The Role of MRI in the Diagnosis of Post-sternotomy Injuries of the Brachial Plexus

Document Type : Case Report


1 Junior Researcher, Post-graduation Program in Medicine (Radiology) at the Federal University of Rio de Janeiro, 21941-901, Rio de Janeiro, Brazil

2 Assistant Physician, Division of Radiology, General Hospital at the University of Caxias do Sul, 95070-560, Caxias do Sul, Brazil

3 Cardiac Surgeon and Consultant Radiologists, Department of Cardiac Surgery and Department of Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, L14 3PE, Liverpool, United Kingdom

4 Radiologist, Department of Radiology, Federal University of Health Sciences of Porto Alegre, 90020-090, Porto Alegre, Brazil


Brachial Plexus Injury (BPI) is an uncommon complication of median sternotomy capable of causing a permanent or transitory sensitivity and/or motor function impairment in the upper limbs. During a cardiac surgery through sternotomy, for the assessment of the thoracic cage configuration and the site of mediastinal structures, a broader surgical field may be required. If the sternal retractors are overstretched, the costovertebral junctions are likely to be dislocated damaging the adjacent soft tissues at the same time. Magnetic Resonance Imaging (MRI) is the modality of choice for estimating the degree of physical damage to the brachial plexus. In this paper, we intended to report the MRI findings of a chronic case of BPI following a cardiac surgery


1. Canbaz S, Turgut N, Halici U, Sunar H, Balci K, Duran E. Brachial plexus injury during open heart surgery-controlled prospective study. Thorac Cardiovasc Surg. 2005; 53: 295-9.
2. Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: a review of 22 cases. Br J Anaesth. 1997; 79: 440–5.
3. Unlü Y, Velioğlu Y, Koçak H, Becit N, Ceviz M. Brachial plexus injury following median sternotomy. Interact Cardiovasc Thorac Surg. 2007; 6: 235-7.
4. Posniak HV, Olson MC, Dudiak CM, Wisniewski R, O'Malley C. MR Imaging of the Brachial Plexus. AJR AJR Am J Roentgenol. 1993; 161: 373-9.
5. Graham JG, Pye IF, McQueen IN. Brachial plexus injury after median sternotomy. J Neurol Neurosurg Psychiatry. 1981; 44: 621-5.
6. Tomlinson DL, Hirsch IA, Kodali SV, Slogoff S. Protecting the brachial plexus during median sternotomy. J Thorac Cardiovasc Surg. 1987; 94: 297-301.
7. Honet JC, Raikes JA, Kantrowitz A, Pursel SE, Rubenfire M. Neuropathy in the upper extremity after open-heart surgery. Arch Phys Med Rehabil. 1976; 57: 264-7.
8. Luigetti M, Pravatà E, Colosimo C, Sabatelli M, Masciullo M, Capone F, et al. MRI Neurography Findings in Patients with Idiopathic Brachial Plexopathy: Correlations with Clinical-neurophysiological Data in Eight Consecutive Cases. Intern Med. 2013; 52: 2031-9.
9. Smania N, Berto G, La Marchina E, Melotti C, Midiri A, Roncari L, et al. Rehabilitation of brachial plexus injuries in adults and children. Eur J Phys Rehabil Med. 2012; 48: 483-506.
10. Thatte MR, Babhulkar S, Hiremath A. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies. Ann Indian Acad Neurol. 2013; 16: 26-33.
11. Arad E, Stephens D, Curtis CG, Clarke HM. Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy. Plast Reconstr Surg. 2013; 131: 1307-15.