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Related Concept Videos

Spinal Nerves: Plexus I01:22

Spinal Nerves: Plexus I

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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
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The cervical plexus, formed by the anterior rami of the first four...
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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Peripheral Artery Disease III: Interprofessional Care01:27

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Assessment of the Cardiovascular System III: Palpation01:27

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Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
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 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
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Spinal Nerves: Plexus II01:21

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The plexuses of the lower body include the lumbar, sacral, and coccygeal plexuses, which innervate the abdomen, pelvis, legs, and coccygeal region. These plexuses control the transmission of sensory information and coordinate motor functions of the lower body.
The Lumbar Plexus
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ACR Appropriateness Criteria® Plexopathy.

, Julie Bykowski1, Joseph M Aulino2

  • 1Principal Author and Panel Chair, UC San Diego Health, San Diego, California.

Journal of the American College of Radiology : JACR
|May 6, 2017
PubMed
Summary

Magnetic Resonance Imaging (MRI) is the most accurate method for evaluating brachial and lumbosacral plexus conditions. CT and PET/CT offer alternative imaging options when MRI is not feasible.

Keywords:
AUCAppropriate Use CriteriaAppropriateness CriteriaMRIbrachial plexusbrachial plexus neuritisbrachial plexus neuropathieslumbosacral plexussacral plexopathy

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Area of Science:

  • Radiology
  • Neurology
  • Medical Imaging

Background:

  • Accurate imaging is crucial for diagnosing intrinsic versus extrinsic nerve processes in the brachial and lumbosacral plexuses.
  • Current Procedural Terminology (CPT) codes do not discretely identify imaging studies of these specific nerve plexuses.
  • Imaging protocols for brachial and lumbosacral plexuses differ from routine scans, necessitating specific considerations.

Purpose of the Study:

  • To assess the accuracy and utility of various imaging modalities for evaluating the brachial and lumbosacral plexuses.
  • To provide guidance on appropriate imaging techniques based on clinical scenarios.
  • To address the lack of specific CPT codes for plexus imaging.

Main Methods:

  • Review of Magnetic Resonance Imaging (MRI) without and with contrast as the gold standard.
  • Evaluation of Computed Tomography (CT) as an alternative for anatomic assessment.
  • Assessment of Positron Emission Tomography/Computed Tomography (PET/CT) for oncologic applications.
  • Application of American College of Radiology Appropriateness Criteria (ACR) methodology.

Main Results:

  • MRI provides the highest accuracy for differentiating intrinsic from extrinsic nerve involvement.
  • CT offers the next best anatomic detail when MRI is contraindicated.
  • PET/CT aids in differentiating radiation plexitis from tumor recurrence in oncology patients but has limited plexus resolution.

Conclusions:

  • MRI is the preferred imaging modality for brachial and lumbosacral plexus evaluation.
  • CT and PET/CT serve as valuable adjuncts or alternatives in specific clinical contexts.
  • Standardized criteria and expert opinion guide appropriate imaging selection in the absence of definitive codes.