Sonographic measurements of normal C5‐C8 nerve roots in children

Abstract

Introduction The aim of this study was to use ultrasound to measure the cervical nerve roots in normal children to determine normal reference values. Methods A total of 441 children of different ages at the Children's Hospital of Chongqing Medical University were examined by ultrasound. The diameter, circumference, and cross‐sectional area of the nerve roots were measured. Results Ultrasonographic measurements were consistent with the ranking C5 < C6 < C7. The C8 nerve root was thicker than C7 in 60% of the participants. The nerve root measurements increased with increasing age, height, weight, and body surface area. Discussion Normal reference ranges of the cervical nerve roots in children of different ages were established, and can serve as the basis for measurement in future studies.

Risk factors for neonatal brachial plexus palsy attributed to anatomy, physiology, and evolution

“…Measuring the neonatal and adult BPs presented in Figure 2, using the scales provided for each image , we obtained the following rough estimates of the C7 nerve diameters: 2 mm for the neonate and 5 mm for the adult. These estimates are reasonably consistent with the absolute values presented by Wang and Wang (2020).…”

“…Many of these differences can contribute to a higher risk of BP damage in neonates than in adults. Wang and Wang (2020) provide comparative data on the size of BP nerves in neonates versus those in juveniles and young adults (Table 1). Regardless of which measure is considered (diameter, perimeter or cross-sectional area), neonatal nerves are much larger than one would expect, based on the massive difference in body F I G U R E 1 (A) Illustration of how the brachial plexus (BP) roots can be stretched by lateral traction when the shoulder is lodged under the pubic symphysis (shoulder dystocia).…”

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

“…113,114 In contrast to the adult population, systematic studies on yield of ultrasound in children with suspected CIDP are lacking. Only a few smaller studies reported on reference values for sonographic nerve sizes in different age categories, [115][116][117] • There is currently no evidence to support MRI in paediatric patients.…”

European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force—Second revision

“…In contrast to the adult population, systematic studies on yield of ultrasound in children with suspected CIDP are lacking. Only a few smaller studies reported on reference values for sonographic nerve sizes in different age categories[115][116][117], but stringent cut-off values based on disease controls are lacking.Rationale: Since in children inherited demyelinating neuropathies are much more prevalent than CIDP and since rater experience on nerve ultrasound in children is limited, the TF suggested not to use ultrasound to support the diagnosis in children. Ultrasound is a low-cost, widely available, non-invasive procedure with moderate diagnostic accuracy.MRI Good Practice Points• The TF suggested diagnose CIDP except in patients fulfilling diagnostic criteria for possible CIDP but not for CIDP.…”