neurosurgeon brachial plexus injury

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bedrock

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I have a patient with a severe complete unilateral brachial plexus injury from football. Happened 4 months ago, I saw him 2 months ago for EMG, and sent him for PT, and PT emailed me yesterday saying there is no improvement. Kid has 1 to 2/5 strength for the past 4 months, though MRI of brachial plexus is normal. I'd like to send him for neurosurgical eval, but I haven't seen a case like this in a dozen years (I'm interventional pain) and I'm not sure where to send him. He lives on the Wyoming/Colorado border, but brachial plexus surgery is highly specialized and I'd like to get the names of a few neurosurgeons who might be able to help him? I realize he might have to travel.

Thank you

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Mayo had really good plexus surgeons. But I’d be surprised if CU doesn’t have someone.
 
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Mayo Clinic
Agreed….. but if no compression, avulsion, laceration etc what is there for them to “fix”?

Even if EMG pointed to plexus, I would still MRI C-spine here. Still however probably won’t end well either way given the duration and magnitude of neurologic deficit.
 
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Agreed….. but if no compression, avulsion, laceration etc what is there for them to “fix”?

Even if EMG pointed to plexus, I would still MRI C-spine here. Still however probably won’t end well either way given the duration and magnitude of neurologic deficit.
The Mayo brachial plexus neurosurgeons are like wizards with their bypasses/grafts. It’s pretty incredible. We use to do lots of pre-and-post surgical EMGs in the lab.
 
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Thank you. Was it for a brachial plexus injury?
Mayo had really good plexus surgeons. But I’d be surprised if CU doesn’t have someone.
Thanks, a good second option for the family if the CU surgeon can't help them.
Agreed….. but if no compression, avulsion, laceration etc what is there for them to “fix”?

Even if EMG pointed to plexus, I would still MRI C-spine here. Still however probably won’t end well either way given the duration and magnitude of neurologic deficit.
I'm no expert in reviewing an MRI of brachial plexus, though this MRI was done at a rinky dink tiny rural hospital due to cost savings for the single mother. Might be more to this MRI, though the report was read as normal.

MRI of c spine was done at our facility and is normal and I reviewed it personally.

Maybe there is nothing that can be done, but I feel the family deserves to explore their options and this is something I'm no expert in.
The literature points to early surgery, though up to 9 months patients can see benefit, and the boy is only 14, so his regenerative capability is better than older patients.
 
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Thank you. Was it for a brachial plexus injury?

Thanks, a good second option for the family if the CU surgeon can't help them.

I'm no expert in reviewing an MRI of brachial plexus, though this MRI was done at a rinky dink tiny rural hospital due to cost savings for the single mother. Might be more to this MRI, though the report was read as normal.

MRI of c spine was done at our facility and is normal and I reviewed it personally.

Maybe there is nothing that can be done, but I feel the family deserves to explore their options and this is something I'm no expert in.
The literature points to early surgery, though up to 9 months patients can see benefit, and the boy is only 14, so his regenerative capability is better than older patients.
yes it was
 
Thank you. Was it for a brachial plexus injury?

Thanks, a good second option for the family if the CU surgeon can't help them.

I'm no expert in reviewing an MRI of brachial plexus, though this MRI was done at a rinky dink tiny rural hospital due to cost savings for the single mother. Might be more to this MRI, though the report was read as normal.

MRI of c spine was done at our facility and is normal and I reviewed it personally.

Maybe there is nothing that can be done, but I feel the family deserves to explore their options and this is something I'm no expert in.
The literature points to early surgery, though up to 9 months patients can see benefit, and the boy is only 14, so his regenerative capability is better than older patients.


As a radiologist, my advice would be to repeat the MRI on a 3T magnet at a center with expertise/experience in MR neurography. Most radiology exams can be read by a diligent general radiologist, but certain cases like this need experienced techs and radiologists. They should not be done at ‘rinky dink’ places.

And, I would refer the patient to a speciality surgeon as soon as possible.
 
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