title: Utility of ultrasound in noninvasive preoperative workup of neonatal brachial plexus palsy.
abstract: BACKGROUND
  Ultrasound has been utilized in the evaluation of compressive and traumatic peripheral nerve pathology.
  
  
  OBJECTIVE
  To determine whether US can provide comprehensive evaluation of the post-ganglionic brachial plexus in the setting of neonatal brachial plexus palsy and whether this information can be used to guide preoperative nerve reconstruction strategies.
  
  
  METHODS
  In this retrospective cohort study, preoperative brachial plexus ultrasonography was performed in 52 children with neonatal brachial plexus palsy who were being considered for surgery. The 33 children who had surgery compose the patient cohort. The presence and location of post-ganglionic neuromas were evaluated by US and compared to the surgical findings. US evaluation of shoulder muscle atrophy was conducted as an indirect way to assess the integrity of nerves. Finally, we correlated glenohumeral joint laxity to surgical and clinical management.
  
  
  RESULTS
  Ultrasound correctly identified 21 of 25 cases of upper trunk and middle trunk neuroma involvement (84% sensitivity for each). It was 68% sensitive and 40% specific in detection of lower trunk involvement. US identified shoulder muscle atrophy in 11 of 21 children evaluated; 8 of these 11 went on to nerve transfer procedures based upon the imaging findings. US identified 3 cases of shoulder joint laxity of the 13 children evaluated. All 3 cases were referred for orthopedic evaluation, with 1 child undergoing shoulder surgery and another requiring casting.
  
  
  CONCLUSIONS
  Ultrasound can provide useful preoperative evaluation of the post-ganglionic brachial plexus in children with neonatal brachial plexus palsy.
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.|Department of Radiology, Section of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Somashekar
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Di Pietro
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Joseph
authors.affiliation: Department of Neurosurgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Lynda J-S
authors.initials: LJ
authors.lastname: Yang
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. parurad@hotmail.com.|Department of Radiology, Section of Neuroradiology, University of Michigan Health System, Ann Arbor, MI, USA. parurad@hotmail.com.
authors.forename: Hemant A
authors.initials: HA
authors.lastname: Parmar
mesh_terms: D001720:Birth Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*
keywords: Brachial plexus palsy; Infant; Neonate; Preoperative assessment; Ultrasound