Magnetic resonance imaging of obstetrical brachial plexus injuries

We reviewed MR imaging in infants with Erb’s palsy. The goal was to determine the effectiveness of MR imaging in predicting operative findings for these infants.

Fifteen patients (mean age: 14.5 months) underwent surgical exploration of the brachial plexus. Preoperative MR imaging was acquired in all patients with a GE (Milwaukee, WI, USA) 1.5-Tesla MRI and correlated with the surgical findings as outlined in the children’s operative notes.

Through imaging, the presence of at least one pseudomeningocele was found in 8 of the 15 patients (53.3%) while 3 of the 15 patients (20%) had multiple pseudomeningoceles. Posterior shoulder subluxation was seen in 11 patients (73.3%). Fourteen children (93.3%) had imaging abnormalities consistent with either a reparative neuroma or scar tissue investing plexus elements. We were unable to differentiate between the two with MR imaging. At surgery, scar tissue was found entrapping the C5–C6 roots, upper trunk, and/or lateral and posterior cords in 11 patients (73.3%) while 4 patients had reparative neuromas. Two patients had both entrapment by scar tissue and a reparative neuroma. Either entrapment by scar tissue or neuroma was found in all 15 patients (100%).

MR imaging is an effective tool for demonstrating lesions of the brachial plexus worthy of surgical exploration.