Differential diagnosis Cervical radiculopathies

Therapy Pain management, anti-inflammatory drugs, physical therapy.

References Mumenthaler M, Schliack H, Stöhr M (1998) Läsionen des Plexus cervico-brachialis. In:

Mumenthaler M, Schliack H, Stöhr M (eds) Läsionen peripherer Nerven und radikuläre Syndrome. Thieme, Stuttgart, pp 203-260

Stewart J (2000) Upper cervical spinal nerves, cervical plexus and nerves of the trunk. In: Stewart J (ed) Focal peripheral neuropathies. Lippincott, Williams & Wilkins, Philadelphia, pp 71-96

Brachial plexus

Genetic testing

NCV/EMG

Laboratory

Imaging

Biopsy

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Fig. 1. / Upper trunk, 2 Middle trunk, 3 Lower trunk, 4 Lateral cord, 5 Posterior cord, 6 Medial cord, 7 Ulnar nerve, 8 Radial nerve, 9 Median nerve, 10 Medial brachial cutaneus nerve, 11 Medial antebrachial cutaneus nerve, 12 Cervical plexus

Fig. 2. Various types of mechanical pressure exerted on the brachial plexus: A Clavicular fracture with a pseudoar-throtic joint. In some positions electric sensations were elicited due to pressure on the brachial plexus. B A patient with arm pain and brachial plexus lesion. Note the mass over her right shoulder. The biopsy showed lymphoma. C MRI scan of a brachial plexus of a 70 year old woman, who was treated for breast carcinoma 10 years earlier. Infiltration and tumor mass in the lower brachial plexus

Fig. 3. Features of a long standing complete brachial plexus lesion: A Atrophy of the left shoulder and deltoid. B The left hand is atrophic and less voluminous than the right hand. C Left sided Horner's syndrome. D Trophic changes of the left hand, glossy skin and nail and nailbed changes

Fig. 4. Neurofibromatosis and the brachial plexus. A MRI of the nerve roots and brachial plexus. Note tumorous enlargement of nerve roots and C brachial plexus. B Note the palpable supraclavicular mass

Fig. 5. Radiation injury of the brachial plexus: the upper picture shows the damaged skin after radiation therapy. The right hand is atrophic and has trophic skin changes. The finger movements were spontaneous and due to continuous muscle fiber activity after radiation of the brachial plexus

The trunks of the brachial plexus are formed by the union of the ventral rami of spinal nerves C5 to C8. The three trunks bifurcate into anterior and posterior divisions. The ventral rami from C5 and C6 fuse to form the upper trunk, those from C8 and T1 the lower trunk and the continuation of the ventral C7 fibers form the middle trunk. The trunks branch and reassemble to form the anterior, medial, and posterior cords (see Fig. 1).

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