title: High-resolution ultrasound of the supraclavicular brachial plexus--can it improve therapeutic decisions in patients with plexus trauma?
abstract: Patients with major traumatic brachial plexus lesions benefit from early surgery, but they are seldom isolated by today's diagnostic workup. Subjects with ambiguous findings after such workups usually undergo a trial of conservative treatment and those without improvement delayed surgery. Our study focuses on this problem. Hence, the purpose of this study was to evaluate the impact of high-resolution ultrasound (HR-US) on patient recruitment for non-delayed surgery. Twelve patients after blunt shoulder trauma and standardized HR-US assessment who underwent plexus surgery were included in this prospective observational study. Thereby, a total of 168 plexus elements were evaluated. All findings were compared to electrophysiological data if available and tested statistically against the gold-standard, i.e., surgical validation. Major plexus lesions were correctly detected by HR-US in nine patients (20 plexus elements). In two patients (five plexus elements), the lesion was underestimated by HR-US in relation to the gold standard (surgical inspection). Our analysis showed a high positive (1.0) and an acceptable negative predictive value (0.92) for the grading of traumatic plexus lesions with HR-US. Based on HR-US findings alone, 9 of 11 patients with objective major lesions would have undergone early surgery. In conclusion, HR-US proved a valuable tool for the triage of patients with traumatic lesions into surgical and non-surgical candidates.
authors.affiliation: Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. hannes.gruber@uibk.ac.at
authors.forename: Hannes
authors.initials: H
authors.lastname: Gruber
authors.forename: Bernhard
authors.initials: B
authors.lastname: Glodny
authors.forename: Klaus
authors.initials: K
authors.lastname: Galiano
authors.forename: Florian
authors.initials: F
authors.lastname: Kamelger
authors.forename: Gerd
authors.initials: G
authors.lastname: Bodner
authors.forename: Heribert
authors.initials: H
authors.lastname: Hussl
authors.forename: Siegfried
authors.initials: S
authors.lastname: Peer
mesh_terms: D000293:Adolescent; D000328:Adult; D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D002102:Cadaver; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery