By Gilbert, Alain
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Additional resources for Brachial Plexus Injuries: Published in Association with the Federation Societies for Surgery of the Hand
In obstetric brachial plexus lesions, the EMG presents more problems due to the different anatomy and the early appearance and disappearance of denervation, and to the very early reinnervation. However, bearing this in mind, the EMG in neonates also offers a reliable analysis of the lesion. Recommended reading For EMG, most handbooks can be used. One of the most recent and detailed handbooks of EMG dealing with brachial plexus lesions is: Dumitru D (1994) Electrodiagnostic medicine. In: Brachial Plexopathies and Proximal Mononeuropathies.
Although MRI is the major tool in diagnostic neuroradiology for the assessment of rootlet avulsions in brachial plexus lesions, CT-myelography still proves more reliable (Miller et al 1993, Francel et al 1995, Panasci et al 1995, Burge 1997, Carvalho et al 1997, van Es 1997, Chow et al 2000). Sunderland (1991) stated that traction of the brachial plexus will normally result initially in tearing of the arachnoidal and dural sheet of the nerve tract. But rootlet avulsions may exist without a concomitant meningocele, probably because of a so-called central mechanism (see Chapter 16).
Apart from its use in research, this technique offers no information about lesions in the peripheral nervous system and will therefore not be discussed further. The EMG The EMG, in this chapter also including nerve conduction studies (NCS), measures the function of the motor unit and the peripheral sensory fibres and is thus the most important technique for analysing peripheral nerve lesions. Important definitions are CMAP (compound muscle action potential) and SNAP (sensory nerve action potential).
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