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This activity addresses the electrodiagnostic evaluation of brachial plexopathies and related neuromuscular disorders, with an emphasis on clinical localization, diagnostic confirmation, lesion characterization, prognostic assessment, and awareness of complications. Brachial plexus injuries can result from trauma, compression, ischemia, inflammatory processes, radiation, or malignant neoplasm, yet overlapping symptoms with radiculopathies, mononeuropathies, and generalized neuropathic disorders can complicate diagnosis. A persistent practice gap remains in clinicians' ability to integrate clinical examination, electrodiagnostic studies, and imaging to accurately localize lesions and guide treatment. This activity is designed to improve diagnostic accuracy, strengthen interpretation of nerve conduction studies, electromyography, and somatosensory evoked potentials, and support patient-centered treatment planning. Participants will gain actionable skills in identifying injury patterns, estimating severity and chronicity, recognizing risks and limitations of testing, and collaborating across specialties to improve outcomes for patients with suspected brachial plexus pathology. Objectives: Identify the relevant anatomy and physiology of the brachial plexus as it relates to electrodiagnostic evaluation. Differentiate brachial plexopathies from cervical radiculopathies and peripheral neuropathies using clinical findings and electrodiagnostic testing. Apply best practices when interpreting electrodiagnostic results to determine prognosis and guide clinical management decisions. Collaborate with interprofessional healthcare team members to improve diagnostic accuracy and patient outcomes in individuals with suspected brachial plexopathy. Access free multiple choice questions on this topic.

Brachial plexus injuries, commonly termed brachial plexopathies, are among the most severe peripheral nerve disorders affecting the upper extremity. These injuries may arise from several mechanisms, including traction events related to trauma, obstetric injury, compressive forces from external devices, penetrating trauma with nerve disruption, vascular compromise, or tumor infiltration. Because the plexus contains both motor and sensory fibers, affected individuals frequently develop a combination of weakness and sensory disturbances within the distribution of the involved roots, trunks, cords, or terminal nerves.[1] Evaluation generally begins with a detailed clinical history and focused neurologic examination, which often identifies the likely anatomical level of injury. Imaging studies and electrodiagnostic testing are then commonly used to characterize the lesion further and determine the extent of neural involvement.[1] Electrodiagnostic assessment, including nerve conduction studies and electromyography, plays a central role in confirming suspected plexus pathology, differentiating preganglionic from postganglionic injury, and estimating injury severity and recovery potential. These studies provide functional information regarding nerve and muscle integrity and complement structural imaging modalities.[2] This article reviews the use of nerve conduction studies and electromyography in the evaluation, localization, and prognostic assessment of brachial plexopathies.

The most frequently reported adverse effect associated with electrodiagnostic testing is mild discomfort at the site of needle electrode insertion. Some patients may experience temporary soreness, tenderness, or minor bruising after the procedure.[13] Infection at the site of needle insertion has been reported, but it occurs very rarely when appropriate sterile technique is used during electromyography. Bleeding complications such as hematoma formation are uncommon but may occur, particularly in individuals receiving anticoagulant or antiplatelet therapy. In such patients, coagulation status should be considered when planning needle examination.[15][19] Electrodiagnostic studies have not been shown to cause complications during pregnancy, and the procedure is generally considered safe when clinically indicated. Direct nerve injury resulting from needle electromyography is extremely uncommon and has rarely been reported in the literature. Pneumothorax is the most serious potential complication of electromyography of muscles near the thoracic cavity, particularly when evaluating truncal or paraspinal muscles. Although this complication is rare, clinicians should be aware of the possibility when performing needle examination in these regions.[20] Electrical activity generated by implanted devices, such as deep-brain or vagal nerve stimulators, may interfere with electrodiagnostic recordings. Coordination with the patient’s treating clinicians may be necessary to temporarily deactivate these devices before testing when accurate recordings are required.[1]

Electrodiagnostic evaluation contributes to patient-centered care by providing objective information that helps clinicians diagnose and treat neuromuscular disorders. Patients with suspected brachial plexus injuries are often initially evaluated by primary care clinicians, emergency clinicians, neurologists, orthopedic surgeons, neurosurgeons, or pain medicine specialists. These clinicians may refer patients for electrodiagnostic testing to better define the location and severity of neural injury.[1][7] Electrodiagnostic studies are typically performed by clinicians trained in neurology, physical medicine and rehabilitation, or related specialties with expertise in neuromuscular disorders. During testing, collaboration with nursing staff or trained technicians can help ensure patient safety, appropriate monitoring, and patient comfort throughout the procedure. Communication among members of the health care team is essential for accurate interpretation of electrodiagnostic findings. Clinical history, physical examination findings, imaging studies, and electrodiagnostic results must be integrated to establish the correct diagnosis and guide treatment decisions. Interdisciplinary collaboration improves the likelihood of identifying the precise site of injury and determining the most appropriate treatment strategy for each patient.[2][18] Electrodiagnostic testing can also assist in determining prognosis and monitoring recovery over time. Repeated studies may demonstrate evidence of nerve regeneration or reinnervation, which can help guide decisions regarding rehabilitation, surgical intervention, or continued conservative management.[16] Although high-level randomized controlled trials evaluating electrodiagnostic testing specifically for brachial plexopathies remain limited, the available clinical evidence supports its usefulness as a diagnostic adjunct in the evaluation of neuromuscular disorders.[24] Through coordinated care involving referring clinicians, electrodiagnosticians, rehabilitation specialists, and other health care professionals, electrodiagnostic studies can contribute to improved diagnostic accuracy, more targeted treatment planning, and better patient outcomes.