Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

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Abstract

Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA.

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The clinical spectrum of neuralgic amyotrophy in 246 cases.

Nens van Alfen, G. Der Sahakian (2006)

We investigated the symptoms, course and prognosis of neuralgic amyotrophy (NA) in a large group of patients with idiopathic neuralgic amyotrophy (INA, n = 199) and hereditary neuralgic amyotrophy (HNA, n = 47) to gain more insight into the broad clinical spectrum of the disorder. Several findings from earlier smaller-scale studies were tested, and for the first time the potential differences between the hereditary and idiopathic phenotypes and between males and females were explored. Generally, the course of the pain manifests itself in three consecutive phases with an initial severe, continuous pain lasting for approximately 4 weeks on average. Sensory involvement was quite common and found in 78.4% of patients but was clinically less impairing than the initial pain and subsequent paresis. As a typically patchy disorder NA can affect almost any nerve in the brachial plexus, although damage in the upper and middle trunk distribution with involvement of the long thoracic and/or suprascapular nerve occurred most frequently (71.1%). We found no correlation between the distribution of motor and sensory symptoms. In INA recurrent attacks were found in 26.1% of the patients during an average 6 year follow-up. HNA patients had an earlier onset (28.4 versus 41.3 years), more attacks (mean 3.5 versus 1.5) and more frequent involvement of nerves outside the brachial plexus (55.8 versus 17.3%) than INA patients, and a more severe maximum paresis, with a subsequent poorer functional outcome. In males the initial pain tended to last longer than it did in females (45 versus 23 days). In females the middle or lower parts of the brachial plexus were involved more frequently (23.1 versus 10.5% in males), and their functional outcome was worse. Overall recovery was less favourable than usually assumed, with persisting pain and paresis in approximately two-thirds of the patients who were followed for 3 years or more.

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Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients.

M Gaskin, C. Helms (2006)

To review retrospectively the magnetic resonance (MR) imaging findings and clinical information of patients with Parsonage-Turner syndrome (PTS). The institutional review board did not require its formal approval or informed patient consent at the time of the study. However, the study was HIPAA compliant. The information in a computerized database of 2875 consecutive shoulder MR examinations was retrospectively reviewed. With use of key terms, the database software identified 81 examinations potentially associated with PTS. Both authors together reviewed the 81 imaging reports and the corresponding patients' medical records. In consensus, they made the diagnosis of PTS in 21 patients (two with bilateral involvement) on the basis of MR findings, electromyographic results, and clinical data. They also examined the data of an additional six patients (one with bilateral involvement) obtained from outside facilities. Ultimately, 30 shoulders of 27 patients (18 male, nine female; age range, 12-81 years; mean age, 41 years) were evaluated. The MR findings and clinical information (ie, regarding atrophy, pain, weakness, electromyographic results, neck and spine history, trauma, excessive overhead activity, recent surgery, vaccination, and illness) of all patients with PTS were reviewed. MR findings of diffuse high T2 signal intensity abnormality and fatty atrophy of muscles were evaluated to assess the pattern of nerve involvement. Structural causes (eg, ganglion cyst or other mass) of neurogenic high T2 signal intensity abnormality were excluded at MR imaging. Twenty-nine (97%) of 30 shoulders had suprascapular nerve involvement; in 15 (50%) shoulders, the involvement was limited to this nerve. Fifteen (50%) shoulders had axillary nerve involvement; in only one (3%) shoulder, the involvement was limited to this nerve. One shoulder (3%) had subscapular nerve involvement. Nine (30%) shoulders demonstrated focal muscular atrophy. Eleven (41%) of 27 patients also underwent electromyography; all of these patients demonstrated neuropathies that matched the patterns of neurogenic high T2 signal intensity abnormality seen at MR imaging. The suprascapular nerve was almost invariably involved (in 97% of shoulders) in patients with PTS. Axillary nerve involvement also was commonly observed (in 50% of shoulders). Subscapular nerve involvement was uncommon (in 3% of shoulders). RSNA, 2006

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The neuralgic amyotrophy consultation

Nens van Alfen (2007)

Abstract Neuralgic amyotrophy is a distinct clinical syndrome with acute severe pain and patchy paresis in the shoulder and arm region. The clinical phenotype was recently found to be more comprehensive and the long-term prognosis less optimistic than usually assumed for many patients. The disorder can be idiopathic or hereditary in an autosomal dominant fashion, with only few phenotypical variations between the two. This article provides a practical overview of current knowledge on the clinical presentation, diagnosis, pathogenesis and the treatment of pain and complications.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Rehabil Med

Journal ID (iso-abbrev): Ann Rehabil Med

Journal ID (publisher-id): ARM

Title: Annals of Rehabilitation Medicine

Publisher: Korean Academy of Rehabilitation Medicine

ISSN (Print): 2234-0645

ISSN (Electronic): 2234-0653

Publication date (Print): April 2016

Publication date (Electronic): 25 April 2016

Volume: 40

Issue: 2

Pages: 362-367

Affiliations

[1 ]Department of Rehabilitation Medicine, Keimyung University School of Medicine, Daegu, Korea.

[2 ]Pain Research Center, Keimyung University School of Medicine, Daegu, Korea.

[3 ]Institute for Medical Science, Keimyung University School of Medicine, Daegu, Korea.

[4 ]Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Korea

[5 ]Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.

Author notes

Corresponding author: Du Hwan Kim. Department of Rehabilitation Medicine, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. Tel: +82-53-250-7477, Fax: +82-53-250-7205, ri-pheonix@ 123456hanmail.net

Article

DOI: 10.5535/arm.2016.40.2.362

PMC ID: 4855133

PubMed ID: 27152289

SO-VID: 888ca406-c36f-40e7-803f-918c9c25b131

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 13 July 2015

Date accepted : 04 August 2015

Funding

Funded by: Keimyung University, CrossRef http://dx.doi.org/10.13039/501100002509;

Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

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Most cited references 7

The clinical spectrum of neuralgic amyotrophy in 246 cases.

Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients.

The neuralgic amyotrophy consultation

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