun and easy but making a positive diagnosis with ultrasound of pathology is more difficult in my hands at least.
Others may have a different opinion,

Steve

[Linh]

Thanks Steve. The MRI was normal so my senior was more confident calling it normal. I guess we can only exclude certain things like nerve sheath tumour and state the limitation of US when writing our reports.

[Stephen Bird]

Yes, I agree,

The brachial plexus is a fascinating area to scan in terms of the anatomy but I am still skeptical about the use of ultrasound for diagnosing subtle neural oedema or adhesions etc.

This is a work in progress for me and has been for many years with to be honest not much progress being made!

I am still keen to earn more about ultrasound being used to diagnose brachial plexus neuritis / adhesions etc.

Steve.

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