CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2023; 33(01): 053-064
DOI: 10.1055/s-0042-1759642
Original Article

A Decade of Imaging Patients with Traumatic Brachial Plexopathy: What have We Learned?

Vaishali Upadhyaya
1   Department of Radiology, Vivekanada Polyclinic and Institute of Medical Sciences, Ramkrishna Mission Sewashram, Lucknow, Uttar Pradesh, India
2   Department of Plastic and Reconstructive Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
Abhijat Mishra
2   Department of Plastic and Reconstructive Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
› Author Affiliations


Aim In this paper, the authors share their experience of imaging patients with traumatic brachial plexopathy by magnetic resonance neurography (MRN) spanning over a period of nearly 10 years.

Setting and Design This was a single-institution, prospective, observational study conducted between August 2012 and March 2022.

Materials and Methods Children and adults presenting to the plastic surgery outpatient department with features of traumatic brachial plexopathy were included in the study. The MRN study was performed in a 1.5T scanner (Magnetom Essenza, Siemens, Erlangen, Germany). The area scanned extended from C3 level to T3 level.

Statistical Analysis Descriptive statistics (percentages, mean, median, and mode).

Results A total of 134 patients (n = 134) were included in the study. The age of our patients ranged from 6 months to 65 years. The mean age was 24.95 ± 12.10 years, with a median of 23 years. All patients had unilateral injury, and the right side was more commonly involved. Road traffic accident was the most common mode of injury, and blunt crush-avulsion was the most common mechanism of injury. Involvement of shoulder, elbow, and hand together (panplexopathy) was the most common clinical presentation.

Conclusion This study of patients with traumatic brachial plexopathy imaged by MRN, spanning nearly a decade, has led to several interesting observations. The majority of these injuries occur in young men from urban areas who usually present with panplexopathy. The most common mode of injury is road traffic accident, and blunt crush-avulsion is the most common mechanism of injury.

Publication History

Article published online:
26 December 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Chhabra A, Thawait GK, Soldatos T. et al. High-resolution 3T MR neurography of the brachial plexus and its branches, with emphasis on 3D imaging. AJNR Am J Neuroradiol 2013; 34 (03) 486-497
  • 2 Mallouhi A, Marik W, Prayer D, Kainberger F, Bodner G, Kasprian G. 3T MR tomography of the brachial plexus: structural and microstructural evaluation. Eur J Radiol 2012; 81 (09) 2231-2245
  • 3 Upadhyaya V, Upadhyaya DN, Kumar A, Gujral RB. MR neurography in traumatic brachial plexopathy. Eur J Radiol 2015; 84 (05) 927-932
  • 4 Upadhyaya V, Upadhyaya DN, Mishra B. MR neurography in traumatic, non-obstetric paediatric brachial plexopathy. Eur Radiol 2018; 28: 2417-2424
  • 5 Lutz AM, Gold G, Beaulieu C. MR imaging of the brachial plexus. Neuroimaging Clin N Am 2014; 24 (01) 91-108
  • 6 Gilcrease-Garcia BM, Deshmukh SD, Parsons MS. Anatomy, Imaging, and Pathologic Conditions of the Brachial Plexus. Radiographics 2020; 40 (06) 1686-1714
  • 7 Chuang DC. Brachial plexus injuries: adult and pediatric. In: Neligan PC, Chang J. eds. Plastic Surgery. 3rd ed.. London, New York, Oxford, Saint Louis, Sydney, Toronto: Elsevier Saunders; 2013: 789-816
  • 8 Upadhyaya V, Upadhyaya DN, Kumar A, Pandey AK, Gujral R, Singh AK. Magnetic resonance neurography of the brachial plexus. Indian J Plast Surg 2015; 48 (02) 129-137
  • 9 Jain DKA, Bhardwaj P, Venkataramani H, Sabapathy SR. An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre. Indian J Plast Surg 2012; 45 (03) 498-503
  • 10 Faglioni Jr W, Siqueira MG, Martins RS, Heise CO, Foroni L. The epidemiology of adult traumatic brachial plexus lesions in a large metropolis. Acta Neurochir (Wien) 2014; 156 (05) 1025-1028
  • 11 Cho AB, Guerreiro AC, Ferreira CHV, Kiyohara LY, Sorrenti L. Epidemiological study of traumatic brachial plexus injuries. Acta Ortop Bras 2020; 28 (01) 16-18
  • 12 Kaiser R, Waldauf P, Ullas G, Krajcová A. Epidemiology, etiology, and types of severe adult brachial plexus injuries requiring surgical repair: systematic review and meta-analysis. Neurosurg Rev 2020; 43 (02) 443-452
  • 13 Yoshikawa T, Hayashi N, Yamamoto S. et al. Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics 2006; 26 (Suppl. 01) S133-S143
  • 14 Taleb C, Nectoux E, Awada T, Liverneaux P. The destiny of an ace: Algimantas Otanas Narakas (1927-1993). J Brachial Plex Peripher Nerve Inj 2013; 8 (01) 6
  • 15 Moran SL, Steinmann SP, Shin AY. Adult brachial plexus injuries: mechanism, patterns of injury, and physical diagnosis. Hand Clin 2005; 21 (01) 13-24
  • 16 Wade RG, Takwoingi Y, Wormald JCR. et al. Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: protocol for a systematic review of diagnostic accuracy. Syst Rev 2018; 7 (01) 76
  • 17 Leigheb M, Tricca S, Percivale I. et al. Diagnostic accuracy of the magnetic resonance imaging in adult post-ganglionic brachial plexus traumatic injuries: a systematic review and meta-analysis. Brain Sci 2021; 11 (02) 173
  • 18 Somashekar D, Yang LJS, Ibrahim M, Parmar HA. High-resolution MRI evaluation of neonatal brachial plexus palsy: a promising alternative to traditional CT myelography. Am J Neuroradiol 2014; 35 (06) 1209-1213
  • 19 Weber RV, Boyd KU, Mackinnon SE. Repair and grafting of peripheral nerve. In: Neligan PC. ed. Plastic Surgery. London, UK: Elsevier; 2013: 464-478
  • 20 Chhabra A, Andreisek G, Soldatos T. et al. MR neurography: past, present, and future. Am J Roentgenol 2011; 197 (03) 583-591
  • 21 Sureka J, Cherian RA, Alexander M, Thomas BP. MRI of brachial plexopathies. Clin Radiol 2009; 64 (02) 208-218
  • 22 Delman BN, Som PM. Imaging of the brachial plexus. In: Som PM, Curtin HD. eds. Head and Neck Imaging. 5th ed.. St. Louis: Elsevier Mosby; 2011: 2743-2770
  • 23 Filler AG, Maravilla KR, Tsuruda JS. MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin 2004; 22 (03) 643-682 , vi–vii
  • 24 Bendszus M, Koltzenburg M. Visualization of denervated muscle by gadolinium-enhanced MRI. Neurology 2001; 57 (09) 1709-1711