Brachial Plexus Disorders
Shoulder pain originating with nerve entrapments
Information on Brachial Plexus Disorders
The oblique coronal view (A) allows counting and identification of the cervical spinal nerves and establishes that only the C5 root is involved with this Schwannoma. “Nerve perpendicular” image slices can be obtained by using the image from the oblique coronal view to depict the direction of travel of the nerve trunks near the tumor.
The resulting oblique sagittal (B) view demonstrates each of the cervical spinal nerves in cross section and demonstrates their relationship to the tumor.
(C) Relationship of nerve trunks to tumor. The surgical approach and risks of nerve injury can be greatly influenced by the relative position of nerve and tumor. In many cases, MR Neurography allows the position of the traversing nerve elements relative to the tumor can be clearly established in advance of surgery. This is a “nerve perpendicular” image in which a double oblique image orientation is prescribed so that the image plane crosses most of the plexus elements at right angles in the region of interest.
The MR Neurography imaging technique also provides a useful MR myelogram capable of efficient demonstrations of traumatic pseudomeningocoeles. This term refers to the residual nerve lining left behind when the nerve elements are literally pulled out of the spinal cord by a severe injury.
Although, these images are still not always definitive in the confirmation of true nerve root avulsion, they are more reliable for making this diagnosis than the other available imaging techniques.
(A) This patient had bright irregular nerves of normal caliber suggestive of a radiation neuritis treatable with steroids.
(B) Hyperintense brachial plexus elements of extremely narrow caliber suggest encircling mechanical entrapment associated with post-irradiation fibrosis. Surgical neurolysis may be helpful.
(C) Grossly swollen nerve roots and hydrothorax associated with aggressive tumor recurrence and nerve invasion by tumor.
(A), (B), (C) Image findings in patients with painless pure motor weakness of hand intrinsics with no sensory findings (Gilliatt-Sumner Hand) there is hyperintensity and swelling in the elements of the lower trunk without mechanical deformation or other evidence of mechanical entrapment. Surgical treatment is unlikely to be effective and an inflammatory or vascular.
(A) The right brachial plexus of a 15-year-old with flail arm – lacking any movement or sensation, two months after a motorcycle accident. The image demonstrates gross discontinuities or disruptions in the upper plexus elements (ue), meningocoeles proximally (me), and bright swollen nerve trunks (st).
(B) Disconnected and retracted lower trunk (lt) in traumatic injury of brachial plexus.
Meet Dr. Filler
A globally recognized expert in the treatment of peripheral nerve disorders and the development of nerve imaging technology, Dr. Aaron Filler is the world’s leading expert in treatment of nerve pain. He has revolutionized nerve-pain treatment by inventing several new technologies. One such technology, MR Neurography, enables doctors to use an MRI scanner to examine nerves, previously a difficult-to-impossible tissue to visualize with MR imaging.
Dr. Filler’s research in axonal transport is leading to a whole new generation of advanced pain medications. He has developed many new “minimal access” surgery methods that allow him to treat complex nerve problems with small outpatient surgeries. He has also pioneered the use of the Open MRI scanner to do surgeries and other therapies with the ultra-high precision and safety of the magnetic resonance imaging.
At Dr. Filler’s Neurological Injury Specialists Management Group in Santa Monica, California, the key to success remains a very traditional endeavor: listening to the patient and doing a thorough and expert neurological examination. Dr. Filler typically spends more than an hour with each new patient. The results of the initial examination are then strengthened and perfected with application of advanced technology available nowhere else in the world.
Dr. Aaron Filler combines three key components in his treatment of each patient:
- Compassionate personal attention,
- Expert medical skills, and
- The best technology in the world
He combines these components to turn insoluble pain problems into specific treatable diagnoses. Prior to coming to the Institute for Nerve Medicine, many of Dr. Filler’s patients have seen a dozen doctors (or more), experienced failed surgeries, and have even had their very pain questioned. Time and again, Dr. Filler demonstrates that in many of these cases the problem is the doctor and not the patient. A cure is in reach when the best available medical care is brought to bear.
Dr. Filler has an MD from the University of Chicago, a PhD from Harvard University, and is also a Fellow of the Royal College of Surgeons in England. His medical training included four years of medical school, eight years of neurosurgical training at one of the leading neurosurgery programs in the US, an additional one-year fellowship in neuroimaging at the University of London, another year of training in complex spinal surgery at UCLA, and a fellowship in peripheral nerve surgery with Dr. David Kline in New Orleans.
He is the inventor on ten major patents, has published more than twenty prominent scientific publications, and has done more than a hundred presentations at scientific and medical meetings. He is also the author of Do You Really Need Back Surgery? from Oxford University Press, a well-received 300-page book for the general public. He enjoys medical staff privileges at Cedars-Sinai Medical Center in Los Angeles.
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