The brachial plexus (BP) is a complicated neural network, which may be affected by trauma, irradiation, neoplasm, infection, and autoimmune inflammatory diseases. Magnetic Resonance Imaging is the preferred diagnostic modality; however, it has the limitations of high cost and lack of portability. High-resolution ultrasound has recently emerged as an unparalleled diagnostic tool for diagnosing postganglionic lesions of the BP. Existing literature describes the technical skills needed for prompt ultrasound imaging and guided injections for the BP. However, it remains particularly challenging for beginners to navigate easily while scanning its different parts. To address this, we share several "clinical pearls" for the sonographic examination of the BP as well as its common pathologies.

Center for Anatomy and Cell Biology Medical University of Vienna and Radiology Hanusch Hospital 1090 Vienna Austria

Department of Biomedical and Neuromotor Science Physical and Rehabilitation Medicine Unit Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute 40136 Bologna Italy

Department of Physical and Rehabilitation Medicine Hacettepe University Medical School 06100 Ankara Turkey

Department of Physical Medicine and Rehabilitation National Taiwan University College of Medicine Taipei 10048 Taiwan

Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Bei Hu Branch Taipei 10845 Taiwan

Department of Physical Medicine and Rehabilitation Taipei Veterans General Hospital Taipei 11221 Taiwan

Department of Rehabilitation Medicine Charles University 1st Faculty of Medicine and General University Hospital Prague 12800 Prague Czech Republic

Institute of Anatomy Charles University 1st Faculty of Medicine 12800 Prague Czech Republic

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Griffith J.F. Seminars in Musculoskeletal Radiology. Volume 22. Thieme Medical Publishers; New York, NY, USA: 2018. Ultrasound of the brachial plexus; pp. 323–333. PubMed DOI

Lapegue F., Faruch-Bilfeld M., Demondion X., Apredoaei C., Bayol M.A., Artico H., Chiavassa-Gandois H., Railhac J.J., Sans N. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn. Interv. Imaging. 2014;95:259–275. doi: 10.1016/j.diii.2014.01.020. PubMed DOI

Chang K.V., Mezian K., Nanka O., Wu W.T., Lou Y.M., Wang J.C., Martinoli C., Ozcakar L. Ultrasound imaging for the cutaneous nerves of the extremities and relevant entrapment syndromes: From anatomy to clinical implications. J. Clin. Med. 2018;7:457. doi: 10.3390/jcm7110457. PubMed DOI PMC

Wu W.T., Chang K.V., Mezian K., Nanka O., Lin C.P., Ozcakar L. Basis of shoulder nerve entrapment syndrome: An ultrasonographic study exploring factors influencing cross-sectional area of the suprascapular nerve. Front. Neurol. 2018;9:902. doi: 10.3389/fneur.2018.00902. PubMed DOI PMC

Chang K.V., Kara M., Su D.C., Gurcay E., Kaymak B., Wu W.T., Ozcakar L. Sonoanatomy of the spine: A comprehensive scanning protocol from cervical to sacral region. Med. Ultrason. 2019;21:474–482. doi: 10.11152/mu-2034. PubMed DOI

Chang K.V., Wu W.T., Ozcakar L. Ultrasound-guided interventions of the cervical spine and nerves. Phys. Med. Rehabil. Clin. N. Am. 2018;29:93–103. doi: 10.1016/j.pmr.2017.08.008. PubMed DOI

Chang K.V., Lin C.P., Hung C.Y., Ozcakar L., Wang T.G., Chen W.S. Sonographic nerve tracking in the cervical region: A pictorial essay and video demonstration. Am. J. Phys. Med. Rehabil. 2016;95:862–870. doi: 10.1097/PHM.0000000000000557. PubMed DOI

Chang K.V., Lin C.P., Lin C.S., Wu W.T., Karmakar M.K., Ozcakar L. Sonographic tracking of trunk nerves: Essential for ultrasound-guided pain management and research. J. Pain Res. 2017;10:79–88. doi: 10.2147/JPR.S123828. PubMed DOI PMC

Wu C.H., Chang K.V., Ozcakar L., Hsiao M.Y., Hung C.Y., Shyu S.G., Wang T.G., Chen W.S. Sonographic tracking of the upper limb peripheral nerves: A pictorial essay and video demonstration. Am. J. Phys. Med. Rehabil. 2015;94:740–747. doi: 10.1097/PHM.0000000000000344. PubMed DOI

Leonhard V., Smith R., Caldwell G., Smith H.F. Anatomical variations in the brachial plexus roots: Implications for diagnosis of neurogenic thoracic outlet syndrome. Ann. Anat. 2016;206:21–26. doi: 10.1016/j.aanat.2016.03.011. PubMed DOI

Finlayson R.J., Etheridge J.P., Chalermkitpanit P., Tiyaprasertkul W., Nelems B., Tran D.Q., Huntoon M.A. Real-time detection of periforaminal vessels in the cervical spine: An ultrasound survey. Reg. Anesth. Pain Med. 2016;41:130–134. doi: 10.1097/AAP.0000000000000363. PubMed DOI

Williams A.A., Smith H.F. Anatomical entrapment of the dorsal scapular and long thoracic nerves, secondary to brachial plexus piercing variation. Anat. Sci. Int. 2020;95:67–75. doi: 10.1007/s12565-019-00495-1. PubMed DOI

Chang K.V., Wu W.T., Mezian K., Nanka O., Ozcakar L. Sonoanatomy revisited: The long thoracic nerve. Med. Ultrason. 2019;21:349–352. doi: 10.11152/mu-1952. PubMed DOI

Chang K.V., Mezian K., Nanka O., Wu W.T., Lin C.P., Ozcakar L. Ultrasound-guided interventions for painful shoulder: From anatomy to evidence. J. Pain Res. 2018;11:2311–2322. doi: 10.2147/JPR.S169434. PubMed DOI PMC

Purkayastha A., Sharma N., Sarin A., Bhatnagar S., Chakravarty N., Mukundan H., Suhag V., Singh S. Radiation fibrosis syndrome: The evergreen menace of radiation therapy. Asia Pac. J. Oncol. Nurs. 2019;6:238–245. doi: 10.4103/apjon.apjon_71_18. PubMed DOI PMC

Warade A.C., Jha A.K., Pattankar S., Desai K. Radiation-induced brachial plexus neuropathy: A review. Neurol. India. 2019;67:S47–S52. doi: 10.4103/0028-3886.250704. PubMed DOI

Chang K.V., Wu W.T. Ultrasound imaging for an uncommon cause of shoulder pain: Metastatic brachial plexopathy in a woman with breast cancer. J. Med. Ultrasound. 2019;27:160–161. doi: 10.4103/JMU.JMU_120_18. PubMed DOI PMC

Jia X., Yang J., Chen L., Yu C., Kondo T. Primary brachial plexus tumors: Clinical experiences of 143 cases. Clin. Neurol. Neurosurg. 2016;148:91–95. doi: 10.1016/j.clineuro.2016.07.009. PubMed DOI

Van Eijk J.J., Groothuis J.T., Van Alfen N. Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle Nerve. 2016;53:337–350. doi: 10.1002/mus.25008. PubMed DOI

Gruber L., Loizides A., Loscher W., Glodny B., Gruber H. Focused high-resolution sonography of the suprascapular nerve: A simple surrogate marker for neuralgic amyotrophy? Clin. Neurophysiol. 2017;128:1438–1444. doi: 10.1016/j.clinph.2017.04.030. PubMed DOI

Haber H.P., Sinis N., Haerle M., Schaller H.E. Sonography of brachial plexus traction injuries. Am. J. Roentgenol. 2006;186:1787–1791. doi: 10.2214/AJR.04.1861. PubMed DOI

Wade R.G., Takwoingi Y., Wormald J.C.R., Ridgway J.P., Tanner S., Rankine J.J., Bourke G. Magnetic resonance imaging for detecting root avulsions in traumatic adult brachial plexus injuries: Protocol for a systematic review of diagnostic accuracy. Syst. Rev. 2018;7:76. doi: 10.1186/s13643-018-0737-2. PubMed DOI PMC

Kaya Y., Sarikcioglu L. Sir Herbert Seddon (1903–1977) and his classification scheme for peripheral nerve injury. Childs Nerv. Syst. 2015;31:177–180. doi: 10.1007/s00381-014-2560-y. PubMed DOI

Povlsen S., Povlsen B. Diagnosing thoracic outlet syndrome: Current approaches and future directions. Diagnostics (Basel) 2018;8:21. doi: 10.3390/diagnostics8010021. PubMed DOI PMC

Archie M., Rigberg D. Vascular TOS—Creating a protocol and sticking to it. Diagnostics (Basel) 2017;7:34. doi: 10.3390/diagnostics7020034. PubMed DOI PMC

Leonhard V., Caldwell G., Goh M., Reeder S., Smith H.F. Ultrasonographic diagnosis of thoracic outlet syndrome secondary to brachial plexus piercing variation. Diagnostics (Basel) 2017;7:40. doi: 10.3390/diagnostics7030040. PubMed DOI PMC

Aranyi Z., Csillik A., Bohm J., Schelle T. Ultrasonographic identification of fibromuscular bands associated with neurogenic thoracic outlet syndrome: The “wedge-sickle” sign. Ultrasound Med. Biol. 2016;42:2357–2366. doi: 10.1016/j.ultrasmedbio.2016.06.005. PubMed DOI

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