CNS Neurosurgery    |    Brachial Plexopathy versus Cervical Radiculopathy

Brachial Plexopathy versus Cervical Radiculopathy

The brachial plexus (one for the left and one for the right arm) is a nerve bundle network lying between the lower front side of the neck and around the clavicle (collar bone). It connects nerve roots C5,6,7,8 and T1 (all from the side of the spinal cord) to the muscles of the shoulder girdle, arm and hand. It sometimes gets injured (partly severed/cut/transected or overstretched) in car and motor cycle accidents or serious assaults/penetrating injuries (trauma) or stretched or compressed in other physical circumstances (palsy, positional neuropraxia). Very occasionally inflammatory, immune and tumour conditions can affect it causing neurological symptoms in the arms affecting sensation and strength there.

Brachial plexopathy can be differentiated from cervical radiculopathy because in brachial plexopathies, multiple nerve roots are typically involved and there is usually an absence of neck symptoms (neck pain, neck immobility, neck spasm). An “MRI of the cervical spine and brachial plexus” and “nerve conduction study with EMG of the upper limbs” can also help resolve any questions about where the problem lies. Taking a good history from the patient always helps, too!

This brief video shows where the brachial plexus is on a diagram and how this network is seen on 3T MRI imaging. The key MRI sequences shown here are STIR and MIP in 2D and 3D rendering.

I see patients from time-to-time with so-called BRACHIAL PLEXUS NEUROPATHY (BRACHIAL PLEXOPATHY) (which I do NOT treat, but other specialists might), to determine if it is somehow related to the local spinal nerve roots/cervical spine pathology (which I often DO treat). As mentioned above, a good quality MRI, nerve conduction study with EMG and a vascular Doppler ultrasound can help sort such presentations out, along with the opinion of a neurologist.

(Drawing courtesy: Hospital for Special Surgery)

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