Diagnosis of root avulsion in brachial plexus injury before surgery

The complex structure and lesion variety of the brachial plexus, together with the frequent presence of concurrent tissue trauma, necessitates a multidisciplinary dia gnostic approach including clinical, radiological, and electrophysiological examinations. Neither examination is individually sensitive or specific enough to dia gnose radicular avulsion. Misinterpretation can result in an incorrect preoperative dia gnosis of the present lesion. False positive results can lead to unnecessary or wrongly planned surgery; false negative results result in permanent morbidity. Careful clinical examination of the patient forms the cornerstone of a correct dia gnosis. Preoperative neurophysiological methods evaluate individual portions of the brachial plexus and include electroneurography, needle electromyography and evoked potentials. Radiological examinations analyze the brachial plexus structure and include most often used CT perimyelography, magnetic resonance imaging or their combination. The article summarizes current combinations of dia-gnostic strategies, which increase the sensitivity and specifi city of the preoperative dia gnosis. This allows accurate identification of optimal surgical candidates for early surgery in a timely and efficient manner.