[Simplified exploration of brachial plexopathies by reduction to well-known mononeuropathies and radiculopathies].
The anatomic complexity of the brachial plexus makes its electrophysiological exploration difficult. Electrodiagnosis nevertheless plays a crucial role in assessing brachial plexopathies, particularly in the perspective of post-traumatic surgical reconstructions. The evaluation aims to locate as precisely as possible injuries within the plexus, as well as to determine their severity and capacity for recovery. This requires various sensory nerve conduction studies and needle EMG recordings of "marker" muscles. Plexopathies differ from radiculopathies by altered sensory nerve responses and unaltered functional innervation of paracervical muscles. We propose to simplify the exploration of brachial plexopathies by following some practical rules derived from a reanalysis of the brachial plexus anatomic sketch. Two main simplification rules can be deduced from an analysis of the anatomic sketch. First it would be judicious to associate the plexopathies involving a single element of the brachial plexus with distinct etiological and symptomatic patterns according to the altered element, as one does for peripheral nerve and root pathologies. The second proposal relies on the observation that each supraclavicular "truncal" element (upper, middle, or lower) of the brachial plexus results from reunion of cervical root nerves and behaves like a "super-root" for the upper limb, while each infraclavicular "cord" element (posterior, lateral, or medial) is the sum of two or more peripheral nerves and behaves like a "super-nerve". Accordingly, the motor and sensory abnormalities associated with the lesion of a single plexus branch may occupy a clinical and electrophysiological territory that recovers those of its constituants. Except the unaltered paracervical muscles, it is useful to reduce the topographical semiology of truncal lesions to well-known cervical radiculopathies (upper trunk neuropathy to C5 and C6 associated radiculopathies, middle trunk neuropathy to C7 radiculopathy, lower trunk neuropathy to C8 and T1 associated radiculopathies); and that of cord lesions to well-known mononeuropathies of the upper limb (for example, a posterior cord neuropathy may be considered as a full radial mononeuropathy associated with an axillary one). This method of simplification allows to demystify the brachial plexopathies and to facilitate their comprehension and exploration.
Fournier
E
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Département de physiologie, faculté de médecine Pitié-Salpêtrière, université Pierre-et-Marie-Curie-Paris-6, 91, boulevard de l'Hôpital, 75013 Paris, France. emmanuel.fournier@upmc.fr
D001917:Brachial Plexus / Q000033:anatomy & histology / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D004568:Electrodiagnosis / Q000379:methods; D006801:Humans; D018482:Muscle, Skeletal / Q000294:innervation / Q000473:pathology; D011826:Radial Nerve / Q000473:pathology