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Fibrosis And Scarring of The Brachial And Sacral Plexus as Displayed by MRI/MRA/MRV

Bilateral rounding of the shoulders (laxity) associated with kyphosis of the thoracic spine causes costoclavicular compression and brachial plexopathy. This form of thoracic outlet syndrome is usually not amenable to surgical treatment in older patients, particularly in severe kyphosis of the thoracic spine. Surgery alters fascial planes within the thorax and pelvis that causes fibrosis and scarring of the blood supply to the brachial and sacral plexus. The objective of this presentation is to display the sites of landmark anatomy compressing the brachial plexus that decreases venous return supply to the nerves causing a shortage of oxygen and glucose needed for cellular metabolism causing fibrosis and scarring of the soft tissues marginating the brachial and sacral plexus. Magnetic Resonance Imaging (MRI) is the only modality that displays fibrosis and scarring of fascial plane anatomy obstructing venous and lymphatic return not possible with ultrasound or Computerized Axial Tomography (CAT). The longer venous obstruction transient ischemia or permanent obstruction ischemia if unrelieved, progressively affect the nerve fibers increasing numbers to an increasing degree. Pathology develops with edematous swelling and vascular congestion. If the pressure is unrelieved and continues to increase, the nerve(s) suffer a first degree or a conduction block injury. Compression ischemia with degeneration and fibrosis develop. In absence of relief, the endoneurial tubes and funniculi atrophy increasing ischemia, fibrosis becomes marked. This presentation displays costoclavicular compression of the brachial and sacral plexus with fibrosis and scarring in two patients. One patient post multiple fractures of the thorax and pelvis complicated by thoracic outlet syndrome post pelvic hardware, and the second patient post cervical fusion and bilateral total shoulder and hip replacement with foot drop. Monitored bilateral MRI, MRA and MRV of the brachial plexus is the only modality of choice to display costoclavicular compression and fibrosis, and scarring of the brachial plexus.