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Sonography of Brachial Plexus Traction Injuries

Hans Peter Haber1, Nektarios Sinis2, Max Haerle2 and Hans-Eberhard Schaller2

1 Department of Pediatrics, University of Tuebingen, Hoppe-Seyler-Str. 1, D-72076 Tuebingen, Germany.
2 Department of Hand-, Plastic-, and Reconstructive Surgery with Burn Unit, BG-Trauma Centre, University of Tuebingen, Tuebingen, Germany.


Figure 1
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  		Fig. 1A —Brachial plexus in longitudinal section. Drawing shows position of transducer in coronal oblique plane to show roots C5-T1 of brachial plexus in longitudinal section.

 

Figure 2
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  		Fig. 1B —Brachial plexus in longitudinal section. Corresponding sonogram (3-week-old healthy female neonate) reveals relationship between hypoechoic nerve roots C5, C6, and C7 (arrows) and hyperechoic transverse processes (stars) of vertebrae. Scale segment distance, 5 mm.

 

Figure 3
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  		Fig. 2A —34-Year-Old Man With Root Avulsion Of Brachial Plexus. Coronal Oblique Sonogram At C6 Vertebral Level Shows Empty Neural Foramen (Arrow) Indicating Nerve Root Avulsion. Hyperechoic Bone Prominences With Posterior Acoustic Shadowing Representing Transverse Processes Of Vertebrae (Stars) Are Also Shown.

 

Figure 4
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  		Fig. 2B —34-Year-Old Man With Root Avulsion Of Brachial Plexus. Coronal Oblique Sonogram At C6 Vertebral Level Of Healthy Contralateral Side Shows Cervical Root C6 (Arrow) As It Exits Neural Foramen. Transverse Processes Of Vertebrae (Stars) And Vertebral Artery (Arrowhead) Are Also Shown.

 

Figure 5
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  		Fig. 2C —34-Year-Old Man With Root Avulsion Of Brachial Plexus. Surgical Photograph Shows Cervical Root C5 (Arrow) And Avulsion Of Cervical Root C6. Star Shows Region Of Intervertebral Foramen Without Spinal Root.

 

Figure 6
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  		Fig. 3 —48-year-old man with scar tissue formation. Coronal oblique sonogram shows echogenic soft tissue (arrows) surrounding nerve roots C5 and C6 found to be scar tissue formation at surgery. Note empty neural foramen (star) indicating avulsion of nerve root C7.

 

Figure 7
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  		Fig. 4A —19-year-old man with neuroma. Transverse sonogram in infraclavicular region shows brachial plexus as ovoid mass (arrows) consisting of multiple hypoechoic fascicles representing neuroma. Note compression of axillary vein (V). A = axillary artery.

 

Figure 8
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  		Fig. 4B —19-year-old man with neuroma. Transverse sonogram of corresponding unaffected side shows normal nerve roots of brachial plexus (arrows).

 

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