Adding Value to the Magnetic Resonance Examination in a Case of Brachial Plexus Birth Palsy

We report a case of brachial plexus birth palsy in an infant with the inability to move the left upper limb since birth. There was neither history of birth trauma nor any complications during delivery. Magnetic resonance imaging (MRI) of brachial plexus showed postganglionic injury with musculoskeletal abnormalities. The child underwent surgical repair of the plexus and is on physical rehabilitation. In this case report, we discuss the utility of a single MRI examination with an elaborate discussion on various MRI signs of brachial plexus injury including secondary musculoskeletal manifestations. The case reiterates the significance of two-in-one approach while imaging these cases with MRI. Apart from reporting the damage to the brachial plexus, the radiologist should actively search for glenohumeral dysplasia. Awareness of classification and assessment of glenohumeral dysplasia should be routinely included as an integral part of imaging report as it adds incremental value to the overall patient management and functional outcome.

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy

Objective: To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and Methods: We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results: The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion: The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.