AJR:202, January 2014 W67 best imaging plane for evaluation and key ad- jacent anatomy will be described. The helpful mnemonic of “Radiology technologists drink cold beverages” (i.e., roots, trunks, divisions, cords, branches) can be used to remember the components of the brachial plexus [3]. The brachial plexus is formed by C5 through T1 spinal nerves and contains both anterior (motor) and posterior (sensory) rootlet fibers [4]. The first portion of the plexus, called roots, is named for the level from which they arise (C5–C8, T1). The axial plane (Fig. 1) best shows the anterior and posterior root- lets and the named roots exiting the neural foramina [2]. Note that each root is subdi- vided into preganglionic and postganglionic portions, which are demarcated by the dor- sal root ganglion because this distinction has bearing on management issues [1, 4], which we discuss later. The anterior rami of the postganglionic por- tion continue as the plexus. More distal com- ponents include the trunks, divisions, cords, and branches (Fig. 2). All of the sections are most easily seen on coronal images, with the sagittal and axial planes used for problem solving [2]. The trunks, of which there are three, are positioned between the anterior and middle scalene muscles. The six divisions are lateral to the scalene muscles and cephalad to the clavicle. The three cords are caudal to the clavicle and medial to the lateral border of the pectoralis minor muscle. Another point of ref- erence for the cords in the sagittal plane is the subclavian artery, which can be used to iden- tify the medial, lateral, and posterior compo- Brachial Plexopathy: A Review of Traumatic and Nontraumatic Causes Baxter D. Tharin 1, 2 Jonathan A. Kini 1 Gerald E. York 1 John L. Ritter 1 Tharin Bd, Kini JA, York GE, Ritter JL 1 Department of Radiology, San Antonio Military Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234. 2 Present address: Department of Diagnostic Imaging, Mike O’Callaghan Federal Medical Center, 4700 Las Vegas Blvd N, Nellis AFB, NV 89191. Address correspondence to B. D. Tharin ([email protected]). Musculoskeletal Imaging • Review This article is available for credit. WEB This is a web exclusive article. AJR 2014; 202:W67–W75 0361–803X/14/2021–W67 © American Roentgen Ray Society B rachial plexopathy is a neurologic affliction that causes pain or func- tional impairment (or both) of the ipsilateral upper extremity. It may result from medical conditions and from vio- lent stretching, penetrating wounds, or direct trauma. Given the morbidity associated with brachial plexopathy, radiologists should be fa- miliar with plexus anatomy, able to recognize traumatic and nontraumatic plexopathies, and capable of communicating findings to refer- ring providers in a manner that will ensure ap- propriate management. Evaluating the brachial plexus may seem daunting given the complexity of the anat- omy and the relative infrequency of dedi- cated studies, typically in the form of MRI [1–3]. However, familiarity with the plexus in the context of adjacent, easily identifiable structures and with the typical appearances of plexopathies will allow a more confident evaluation. Furthermore, this understanding will enable the interpreter to better evaluate the plexus on nondedicated studies such as CT of the cervical spine, which is routinely performed in the setting of nontraumatic up- per extremity weakness and trauma. Anatomy For many clinicians, the brachial plexus may seem like a confusing cluster of nerve fibers. Simply remembering the components of the plexus and which adjacent anatomic structures delineate each part makes the task more manageable. Working from proximal to distal, the components of the plexus with the Keywords: anatomy, brachial plexus, imaging findings, injury, neuropathies DOI:10.2214/AJR.12.9554 Received July 1, 2012; accepted after revision October 14, 2012. The opinions expressed on this document are solely those of the authors and do not represent an endorse- ment by or the views of the U.S. Army or Air Force, the Department of Defense, or the U.S. Government. OBJECTIVE. This article reviews brachial plexus anatomy in the context of key land- marks, illustrates common findings of traumatic and nontraumatic causes of brachial plexop- athies, describes symptoms associated with these maladies, and explains how proper diagno- sis impacts clinical decisions. CONCLUSION. Knowledge of brachial plexus anatomy and of the imaging sequelae of traumatic and nontraumatic plexopathies enables the radiologist to more easily identify these af- flictions, thereby facilitating a multidisciplinary treatment plan and improving patient outcome. Tharin et al. Traumatic and Nontraumatic Causes of Brachial Plexopathy Musculoskeletal Imaging Review Downloaded from www.ajronline.org by 171.243.67.90 on 05/26/23 from IP address 171.243.67.90. Copyright ARRS. For personal use only; all rights reserved
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