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Brachial Plexopathy

Goals for EMG in Brachial Plexopathy


localize the lesion Measure its severity Exclude radiculopathy (paraspinals)

Brachial Plexopathy


SNAPs Needle EMG Motor nerve conduction not useful

Anatomy of the Brachial Plexus


Cords Nerves

Median Ulnar radial

Upper Trunk Plexopathy


& median sensory responses may be abnormal EMG of supraspinatus & infraspinatus abnormal Rhomboids and cervical paraspinals are spared

Middle Trunk Plexopathy


& radial SNAPs may be abnormal Abnormalities in C7-innervated muscles e.g. pronator teres, flexor carpi radialis

Lower Trunk Plexopathy


SNAPs affected Ulnar innervated muscles affected Extensor indices (C8 innervated muscle)

Lateral Cord Plexopathy


SNAPs affected Biceps affected Proximal median forearm muscles (pronator teres, flexor carpi radialis)

Posterior Cord Plexopathy


SNAPs abnormal Radial innervated muscles (extensor indices, brachioradialis, triceps) Axillary innervated muscles (deltoid, teres minor)

Medial Cord Plexopathy


similar to lower trunk plexopathy except:

Radial innervated C8 muscles are normal

Case 1

68 year old man developed numbness and weakness in the left hand after coronary artery bypass surgery He noted numbness in the 4th & 5th fingers There was hypothesia of the left forth & 5th fingers and the hypothenar eminence Also hypothesia in the medial forearm

Case 1

revealed: All the intrinsic hand muscles were moderately weak including APB, ADM Wrist & finger extensors were mildly weak The index extensor was the weakest

Case 1

Nerve conduction studies revealed: Low amplitude ulnar motor response Normal median motor response Left ulnar SNAPs is of low amplitude Needle EMG examination revealed: Mildly reduced MUAP recruitment in the 1ST dorsal interosseus muscle, APB, Flexor carpi ulnaris, Moderately reduced MUAP recruitment in EI