Magnetic Resonance Imaging in Traumatic Brachial Plexopathy: A Guiding Light for Surgeons

Background: The brachial plexus is a group of major neural structures providing sensory and motor innervations to the upper limb. The brachial plexus originates from four cervical (C5-C8) and the first thoracic root (T1). Objectives: The aim of the current study was to evaluate the role of MRI in the diagnosis and localization of traumatic brachial plexopathies and co-relate MRI findings with intraoperative findings wherever possible. Methods: A total of 40 patients with traumatic brachial plexitis underwent a dedicated MRI at our institution. Clinical and electrodiagnostic tests were done in all patients. The findings of MR imaging were correlated with surgical findings as concordant (CR), partially concordant (PC), or nonconcordant (NC). Patients who were not operated were followed over a period of six months to one year. Results: Road traffic accidents (n=32) were the most common cause of brachial plexopathy in our study. Clinical evaluation revealed sensory symptoms in 28 (70 %), motor symptoms in 25 (63%), and autonomic manifestation in 2 (5%) patients. The electrodiagnostic tests were abnormal in 30 (75%) of our patients. MRI findings included pre-ganglionic injury (n=5, 12.5%), post-ganglionic injury (n=17 42.5%), mixed injury (n=9 22.5%) and normal in 9 (22.5%) patients. MRI findings were perfectly concordant with surgical findings in 23(66%), partially concordant in 8(23%), and nonconcordant in 4(11%) patients. MRI has a sensitivity of 87.88%, specificity of 100%, and accuracy of 89.47% for traumatic brachial plexopathy evaluation. Conclusion: MRI is an essential component of traumatic brachial plexopathy evaluation. MR imaging, although not absolutely perfect, helps in the localization of injury in traumatic plexopathies (pre vs. post-ganglionic), thereby acting as a guiding light for surgical management. Normal MRI in traumatic brachial plexopathy is an enigma, and management in these patients should be based on clinical and electrodiagnostic tests.