Illustration of a damaged brachial plexus with an MRI scan overlay.

Brachial Plexus Injuries: Can MRI Scans Accurately Detect Nerve Root Damage?

Samir D’Costa in Health & Wellness November 2025 • 5 min read.

"A new study examines the effectiveness of magnetic resonance imaging (MRI) in diagnosing root avulsions in adults following traumatic brachial plexus injuries."

Traumatic brachial plexus injuries can occur from traffic collisions or high-impact accidents and often affect adults, leading to significant disability. These injuries involve damage to the network of nerves (the brachial plexus) that controls movement and sensation in the arm and hand. The type and severity of the injury are crucial for determining the best course of treatment and predicting recovery.

Injuries are generally classified as either pre-ganglionic or post-ganglionic. Post-ganglionic injuries, such as nerve ruptures or attenuations, typically have a better prognosis because they can be repaired with surgery or nerve grafts. Pre-ganglionic injuries, also known as root avulsions, involve the nerve roots being torn away from the spinal cord. These injuries are more complex and often require nerve transfers from other parts of the body, as re-implantation of the avulsed root is often unsuccessful.

Identifying root avulsions is therefore critical because it significantly alters the surgical plan and the expected outcome. Doctors often use exploratory surgery to assess the damage, but imaging techniques like magnetic resonance imaging (MRI) are becoming increasingly popular for pre-operative assessment. MRI offers detailed images of the soft tissues in the brachial plexus, but questions remain about its accuracy in detecting root avulsions.

MRI Accuracy in Diagnosing Root Avulsions: What the Study Shows

Illustration of a damaged brachial plexus with an MRI scan overlay.

A recent study published in the Journal of Hand Surgery (European Volume) investigated the accuracy of MRI in detecting root avulsions in adults with traumatic brachial plexus injuries. The study retrospectively analyzed data from 29 male patients who underwent both MRI and exploratory surgery at a single institution between 2008 and 2016. The goal was to determine how well MRI results matched the findings during surgery, which is considered the gold standard for diagnosis.

The study found that MRI had an overall diagnostic accuracy of 79% for detecting root avulsions in the C5-T1 nerve roots. This means that in approximately one out of four cases, the MRI either incorrectly identified a root as avulsed when it wasn't, or missed an avulsion that was present. The researchers also looked at the accuracy of MRI in detecting pseudomeningoceles, which are fluid-filled sacs that can form when a nerve root is torn from the spinal cord. They found that pseudomeningoceles had a diagnostic accuracy of only 68% as a marker for root avulsions.

Root Avulsion: Nerve roots torn away from the spinal cord.
Pre-ganglionic Injury: Injury occurring before the nerve cell body.
Post-ganglionic Injury: Injury occurring after the nerve cell body.
Pseudomeningocele: Fluid-filled sac that forms when a nerve root is torn from the spinal cord.
MRI (Magnetic Resonance Imaging): A detailed imaging technique using magnetic fields and radio waves to create images of the body's soft tissues.

The study also explored whether other injuries, such as fractures or vascular damage, were associated with root avulsions. They found that suspicion of root avulsions on MRI, vascular injuries on the same side as the brachial plexus injury, and clavicle fractures were potential predictors of root avulsions. However, further research is needed to confirm these findings.

Implications for Patients and Future Research

While MRI is a valuable tool for assessing brachial plexus injuries, this study highlights its limitations in accurately diagnosing root avulsions. The findings suggest that doctors should not rely solely on MRI results when making treatment decisions. Surgical exploration, performed by an experienced surgeon, remains the most reliable method for determining the extent of the damage and planning the appropriate reconstructive procedures. Further research is needed to improve the accuracy of MRI and other imaging techniques for diagnosing brachial plexus injuries. This could involve using higher-resolution MRI scanners, advanced imaging sequences, or combining MRI with other diagnostic tests, such as diffusion tensor imaging or hyperpolarization methods. Ultimately, the goal is to provide patients with more accurate diagnoses and better treatment outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1177/1753193417729587, Alternate LINK

Title: The Diagnostic Accuracy Of 1.5T Magnetic Resonance Imaging For Detecting Root Avulsions In Traumatic Adult Brachial Plexus Injuries

Subject: Surgery

Journal: Journal of Hand Surgery (European Volume)

Publisher: SAGE Publications

Authors: Ryckie G. Wade, Vinay Itte, James J. Rankine, John P. Ridgway, Grainne Bourke

Published: 2017-09-08

Everything You Need To Know

What are the different types of brachial plexus injuries, and how does their location impact treatment and recovery?

Brachial plexus injuries are categorized into pre-ganglionic and post-ganglionic injuries. Post-ganglionic injuries, such as nerve ruptures or attenuations, generally have a better prognosis and can often be treated surgically with nerve grafts. Conversely, pre-ganglionic injuries, also known as root avulsions, are more complex because they involve the nerve roots being torn away from the spinal cord. The treatment for root avulsions often involves nerve transfers, as reimplantation of the avulsed root is frequently unsuccessful. The location of the injury, pre- or post-ganglionic, significantly affects the surgical approach and the expected outcome, influencing the patient's recovery trajectory.

How accurate is MRI in detecting root avulsions in brachial plexus injuries?

A study published in the Journal of Hand Surgery (European Volume) found that MRI had an overall diagnostic accuracy of 79% for detecting root avulsions in the C5-T1 nerve roots. This means that in roughly one out of four cases, the MRI either misidentified a root as avulsed or missed an actual avulsion. The accuracy for detecting pseudomeningoceles, which can indicate a root avulsion, was even lower, at only 68%. These findings highlight that while MRI is useful, it has limitations and should not be the sole determinant in treatment decisions. Surgical exploration remains the most reliable diagnostic method.

What are pseudomeningoceles, and what is their significance in the context of brachial plexus injuries?

Pseudomeningoceles are fluid-filled sacs that can form when a nerve root is torn away from the spinal cord in a brachial plexus injury. Their presence on an MRI scan can indicate a root avulsion, which is a pre-ganglionic injury. However, the study found that the diagnostic accuracy of pseudomeningoceles as a marker for root avulsions was only 68%. This implies that while they can be a helpful clue, their presence or absence doesn't definitively confirm or rule out a root avulsion, further emphasizing the need for comprehensive diagnostic methods beyond just imaging.

Besides MRI, what other factors are considered when assessing brachial plexus injuries, and how do they influence the treatment plan?

Besides MRI findings, other factors play a role in assessing brachial plexus injuries. The study noted that suspicion of root avulsions on MRI, any vascular injuries on the same side as the brachial plexus injury, and clavicle fractures were potential predictors of root avulsions. The classification of the injury (pre-ganglionic or post-ganglionic), the severity of nerve damage, and the patient's overall health also influence treatment plans. Surgical exploration remains critical for confirming the extent of damage, which then dictates the reconstructive procedures required, such as nerve grafts or transfers. A comprehensive assessment, combining imaging with clinical findings, leads to more informed treatment decisions and better patient outcomes.

What are the implications of the study's findings for patients and the future of brachial plexus injury diagnosis and treatment?

The study's findings highlight the limitations of MRI in accurately diagnosing root avulsions in brachial plexus injuries, suggesting that doctors should not rely solely on MRI results when deciding on treatment. For patients, this means that a more thorough diagnostic approach is often necessary, which may include exploratory surgery. Future research aims to improve the accuracy of MRI and other imaging techniques. This could involve using higher-resolution MRI scanners, advanced imaging sequences, or combining MRI with other diagnostic tests, such as diffusion tensor imaging or hyperpolarization methods. The ultimate goal is to provide patients with more accurate diagnoses, leading to better treatment outcomes and improved quality of life.