In addition, assessment of the cervical cord, post-traumatic changes in soft tissues and associated injuries (e.g. fractures, cuff tears, etc.) may be appreciated. Although superior to nerve conduction studies, ultrasound and other tests, conventional MRI has a poor specificity (72%) meaning that the false-positive rate is high and surgeons cant rely upon the test to guide treatment. Consequently, the future of peripheral nerve MR imaging (including imaging brachial plexus injuries) is likely to be based on diffusion-weighted imaging, such as diffusion tensor techniques, which are of significant potential clinical utility and can enable the production of easily interpreted 3D reconstructions of the spinal cord and brachial plexus such as this. Several weeks/months after BPI, EMG examination can provide additional information about whether the muscle is denervated. These examinations are painful, highly user-dependent and lack normal values so cannot be relied upon. Classification
The severity of brachial plexus injury is determined by the type of nerve damage. There are several different classification systems for grading the severity of nerve and brachial plexus injuries. Most systems attempt to correlate the degree of injury with symptoms, pathology and prognosis. Seddons classification, devised in 1943, continues to be used, and is based on three main types of nerve fiber injury, and whether there is continuity of the nerve. Neurapraxia: The mildest form of nerve injury. It involves an interruption of the nerve conduction without loss of continuity of the axon. Recovery takes place without wallerian degeneration.
Less frequently, the whole brachial plexus lesion occurs;
most infrequently, sudden upward pulling on an abducted arm (as when someone breaks a fall by grasping a tree branch) produces a lower brachial plexus lesion, in which the eighth cervical (C8) and first thoracic (T1) nerves are injured "either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand and the flexors of the wrist and fingers". This results in a form of paralysis known as Klumpkes paralysis.Backpack palsy is caused by much use of a heavy backpack whose pack-straps chronically press on the brachial plexus. Mechanism
Injury to the brachial plexus can happen in numerous environments. These may include contact sports, motor vehicle accidents, and birth. Although these are but a common few events, there is one of two mechanisms of injury that remain constant during the point of injury. The two mechanisms that can occur are traction and heavy impact. Anatomy
The brachial plexus is made up of spinal nerves that are part of the peripheral nervous system. It includes sensory and motor nerves that innervate the upper limbs. The brachial plexus includes the last four cervical nerves (C5-C8) and the 1st thoracic nerve (T1). Each of those nerves splits into smaller trunks, divisions, and cords. The lateral cord includes the musculocutaneous nerve and lateral branch of the median nerve. The medial cord includes the medial branch of the median nerve and the ulnar nerve. The posterior cord includes the axillary nerve and radial nerve.