Mateusz Gładysz FESSH prep

FESSH prep Peripheral nerve injury Incidence in multitrauma and in motorcycle injury, supraclavicular versus infraclavicular severity, Horner syndrome and lower root avulsion, frequency of root avulsion, MRI accuracy against surgical exploration

Adult traumatic brachial plexus injury: epidemiology, localisation and imaging

Last reviewed v1.0

FESSH-075Peripheral nerve injury●●● advanced

Regarding traumatic brachial plexus injury in adults:

  1. 1.In a regional trauma centre series, brachial plexus injury affected about 1% of multitrauma patients, and motorcycle riders were at particularly high risk.

  2. 2.Infraclavicular injuries are generally more severe, and more often need surgical reconstruction, than supraclavicular injuries.

  3. 3.In adults, an ipsilateral Horner syndrome after brachial plexus injury points to avulsion of the lower (C8–T1) roots.

  4. 4.Preoperative MRI is accurate enough to replace surgical exploration in diagnosing root avulsion.

  5. 5.In surgical series, most adults with traumatic brachial plexus injury have at least one avulsed root.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-075
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In a regional trauma centre series, brachial plexus injury affected about 1% of multitrauma patients, and motorcycle riders were at particularly high risk.

    True

    Midha's review of 4538 multitrauma patients found brachial plexus injury in 1.2%. Motor vehicle accidents were the commonest cause overall, but the risk among accident victims was much higher for motorcycle (4.2%) and snowmobile (4.8%) accidents than for motor vehicle accidents (0.67%).

    • Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurgery. 1997;40(6):1182-8; discussion 1188-9. PMID 9179891

  2. 2. Infraclavicular injuries are generally more severe, and more often need surgical reconstruction, than supraclavicular injuries.

    False

    In the same series, supraclavicular injuries (62%) were more often severe and needed exploration and reconstruction more often (52% against 17%). Half of the infraclavicular injuries were neurapraxic, and supraclavicular injuries carried the worse prognosis.

    • Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurgery. 1997;40(6):1182-8; discussion 1188-9. PMID 9179891

  3. 3. In adults, an ipsilateral Horner syndrome after brachial plexus injury points to avulsion of the lower (C8–T1) roots.

    True

    Huang and colleagues note that in adult brachial plexus injury Horner syndrome is usually taken as an indicator of avulsion of the C8 and T1 ventral roots. They show that the sign is less specific in infants, in whom some T1 sympathetic preganglionic fibres reach the superior cervical ganglion through the C7 ventral root.

    • Huang YG, Chen L, Gu YD, Yu GR. Histopathological basis of Horner's syndrome in obstetric brachial plexus palsy differs from that in adult brachial plexus injury. Muscle Nerve. 2008;37(5):632-7. PMID 18236458

  4. 4. Preoperative MRI is accurate enough to replace surgical exploration in diagnosing root avulsion.

    False

    Wade's meta-analysis of 11 studies (275 adults), with surgical exploration as the reference standard, found a mean per-root sensitivity of 93% but a specificity of only 72%. The authors judged MRI's accuracy modest, on limited data at risk of bias, and concluded that early surgical exploration should remain the preferred method of diagnosis.

    • Wade RG, Takwoingi Y, Wormald JCR, Ridgway JP, Tanner S, Rankine JJ, et al.. MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Radiology. 2019;293(1):125-133. PMID 31429680

  5. 5. In surgical series, most adults with traumatic brachial plexus injury have at least one avulsed root.

    True

    Across the studies in Wade's meta-analysis, about 72% of patients had at least one root avulsion (interquartile range 53–86%), and a median of about 55% of individual roots were avulsed.

    • Wade RG, Takwoingi Y, Wormald JCR, Ridgway JP, Tanner S, Rankine JJ, et al.. MRI for Detecting Root Avulsions in Traumatic Adult Brachial Plexus Injuries: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Radiology. 2019;293(1):125-133. PMID 31429680