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European Radiology
Published in: European Radiology 6/2021

01-06-2021 | Neurotomy | Musculoskeletal

Do not forget the brachial plexus—prevalence of distal brachial plexus pathology on routine shoulder MRI

Authors: Neha Antil, Yehia ElGuindy, Amelie M. Lutz

Published in: European Radiology | Issue 6/2021

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Abstract

Objectives

Most of the shoulder magnetic resonance imaging (MRI) examination focuses on internal joint structures but disregarding other structures like the distal brachial plexus, which may miss important findings. Hereby, we attempt to evaluate the prevalence of distal brachial plexus abnormalities and/or muscular denervation changes seen on routine shoulder MRI examinations and discuss common pathologies affecting the distal brachial plexus.

Material and methods

A total of 701 routine shoulder MRI studies were evaluated. The evaluation of each exam was focused on the visualized brachial plexus elements and musculature abnormalities in each case. If any abnormalities of plexus and/or musculature were found, potential underlying etiologies such as paralabral or spinoglenoid notch cysts, infiltrative/primary masses on imaging, history of prior viral illness, and radiation therapy were searched. It was then confirmed whether the abnormal findings were mentioned in the exam reports or not.

Results

Thirty-four cases (4.85%) demonstrated abnormal findings of the visualized brachial plexus cords or branches and/or musculature. It was observed that in 35.3% of exam reports these findings were not mentioned, mainly missing subtle nerve abnormalities, but correctly reporting and interpreting the encountered muscle abnormalities.

Conclusion

The distal brachial plexus and its branches should be included in the search pattern for shoulder MRI examinations.

Key Points

• Normal T2 signal of the brachial plexus is iso- to slightly hyperintense to muscle but less signal intense than fluid.
• Diffuse, geographic muscle edema is an indirect sign of brachial plexus pathology.
• Increased T2-weighted nerve signal with or without caliber or course change should be reported and followed up to find the underlying etiology.
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Metadata
Title
Do not forget the brachial plexus—prevalence of distal brachial plexus pathology on routine shoulder MRI
Authors
Neha Antil
Yehia ElGuindy
Amelie M. Lutz
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07476-3

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