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Designing for Upper Torso and Arm Anatomy
Published in Karen L. LaBat, Karen S. Ryan, Human Body, 2019
Understanding the location and structure of the brachial plexus is important when designing upper torso wearables (Figure 4.26). Spinal nerve fibers—motor, sensory, and autonomic nervous system fibers—from cervical spinal nerves 5 through 8, plus the first thoracic spinal nerve form the brachial plexus. They regroup into different fiber combinations as they move through the brachial plexus. As with the phrenic nerves, this fiber regrouping likely helps diminish localized injury effects. Leaving the plexus, the fibers branch into 16 peripheral nerves which serve the shoulder region, the arm (brachium), and hand. The brachial plexus is vulnerable to compression, and injury, between the clavicle and the first rib. Carrying loads in packs with straps across the trapezius muscle, above the clavicle, puts it at risk. Distributing weight in a vest or providing a waist belt to shift weight from the shoulder can help to decrease focal pressure on the brachial plexus.
Treatment planning
Published in Jing Cai, Joe Y. Chang, Fang-Fang Yin, Principles and Practice of Image-Guided Radiation Therapy of Lung Cancer, 2017
Yan Yu, Kamila Nowak Choi, Virginia Lockamy
The brachial plexus is a nervous network that arises from the four lower-most cervical nerves and the first thoracic nerves. This network controls the sensation and motor function of the upper extremities. Radiation injury of the brachial plexus, or brachial plexopathy, may manifest as pain, paresthesia, or motor weakness. A 2012 retrospective study of patients with NSCLC undergoing conventionally fractionated RT with concurrent chemotherapy examining rates of brachial plexopathy found a strong association and higher rates of brachial plexopathy with median brachial plexus doses greater than 69 Gy and doses to 0.1 cm3 of brachial plexus greater than 75 Gy [84]. In a retrospective study from Indiana University looking at apical lung lesions treated with SBRT, a maximum brachial plexus dose of 26 Gy or greater was associated with significantly higher rates of brachial plexopathy. Current clinical trials recommend a maximum dose ≤63–66 Gy [79] with conventional fractionation. For SBRT, brachial plexus dose constraints include 17.5 Gy if single fraction, 24 Gy (8 Gy/fx) max with 3-fraction regimens, 27.2 Gy (6.8 Gy per fraction with 4-fraction regimens, and 32 Gy max (6.4 Gy/fx) with 5-fraction regimens [66].
MR neurography of the brachial plexus in adult and pediatric age groups: evolution, recent advances, and future directions
Published in Expert Review of Medical Devices, 2020
Alexander T. Mazal, Ali Faramarzalian, Jonathan D. Samet, Kevin Gill, Jonathan Cheng, Avneesh Chhabra
The Brachial plexus is a large network of peripheral nerves arising from the cervicothoracic spine which provides motor and sensory functions to the upper extremities. The clinical differentiation of brachial plexopathy from cervical spine-related radiculopathy or nerve injury has been a longstanding diagnostic challenge, as history, physical examination findings and electrodiagnostic testing are frequently indeterminate in this domain. MR neurography (MRN) of the brachial plexus has emerged in recent years as a useful modality for the identification of brachial plexopathies in both pediatric and adult populations. The article discusses the current state of brachial plexus MRN, including recent advances and future directions, as well as illustrate adult and pediatric brachial plexopathies that can be optimally characterized using these techniques.