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Cheng Y, Xu X, Chen W, Wang Y. Doppler sonography for ulnar neuropathy at the elbow. Muscle Nerve 2016; 54:258-63. [PMID: 26718909 DOI: 10.1002/mus.25022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The aim of this study was to determine the value of Doppler sonography for evaluation of ulnar neuropathy at the elbow (UNE). METHODS A total of 102 patients with a clinical suspicion of UNE and 50 healthy controls were examined by Doppler and gray-scale sonography. RESULTS Intraneural vascularization was found in 31 (46.3%) of 67 patients with confirmed UNE and in 3 (6.0%) of 50 healthy controls. Combining gray-scale sonography measurement of nerve size and the presence of intraneural vascularization increased sensitivity by 3%, but decreased the specificity. Patients with intraneural vascularization had more severe disease than those without intraneural vascularization (P < 0.05). The variables obtained by Doppler sonography were associated with the severity of UNE (P < 0.05). CONCLUSIONS Doppler sonography is not helpful for diagnosing UNE but can be used to assess the severity of UNE. Muscle Nerve 54: 258-263, 2016.
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Affiliation(s)
- Yi Cheng
- Department of Ultrasound in Medicine, Fudan University affiliated Huashan Hospital, 12 Urumqi Middle Road, Shanghai, 200012, China
| | - Xiuyue Xu
- Department of Hand Surgery, Fudan University affiliated Huashan Hospital, Shanghai, China
| | - Weimin Chen
- Department of Ultrasound in Medicine, Fudan University affiliated Huashan Hospital, 12 Urumqi Middle Road, Shanghai, 200012, China
| | - Yi Wang
- Department of Ultrasound in Medicine, Fudan University affiliated Huashan Hospital, 12 Urumqi Middle Road, Shanghai, 200012, China
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Kang S, Kim SH, Yang SN, Yoon JS. Sonographic features of peripheral nerves at multiple sites in patients with diabetic polyneuropathy. J Diabetes Complications 2016; 30:518-23. [PMID: 26782023 DOI: 10.1016/j.jdiacomp.2015.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Diabetic polyneuropathy (DPN) is one of the major complications of diabetes mellitus. Ultrasound has been frequently used for evaluation of peripheral nerves. However, there are few studies that have evaluated multiple peripheral nerves in DPN. In this study, ultrasonographic features of multiple peripheral nerves in upper and lower extremities of DPN patients were investigated and compared with those of healthy controls. METHODS This study was a case-control study that enrolled 20 patients with confirmed diagnosis of DPN and 20 healthy controls. The ultrasonography was performed on the sural, tibial, fibular, sciatic, median, ulnar, radial, and musculocutaneous nerves. Nerve cross-sectional area (CSA) was measured at multiple points for each peripheral nerve. The CSAs were compared between DPN and control groups, and analyzed in relation to the clinical characteristics and electrophysiologic findings. RESULTS The CSAs were significantly larger in the DPN group for sural nerve, fibular nerve at the fibular head level, median nerve at the carpal tunnel and mid-humerus level, ulnar nerve at the cubital tunnel outlet and mid-humerus level, and radial nerve at the spiral groove. The CSAs of sural nerve, tibial nerve and median nerve were significantly correlated with electrophysiologic findings. The sural nerve CSA revealed significant correlation with HbA1c. CONCLUSIONS These results suggest that the ultrasonography can provide useful information in diagnosis and evaluation of DPN.
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Affiliation(s)
- Seok Kang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Se Hwa Kim
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea.
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Jacobson JA, Wilson TJ, Yang LJS. Sonography of Common Peripheral Nerve Disorders With Clinical Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:683-693. [PMID: 26931790 DOI: 10.7863/ultra.15.05061] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
Sonography is now considered an effective method to evaluate peripheral nerves. Low cost, high resolution, the ability to image an entire limb in a short time, and dynamic assessment are several of the positive attributes of sonography. This article will review the normal appearance of peripheral nerves as shown with sonography. In addition, the most common applications for sonography of the peripheral nerves will be reviewed, which include entrapment neuropathies, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Clinical information related to nerve disorders is also included, as it provides valuable information that can be obtained during sonographic examinations, increasing diagnostic accuracy.
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Affiliation(s)
- Jon A Jacobson
- Departments of Radiology, University of Michigan, Ann Arbor, Michigan USA.
| | - Thomas J Wilson
- Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan USA
| | - Lynda J-S Yang
- Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan USA
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Zbojniewicz AM. US for diagnosis of musculoskeletal conditions in the young athlete: emphasis on dynamic assessment. Radiographics 2015; 34:1145-62. [PMID: 25208273 DOI: 10.1148/rg.345130151] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) is increasingly recognized as an important tool for diagnosis and therapeutic management of a variety of musculoskeletal conditions. Advantages of US use in the young athlete include the ability to diagnose dynamic conditions that are occult with other modalities, provide additional diagnostic information, and aid in treatment. Uses of US in young patients include evaluation of acquired musculoskeletal conditions that manifest with symptoms and assessment of congenital variants that may manifest with pain or limitations in activity. Acquired conditions in the young athlete include tendon disorders, such as proximal tendinosis, and ligament disorders, such as anterior talofibular ligament or ulnar collateral ligament tears. While static images are frequently able to depict these disorders without difficulty, a dynamic examination that provides stress to the joint of interest may be able to uncover a ligament tear or insufficiency and concurrently provide the clinician with information regarding joint stability. Numerous congenital variants that occur throughout the musculoskeletal system can be associated with awkward sensations such as snapping, popping, and clunking and occasionally with pain. Pathologic processes associated with congenital variants in the upper extremities include slipping rib syndrome, atraumatic anterior subluxation of the sternoclavicular joint, and snapping triceps syndrome. Conditions that affect the lower extremities include internal and external snapping hip syndrome, snapping knee syndrome, and medial plica syndrome. The dynamic capability of US is ideal for diagnosis of many conditions that affect the musculoskeletal system of the young athlete, many of which would be difficult or impossible to identify with use of other imaging modalities.
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Affiliation(s)
- Andrew M Zbojniewicz
- From the Division of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45229
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Diagnostic accuracy of ultrasonographic and nerve conduction studies in ulnar neuropathy at the elbow. Clin Neurophysiol 2015; 126:1797-804. [DOI: 10.1016/j.clinph.2014.12.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 01/29/2023]
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Postoperative ulnar neuropathy is not necessarily iatrogenic: a prospective study on dynamic ulnar nerve dislocation at the elbow. World J Surg 2015; 38:1978-83. [PMID: 24668453 DOI: 10.1007/s00268-014-2508-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients who undergo surgery may develop ulnar neuropathy. Although the mechanism of ulnar neuropathy is still not clear, ulnar neuropathies are common causes of successful lawsuits against surgeons. Recently, the concept developed that endogenous patient factors can lead to postoperative peripheral neuropathies. We hypothesize that dynamic ulnar nerve dislocation at the elbow (DUNDE) may be a predisposing factor for ulnar irritation (i.e., neuropathy) in normal subjects. METHODS In a prospective investigation, patients aged 20 years and older presenting in our emergency department were asked to participate. Three physicians examined both elbows of subjects included in our study for evidence of DUNDE (through clinical and sonographic examination) and for clinical symptoms related to ulnar neuropathy. RESULTS Dynamic ulnar nerve dislocation was observed in 29.3% of examined subjects. No significant difference in its occurrence was observed in relation to gender or dominant side. Physical examination with provocation tests demonstrated significantly more positive Tinel tests and spontaneous signs of neuropathy in patients with dynamic dislocating ulnar nerves (14.7 vs. 1.1%). CONCLUSION Dynamic ulnar nerve dislocation may be linked to ulnar nerve irritability (i.e., ulnar neuropathy) in normal subjects without history of trauma, surgical procedure, or anesthesia. Considering the high incidence of this variant in the general population, our study supports previous investigations suggesting that many postoperative ulnar nerve deficits are traceable to chronic patient conditions. Our study suggests that dynamic ulnar nerve dislocation is a predisposing factor in the development of ulnar neuropathy in the postoperative period. NOTES (1) neuropathy should be viewed as a broad definition as signs of nerve irritation/inflammation, and independently of the pathophysiology and etiology; (2) because no specific term exists in the international anatomic nomenclature (Nomina Anatomica) to designate this variant, several synonyms have been used in the literature, leading to confusion and misleading conclusions concerning its traumatic etiologies and their consequences: (a) recurrent or habitual ulnar nerve luxation (or subluxation); (b) recurrent or habitual ulnar nerve dislocation; (c) ulnar nerve instability; (d) laxity of the ulnar nerve; and (e) ulnar nerve hypermobility.
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Ellegaard HR, Fuglsang-Frederiksen A, Hess A, Johnsen B, Qerama E. High-resolution ultrasound in ulnar neuropathy at the elbow: A prospective study. Muscle Nerve 2015; 52:759-66. [DOI: 10.1002/mus.24638] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Hanne R. Ellegaard
- Department of Clinical Neurophysiology; Aarhus University Hospital; Noerrebrogade 44, Building 10, Parterre 8000 Aarhus C Denmark
| | - Anders Fuglsang-Frederiksen
- Department of Clinical Neurophysiology; Aarhus University Hospital; Noerrebrogade 44, Building 10, Parterre 8000 Aarhus C Denmark
| | - Alexander Hess
- Department of Clinical Neurophysiology; Aarhus University Hospital; Noerrebrogade 44, Building 10, Parterre 8000 Aarhus C Denmark
| | - Birger Johnsen
- Department of Clinical Neurophysiology; Aarhus University Hospital; Noerrebrogade 44, Building 10, Parterre 8000 Aarhus C Denmark
| | - Erisela Qerama
- Department of Clinical Neurophysiology; Aarhus University Hospital; Noerrebrogade 44, Building 10, Parterre 8000 Aarhus C Denmark
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Carter GT, Weiss MD, Friedman AS, Allan CH, Robinson L. Diagnosis and Treatment of Work-Related Ulnar Neuropathy at the Elbow. Phys Med Rehabil Clin N Am 2015; 26:513-22. [PMID: 26231962 DOI: 10.1016/j.pmr.2015.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome and occurs most commonly at the elbow due to mechanical forces that produce traction or ischemia to the nerve. The primary symptom associated with UNE is diminished sensation or dysesthesias in the fourth or fifth digits, often coupled with pain in the proximal medial aspect of the elbow. Treatment may be conservative or surgical, but optimal management remains controversial. Surgery should include exploration of the ulnar nerve throughout its course around the elbow and release of all compressive structures.
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Affiliation(s)
- Gregory T Carter
- St Luke's Rehabilitation Institute, 711 South Cowley Avenue, Spokane, WA 99202, USA.
| | - Michael D Weiss
- Department of Neurology, University of Washington School of Medicine, 1959 NE, Pacific Avenue, Seattle, WA 98195, USA
| | - Andrew S Friedman
- Department of Physical Medicine and Rehabilitation, Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA 98101, USA
| | - Christopher H Allan
- Department of Orthopedic Surgery, Hand and Microsurgery Section, Harborview Medical Center, The University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Larry Robinson
- Rehabilitation Services, Physical Medicine and Rehabilitation, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
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Merkies ISJ, Faber CG, Lauria G. Advances in diagnostics and outcome measures in peripheral neuropathies. Neurosci Lett 2015; 596:3-13. [PMID: 25703220 DOI: 10.1016/j.neulet.2015.02.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/05/2015] [Accepted: 02/17/2015] [Indexed: 12/13/2022]
Abstract
Peripheral neuropathies are a group of acquired and hereditary disorders presenting with different distribution and nerve fiber class involvement. The overall prevalence is 2.4%, increasing to 8% in the elderly population. However, the frequency may vary depending on the underlying pathogenesis and association with systemic diseases. Distal symmetric polyneuropathy is the most common form, though multiple mononeuropathies, non-length dependent neuropathy and small fiber neuropathy can occur and may require specific diagnostic tools. The use of uniform outcome measures in peripheral neuropathies is important to improve the quality of randomized controlled trials, enabling comparison between studies. Recent developments in defining the optimal set of outcome measures in inflammatory neuropathies may serve as an example for other conditions. Diagnostic and outcome measure advances in peripheral neuropathies will be discussed.
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Affiliation(s)
- Ingemar S J Merkies
- Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Giuseppe Lauria
- 3rd Neurology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
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63
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Omejec G, Podnar S. Precise localization of ulnar neuropathy at the elbow. Clin Neurophysiol 2015; 126:2390-6. [PMID: 25743266 DOI: 10.1016/j.clinph.2015.01.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/11/2015] [Accepted: 01/26/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To report the utility of short-segment nerve conduction studies (SSNCSs) and ultrasonography (US) in the precise localization of ulnar neuropathy at the elbow (UNE) and differentiation between lesions in the retroepicondylar (RTC) groove and under the humeroulnar aponeurotic arcade (HUA; i.e., cubital tunnel). METHODS In a group of prospectively recruited patients with suspected UNE, four blinded examiners took a history and performed neurologic, electrodiagnostic (EDx) and ultrasonographic (US) examinations. Precise UNE localization was determined by SSNCSs criteria (conduction slowing and conduction block), and by US criteria (changes in cross-sectional area - CSA). Localizations obtained by EDx and US studies were compared. RESULTS We included 83 patients (86 arms) with SSNCSs or US diagnosis of UNE. US confirmed the SSNCSs localization in 45%, provided localization alone in 24%, and was unable to confirm SSNCSs localization in 23% of arms. Lesions in RTC (76%) were mainly demyelinating (63%), and localized at the medial epicondyle (29%) or 2 cm proximal to it (69%). By contrast, lesions at HUA (17%) were mainly axonal (73%), and localized 2 cm (57%) or 3 cm (43%) distal to the medial epicondyle. CONCLUSION SSNCSs and US are able to precisely localize UNE in the majority (93%) of arms with pathologic SSNCSs or US. UNE in RTC are predominantly demyelinating, and approx. 5-times more common than UNE at HUA that are more commonly axonal. SIGNIFICANCE SSNCSs and US are of similar utility and complement each other in precise UNE localization.
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Affiliation(s)
- Gregor Omejec
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
| | - Simon Podnar
- Institute of Clinical Neurophysiology, Division of Neurology, University Medical Center Ljubljana, Slovenia.
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64
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MR neurography of ulnar nerve entrapment at the cubital tunnel: a diffusion tensor imaging study. Eur Radiol 2015; 25:1911-8. [DOI: 10.1007/s00330-015-3613-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/30/2014] [Accepted: 01/19/2015] [Indexed: 01/21/2023]
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Abstract
Ulnar neuropathy at the elbow (UNE) is the second most frequent compression neuropathy. While other diagnostic imaging tools are emerging to assist in the diagnosis of UNE, electrodiagnosis remains the gold standard. However, the electrodiagnostic approach to UNE presents unique challenges limiting its diagnostic accuracy. We review advances in 5 areas relevant to the diagnosis of UNE: technologic advancements with modern EMG machines have allowed for reconsideration of the question of experimental error and lesion detection; how temperature effects can lead to misdiagnosis; the effect of body mass index on the electrodiagnosis of UNE; the validation of short segment studies; and the emerging role of high-resolution sonography as a diagnostic tool.
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Affiliation(s)
- William W Campbell
- Department of Neurology (WWC), Uniformed Services University of Health Sciences; and Department of Neurology (CC, MEL), Walter Reed National Military Medical Center, Bethesda, MD
| | - Craig Carroll
- Department of Neurology (WWC), Uniformed Services University of Health Sciences; and Department of Neurology (CC, MEL), Walter Reed National Military Medical Center, Bethesda, MD
| | - Mark E Landau
- Department of Neurology (WWC), Uniformed Services University of Health Sciences; and Department of Neurology (CC, MEL), Walter Reed National Military Medical Center, Bethesda, MD
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66
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Peck E, Strakowski JA. Ultrasound evaluation of focal neuropathies in athletes: a clinically-focused review. Br J Sports Med 2015; 49:166-75. [DOI: 10.1136/bjsports-2014-094268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zaidman CM, Pestronk A. Nerve size in chronic inflammatory demyelinating neuropathy varies with disease activity and therapy response over time: a retrospective ultrasound study. Muscle Nerve 2014; 50:733-8. [PMID: 24615614 DOI: 10.1002/mus.24227] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Nerves are often enlarged in chronic inflammatory demyelinating polyneuropathy (CIDP). In this investigation we studied changes with treatment over time. METHODS We retrospectively compared serial ultrasound measurements of median and ulnar nerve size with clinical and electrodiagnostic evaluations in 23 CIDP subjects. We defined remission as stable clinical improvement on low or decreasing amounts of medication. RESULTS Nerves were normal at last follow-up more often in subjects who achieved remission than in those who did not (10 of 13 vs. 0 of 10, P = 0.0001). Nerves were normal or smaller (>30% reduction) more often in subjects whose grip strength improved or remained strong compared those whose grip strength weakened (12 of 16 vs. 0 of 3, P = 0.04), and in subjects whose demyelinating electrodiagnostic features resolved compared with those whose demyelination persisted (7 of 7 vs. 6 of 12, P = 0.04). Over time, nerve size decreased more in subjects with baseline nerve enlargement who achieved remission than in those who did not (-41% vs. 7%, P = 0.04). CONCLUSION In CIDP, enlarged nerves normalized or decreased with remission.
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Affiliation(s)
- Craig M Zaidman
- Department of Neurology, Washington University School of Medicine, 660 South Euclid Avenue, Box 8111, St. Louis, Missouri, 63110, USA
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Alaqeel A, Alshomer F. High resolution ultrasound in the evaluation and management of traumatic peripheral nerve injuries: review of the literature. Oman Med J 2014; 29:314-9. [PMID: 25337305 PMCID: PMC4202223 DOI: 10.5001/omj.2014.86] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/13/2014] [Indexed: 01/09/2023] Open
Abstract
High-resolution ultrasound has been used as an important tool in the diagnosis, management and monitoring of both acute and chronic peripheral nerve injuries. According to literature, it demonstrated high sensitivity and specificity for the detection of specific pathologies and its ability to differentiate between them. Literature has been reviewed, summarizing the specific finding of such modality in various peripheral neuropathies and with a specific focus over its role in evaluation and management of traumatic peripheral neuropathies.
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Affiliation(s)
- Ahmed Alaqeel
- Division of Neurosurgery, Department of Clinical Neurosciences, Room 1195, 1403 29th St NW, Calgary, Alberta, Canada T2L 2T9; Division of Neurosurgery, Department of Surgery, Collage of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Feras Alshomer
- Division of Plastic Surgery, Department of Surgery, Collage of medicine, King Saud University, Riyadh, Saudi Arabia
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Poujade T, Hanouz N, Lecoq B, Hulet C, Collon S. Ultrasound-guided surgical treatment for ulnar nerve entrapment: a cadaver study. ACTA ACUST UNITED AC 2014; 33:256-62. [PMID: 24981578 DOI: 10.1016/j.main.2014.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/05/2014] [Accepted: 05/30/2014] [Indexed: 11/16/2022]
Abstract
Several open and endoscopic techniques for the surgical treatment of ulnar nerve entrapment at the elbow (cubital tunnel syndrome) have been described that provide decompression with or without anterior transposition. Based on our experience with US-guided decompression for carpal tunnel syndrome in our department, we developed a similar surgical technique for the decompression of the ulnar nerve at the elbow. Using sixteen cadaver upper limbs, we performed decompression of all the structures possibly responsible for ulnar nerve compression at the elbow. The structures involved were Struthers' arcade, the cubital tunnel retinaculum, Osborne's fascia and Amadio-Beckenbaugh's arcade. The procedure was followed by anatomical dissection to confirm complete sectioning of the compressive structures, absence of iatrogenic vascular or nervous injuries and absence of nerve dislocation or instability. There were no remaining compressive structures after the release procedure. There was no iatrogenic damage to the nerves and no nerve dislocation was observed during elbow flexion or extension. In 3.4% cases, a thin superficial layer of one or more of the identified structures remained but these did not appear to compress the nerve based on US imaging. Using ultrasonographic visualization of the nerve and compressive structures is easy. Each procedure can be tailored according to the nerve compression sites. Our cadaveric study shows the feasibility of an US-guided percutaneous surgical release for ulnar nerve entrapment.
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Affiliation(s)
- T Poujade
- Comete Inserm U1075 - UCBN EA 3917, département de chirurgie orthopédique et traumatologique, hôpital Côte-de-Nacre, CHU de Caen, BP 95182, 14033 Caen cedex 9, France.
| | - N Hanouz
- Comete Inserm U1075 - UCBN EA 3917, département de chirurgie orthopédique et traumatologique, hôpital Côte-de-Nacre, CHU de Caen, BP 95182, 14033 Caen cedex 9, France
| | - B Lecoq
- Service de rhumatologie, hôpital Côte-de-Nacre, CHU de Caen, BP 95182, 14033 Caen cedex 9, France
| | - C Hulet
- Comete Inserm U1075 - UCBN EA 3917, département de chirurgie orthopédique et traumatologique, hôpital Côte-de-Nacre, CHU de Caen, BP 95182, 14033 Caen cedex 9, France
| | - S Collon
- Comete Inserm U1075 - UCBN EA 3917, département de chirurgie orthopédique et traumatologique, hôpital Côte-de-Nacre, CHU de Caen, BP 95182, 14033 Caen cedex 9, France
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Lu M, Wang Y, Yue L, Chiu J, He F, Wu X, Zang B, Lu B, Yao X, Jiang Z. Follow-up evaluation with ultrasonography of peripheral nerve injuries after an earthquake. Neural Regen Res 2014; 9:582-8. [PMID: 25206859 PMCID: PMC4146238 DOI: 10.4103/1673-5374.130095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 01/02/2023] Open
Abstract
Published data on earthquake-associated peripheral nerve injury is very limited. Ultrasonography has been proven to be efficient in the clinic to diagnose peripheral nerve injury. The aim of this study was to assess the role of ultrasound in the evaluation of persistent peripheral nerve injuries 1 year after the Wenchuan earthquake. Thirty-four patients with persistent clinical symptoms and neurologic signs of impaired nerve function were evaluated with sonography prior to surgical repair. Among 34 patients, ultrasonography showed that 48 peripheral nerves were entrapped, and 11 peripheral nerves were disrupted. There was one case of misdiagnosis on ultrasonography. The concordance rate of ultrasonographic findings with those of surgical findings was 98%. A total of 48 involved nerves underwent neurolysis and the symptoms resolved. Only five nerves had scar tissue entrapment. Preoperative and postoperative clinical and ultrasonographic results were concordant, which verified that ultrasonography is useful for preoperative diagnosis and postoperative evaluation of injured peripheral nerves.
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Affiliation(s)
- Man Lu
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Yue Wang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Linxian Yue
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Jack Chiu
- Department of Radiology, University Hospital, University of Western Ontario, Ontario, Canada
| | - Fanding He
- Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Xiaojing Wu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Bin Zang
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Bin Lu
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Xiaoke Yao
- Department of Orthopedics, Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, China
| | - Zirui Jiang
- Chengdu Jiaxiang Foreign Languages School, Chengdu, Sichuan Province, China
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Toros T. Commentary on Zyluk et al. No correlation between sonographic and electrophysiological parameters in carpal tunnel syndrome; and Yalcin et al. Ultrasound diagnosis of ulnar neuropathy: comparison of symptomatic and asymtomatic nerve thickness. J Hand Surg Eur Vol 2014; 39:172-4. [PMID: 24448794 DOI: 10.1177/1753193413513524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T Toros
- EMOT Hospital, Hand Surgery, İzmir, Turkey.
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Yalcin E, Unlu E, Akyuz M, Karaahmet OZ. Ultrasound diagnosis of ulnar neuropathy: comparison of symptomatic and asymptomatic nerve thickness. J Hand Surg Eur Vol 2014; 39:167-71. [PMID: 23592536 DOI: 10.1177/1753193413484627] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is still no consensus on a normal value for the cross-sectional area of the ulnar nerve at the elbow. Such data would be valuable for the ultrasound diagnosis of ulnar neuropathy. Comparison of the symptomatic and contralateral asymptomatic sides has been recommended. The aim of this study was to investigate whether or not the asymptomatic ulnar nerve could be a reference value. High-resolution ultrasonic measurements of the cross-sectional areas of the ulnar nerves at the elbow were compared with 38 contralateral asymptomatic elbows of patients with unilateral ulnar neuropathy and 38 healthy controls. There were significant differences in the cross-sectional areas at all levels between the healthy control subjects and asymptomatic side of the ulnar neuropathy patients (p < 0.05). The findings of this study suggest that there is a limitation in using the asymptomatic side for obtaining reference values in ultrasonographic studies. Each ultrasonographic laboratory should determine its own reference values.
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Affiliation(s)
- E Yalcin
- 1Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine & Rehabilitation Training and Research Hospital of the Ministry of Health, Ankara, Turkey
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73
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Hobson-Webb LD, Cartwright MS. Nerve ultrasound in CIDP: Poly-parameters for polyneuropathies. Clin Neurophysiol 2014; 125:3-4. [DOI: 10.1016/j.clinph.2013.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/19/2013] [Indexed: 01/10/2023]
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74
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Ultrasound of inherited vs. acquired demyelinating polyneuropathies. J Neurol 2013; 260:3115-21. [PMID: 24101129 DOI: 10.1007/s00415-013-7123-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 12/23/2022]
Abstract
We compared features of nerve enlargement in inherited and acquired demyelinating neuropathies using ultrasound. We measured median and ulnar nerve cross-sectional areas in proximal and distal regions in 128 children and adults with inherited [Charcot-Marie-Tooth-1 (CMT-1) (n = 35)] and acquired [chronic inflammatory demyelinating polyneuropathy (CIDP) (n = 55), Guillaine-Barre syndrome (GBS) (n = 21) and multifocal motor neuropathy (MMN) (n = 17)] demyelinating neuropathies. We classified nerve enlargement by degree and number of regions affected. We defined patterns of nerve enlargement as: none, no enlargement; mild, nerves enlarged but never more than twice normal; regional, nerves normal in at least one region and enlarged more than twice normal in at least one region; diffuse, nerves enlarged at all four regions with at least one region more than twice normal size. Nerve enlargement was commonly diffuse (89 %) and generally more than twice normal size in CMT-1, but not (p < 0.001) in acquired disorders which mostly had either no, mild or regional nerve enlargement [CIDP (64 %), GBS (95 %), and MMN (100 %)]. In CIDP, subjects treated within 3 months of disease onset had less nerve enlargement than those treated later. Ultrasound identified patterns of diffuse nerve enlargement can be used to screen patients suspected of having CMT-1. Normal, mildly, or regionally enlarged nerves in demyelinating polyneuropathy suggests an acquired etiology. Early treatment in CIDP may impede nerve enlargement.
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75
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Yang SN, Yoon JS, Kim SJ, Kang HJ, Kim SH. Movement of the ulnar nerve at the elbow: a sonographic study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1747-1752. [PMID: 24065255 DOI: 10.7863/ultra.32.10.1747] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aim of this study was to measure the degree of movement of the ulnar nerve in the cubital tunnel using sonography in patients with ulnar neuropathy at the elbow compared to a healthy control group. METHODS We examined the ulnar nerve in the cubital tunnel using sonography with the elbow extended and then flexed in 26 patients with ulnar neuropathy and 13 control participants. The distance from the ulnar nerve to the skin, medial epicondyle, and tip of olecranon at the inlet of the cubital tunnel and the distance from the ulnar nerve to the skin and olecranon recess at the outlet of the cubital tunnel were measured when the elbow was extended and flexed, respectively. Displacement of the ulnar nerve during elbow extension and flexion between patients with ulnar neuropathy and controls was compared. RESULTS There was significantly greater displacement of the ulnar nerve to the medial epicondyle at the inlet of the cubital tunnel in the patients with ulnar neuropathy (mean ± SD, 4.22 ± 3.79 mm) compared to the controls (1.76 ± 1.51 mm) during elbow extension and flexion (P = .008). CONCLUSIONS A significantly greater degree of movement of the ulnar nerve occurs in patients with ulnar neuropathy at the elbow compared to healthy people, as determined by sonography.
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Affiliation(s)
- Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 80 Guro-gu, Guro-dong, Seoul 152-703, Korea.
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76
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Abstract
Over the last decade, neuromuscular ultrasonography has emerged as a useful tool for the diagnosis of peripheral nerve disorders. This article reviews sonographic findings of normal nerves, including key quantitative ultrasound measurements that are helpful in the evaluation of focal and possibly generalized peripheral neuropathies. It also discusses several recent articles outlining the evidence base for the use of this technology, as well as new findings in compressive, traumatic, and generalized neuropathies. Ultrasonography is well suited for use in electrodiagnostic laboratories, where physicians, experienced in both the clinical evaluation of patients and the application of hands-on technology, can integrate findings from the patient's history, physical examination, electrophysiological studies, and imaging for diagnosis and management.
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Affiliation(s)
- Jung Im Suk
- Department of Neurology, School of Medicine, Catholic University of Daegu, 3056-6, Daemyeong-4-dong, Nam-gu, Daegu, South Korea.
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77
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Goedee HS, Brekelmans GJF, van Asseldonk JTH, Beekman R, Mess WH, Visser LH. High resolution sonography in the evaluation of the peripheral nervous system in polyneuropathy - a review of the literature. Eur J Neurol 2013; 20:1342-51. [DOI: 10.1111/ene.12182] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/25/2013] [Indexed: 12/20/2022]
Affiliation(s)
- H. S. Goedee
- Department of Neurology and Clinical Neurophysiology; St Elisabeth Hospital; Tilburg; The Netherlands
| | - G. J. F. Brekelmans
- Department of Neurology and Clinical Neurophysiology; St Elisabeth Hospital; Tilburg; The Netherlands
| | | | - R. Beekman
- Department of Neurology; Atrium Medical Centre; Heerlen; The Netherlands
| | - W. H. Mess
- Department of Clinical Neurophysiology; Maastricht University Medical Centre; Maastricht; The Netherlands
| | - L. H. Visser
- Department of Neurology and Clinical Neurophysiology; St Elisabeth Hospital; Tilburg; The Netherlands
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78
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Won SJ, Kim BJ, Park KS, Yoon JS, Choi H. Reference values for nerve ultrasonography in the upper extremity. Muscle Nerve 2013; 47:864-71. [DOI: 10.1002/mus.23691] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 12/24/2022]
Affiliation(s)
- Sun Jae Won
- Department of Rehabilitation Medicine; Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Seoul; South Korea
| | - Byung-Jo Kim
- Department of Neurology; Korea University College of Medicine; Seoul; South Korea
| | - Kyung Seok Park
- Department of Neurology; Seoul National University Bundang Hospital, Seoul National University, College of Medicine; Seoul; South Korea
| | - Joon Shik Yoon
- Department of Rehabilitation Medicine; Korea University College of Medicine; 80 Guro Gu, Guro Dong; Seoul; South Korea
| | - Hyuk Choi
- Department of Medical Sciences; Graduate School of Medicine, Korea University; Seoul; South Korea
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79
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Hobson-Webb LD. Neuromuscular ultrasound in polyneuropathies and motor neuron disease. Muscle Nerve 2013; 47:790-804. [DOI: 10.1002/mus.23737] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 12/12/2022]
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80
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The international society of peripheral neurophysiological imaging: Pioneering innovation in a multidisciplinary context. Clin Neurophysiol 2013; 124:631-3. [DOI: 10.1016/j.clinph.2012.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/26/2012] [Indexed: 11/17/2022]
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81
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Cho NS, Kim DH, Kim MY, Park BK. Electrophysiological and ultrasonographic findings in ulnar neuropathy with Martin-Gruber anastomosis. Muscle Nerve 2013; 47:604-7. [PMID: 23463669 DOI: 10.1002/mus.23607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2012] [Indexed: 11/05/2022]
Abstract
INTRODUCTION It is important to understand the presence of Martin-Gruber anastomosis in patients with complete ulnar neuropathy at the elbow. CASE REPORT We describe a patient with complete ulnar neuropathy at the elbow and Martin-Gruber anastomosis in the forearm, mimicking incomplete ulnar neuropathy with complete conduction block in the forearm segment. Ultrasonography of the ulnar nerve around the elbow demonstrated severe swelling of the ulnar nerve, which was compatible with severe ulnar neuropathy at the elbow. CONCLUSIONS This case report demonstrates that combination of ultrasonography with electrophysiological studies can provide more detailed information about the changes of nerve structures and lesion sites.
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Affiliation(s)
- Nam Soon Cho
- Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, #516, Gojan-dong, Danwon-gu, Ansan city, Gyeonggi Province, Republic of Korea
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82
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Scheidl E, Böhm J, Farbaky Z, Simó M, Bereczki D, Arányi Z. Ultrasonography of ulnar neuropathy at the elbow: Axonal involvement leads to greater nerve swelling than demyelinating nerve lesion. Clin Neurophysiol 2013; 124:619-25. [DOI: 10.1016/j.clinph.2012.08.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 07/14/2012] [Accepted: 08/19/2012] [Indexed: 11/29/2022]
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83
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Landau ME, Campbell WW. Clinical Features and Electrodiagnosis of Ulnar Neuropathies. Phys Med Rehabil Clin N Am 2013. [DOI: 10.1016/j.pmr.2012.08.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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84
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Stoll G, Wilder-Smith E, Bendszus M. Imaging of the peripheral nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:137-153. [PMID: 23931778 DOI: 10.1016/b978-0-444-52902-2.00008-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This chapter summarizes progress in the evaluation of peripheral nerve (PN) lesions and disorders by imaging techniques encompassing magnetic resonance imaging (MRI) and nerve ultrasound (US). Due to the radiation exposure and limited sensitivity in soft tissue contrast, computed-tomography (CT) plays no significant role in the diagnostic work-up of PN disorders. MRI and US are complementary techniques for the evaluation of peripheral nerves, each having particular advantages and disadvantages. Nerve injury induces intrinsic MRI signal alterations on T2-weighted sequences in degenerating or demyelinating nerve segments as well as in corresponding muscle groups exhibiting denervation which can be exploited diagnostically. Nerve US is based on changes in the nerve echotexture due to tumor formation or focal enlargement caused by entrapment or inflammation. Both MRI and US provide morphological information on the precise site and extent of nerve injury. While US has the advantage of easy accessibility, providing images with superior spatial resolution at low cost, MRI shows better soft tissue contrast and better image quality for deep-lying nerve structures since imaging is not hindered by bone. Recent advances have remarkably increased spatial resolution of both MRI and US making imaging indispensible for the elucidation of causes of nerve compression, peripheral nerve tumors, and focal inflammatory conditions. Both MRI and US further guide neurosurgical exploration and can simplify treatment. Importantly, imaging can reveal treatable conditions even in the absence of gross electrophysiological alterations, illustrating its increasing role in clinical practice. In experimental settings, novel molecular and cellular MRI contrast agents allow in-vivo assessment of nerve regeneration as well as monitoring of neuroinflammation. Depending on further clinical development, contrast-enhanced MRI has the potential to follow cellular responses over time in vivo and to overcome the current limitations of histological assessment of nerve afflictions. Further advances in contrast-enhanced US has the potential for developing into a tool for the assessment of nerve blood perfusion, paving the way for better assessments of ischemic neuropathies.
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Affiliation(s)
- Guido Stoll
- Department of Neurology, University of Würzburg, Würzburg, Germany.
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85
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Won SJ, Kim BJ, Park KS, Kim SH, Yoon JS. Measurement of cross-sectional area of cervical roots and brachial plexus trunks. Muscle Nerve 2012; 46:711-6. [PMID: 23055312 DOI: 10.1002/mus.23503] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aim of this study was to determine normal reference values for cross-sectional area (CSA) and the correlation between demographic factors and CSA in the cervical roots and brachial plexus trunks using ultrasonography. METHODS Ninety-five age-matched healthy individuals were studied. Ultrasonographic tests were performed via nerve tracing from the cervical root to the brachial plexus trunk. The CSA of each nerve was measured in the C5-8 ventral roots and brachial plexus (trunk level). RESULTS Normal values of each cervical root were: C5, 5.66 ± 1.02 mm(2); C6, 8.98 ± 1.65 mm(2); C7, 10.43 ± 1.86 mm(2); and C8, 10.76 ± 2.02 mm(2). Values for the brachial plexus were: upper trunk, 16.70 ± 2.88 mm(2); middle trunk, 14.01 ± 2.70 mm(2); and lower trunk, 13.75 ± 2.57 mm(2). The side-to-side discrepancy was 11.91 ± 11.11%. Body mass index (BMI) and height correlated frequently with nerve CSA. CONCLUSIONS These reference values may be helpful in investigating pathologies involving the cervical area.
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Affiliation(s)
- Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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86
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Walker FO. Measuring severity and dolor almighty. Clin Neurophysiol 2012; 124:435-6. [PMID: 23072777 DOI: 10.1016/j.clinph.2012.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 09/10/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022]
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87
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Pompe SM, Beekman R. Which ultrasonographic measure has the upper hand in ulnar neuropathy at the elbow? Clin Neurophysiol 2012; 124:190-6. [PMID: 23036180 DOI: 10.1016/j.clinph.2012.05.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/09/2012] [Accepted: 05/15/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy of ultrasonographic ulnar nerve diameter, cross-sectional area (CSA) and swelling ratio measurement in ulnar neuropathy at the elbow (UNE). METHODS Ultrasonographic diameter, CSA, and swelling ratio measurements were compared with a reference standard including clinical examination, electrophysiological studies, and follow-up in a prospective cohort of patients. All patients in whom a diagnosis of UNE was considered were eligible for the study. Reference values for ultrasonography were obtained in 73 healthy volunteers. RESULTS Of 191 patients, 137 had UNE or probable UNE, while 54 had another condition and these were analysed as patient controls. Patients with UNE had a larger ulnar nerve diameter, CSA and swelling ratio than healthy controls and patient controls (p < 0.01). The diagnostic accuracies of these different measurements were comparable with a specificity of 78-87%, a positive predictive value of 87-90%, a sensitivity of 42-61% and negative predictive value of 37-44%. ROC-analysis for these measurements showed an area under the curve of 0.75-0.77. CONCLUSION Ultrasonographic measurements of ulnar nerve diameter, CSA and swelling ratio have comparable diagnostic value, which was lower than reported previously. SIGNIFICANCE Ultrasonographic ulnar nerve diameter, CSA and swelling ratio measurements are equally useful in diagnosing UNE.
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Affiliation(s)
- Sander M Pompe
- Departments of Neurology and Clinical Neurophysiology, Atrium Medical Centre Heerlen, The Netherlands.
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88
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Erez O, Khalil JG, Legakis JE, Tweedie J, Kaminski E, Reynolds RAK. Ultrasound evaluation of ulnar nerve anatomy in the pediatric population. J Pediatr Orthop 2012; 32:641-6. [PMID: 22892630 DOI: 10.1097/bpo.0b013e318263a3c0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ulnar nerve instability has been reported in up to 17% of children. Accurate assessment is important to achieve because of potential nerve complications that can arise from treatment of common pediatric fractures, including supracondylar humerus fractures. The objective of our study was to evaluate our ability to use ultrasonography to determine the extent of ulnar nerve dislocation in the normal pediatric population and to determine if there is a relationship between ulnar nerve instability and ligamentous laxity. METHODS We conducted a prospective ultrasound evaluation of 51 children, examining the excursion of the ulnar nerve through full range of motion. On the basis of its movement during flexion, the ulnar nerve was categorized as stable, subluxating, or dislocating. In addition, we assessed all subjects for ligamentous laxity using the Wynne-Davies signs of joint laxity. The subjects were then divided into groups based on age or ligamentous laxity, and statistical analysis was performed. RESULTS Most of the elbows evaluated had stable ulnar nerves (64/102, 62.7%), 27.5% (28/102) had subluxating nerves, and 9.8% (10/102) had dislocating nerves. Patients aged between 6 and 10 showed the highest rate of dislocating or subluxating nerves, with 50%, and also the highest average laxity score, 2.0. When grouped according to ligamentous laxity, patients who had multiple signs of ligamentous laxity had statistically higher numbers of subluxating and dislocating nerves (91.6%, 11/12) than those with lower laxity scores (25.6%, 10/39). CONCLUSIONS There are a substantial number of subluxating or dislocating ulnar nerves in children, and the incidence is often bilateral. Patients with ligamentous laxity are more likely to possess unstable ulnar nerves. Ultrasound evaluation and assessment of ligamentous laxity are additional tools that can be used to assess elbow anatomy and identify children at risk for iatrogenic nerve injury. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Orry Erez
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, MI, USA
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89
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Vuillemin V, Guerini H, Morvan G. Musculoskeletal interventional ultrasonography: the upper limb. Diagn Interv Imaging 2012; 93:665-73. [PMID: 22921692 DOI: 10.1016/j.diii.2012.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Forty percent of the 823 ultrasound-guided injections performed in our centre over a year and a half concerned the upper limb, injections involving the shoulder, for subacromial bursitis and the treatment of calcific tendinitis, being the prime indications (24%). The wrist represented 8% of the prescriptions, for treatment of tendinopathy, ganglion cysts, carpal tunnel syndrome and rhizarthrosis. Trigger finger, tenosynovitis and pulley ganglia made up 6% of the indications and the elbow 2.5%. Ultrasound improves the accuracy of the procedure by helping guide the path of the needle and allowing the distribution of the substance injected to be visualised. We shall give details of the technique used for each indication, with advice and hints and post-procedure recommendations.
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Affiliation(s)
- V Vuillemin
- Imagerie médicale Léonard de Vinci, Paris, France.
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90
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Ayromlou H, Tarzamni MK, Daghighi MH, Pezeshki MZ, Yazdchi M, Sadeghi-Hokmabadi E, Sharifipour E, Ghabili K. Diagnostic value of ultrasonography and magnetic resonance imaging in ulnar neuropathy at the elbow. ISRN NEUROLOGY 2012; 2012:491892. [PMID: 22888452 PMCID: PMC3409534 DOI: 10.5402/2012/491892] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/30/2012] [Indexed: 11/23/2022]
Abstract
Aim. To evaluate the diagnostic value of ultrasonography and magnetic resonance imaging (MRI) in patients with ulnar neuropathy at the elbow (UNE). Methods. We prospectively performed electrodiagnostic, ultrasonographic, and MRI studies in UNE patients and healthy controls. Three cross-sectional area (CSA) measurements of the ulnar nerve at multiple levels along the arm and maximum CSA(-max) were recorded. Results. The ulnar nerve CSA measurements were different between the UNE severity grades (P < 0.05). CSA-max had the greatest sensitivity (93%) and specificity (68%). Moreover, CSA-max ≥10 mm2 defined the severe UNE cases (sensitivity/specificity: 82%/72%). In MRI, ulnar nerve hyperintensity had the greatest sensitivity (90%) and specificity (80%). Conclusion. Ultrasonography using CSA-max is sensitive and specific in UNE diagnosis and discriminating the severe UNE cases. Furthermore, MRI particularly targeting at increased signal of the ulnar nerve can be a useful diagnostic test of UNE.
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Affiliation(s)
- Hormoz Ayromlou
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz 51666-14756, Iran
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91
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Hobson-Webb LD, Padua L, Martinoli C. Ultrasonography in the diagnosis of peripheral nerve disease. ACTA ACUST UNITED AC 2012; 6:457-71. [PMID: 23480810 DOI: 10.1517/17530059.2012.692904] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION High-resolution ultrasound (US) of the peripheral nerves is now a standard means of assessing neuromuscular disorders in many centers. Currently used in conjunction with electrodiagnostic (EDX) studies, nerve US is especially effective in the diagnosis of entrapment neuropathies. AREAS COVERED This article reviews the basic physics of peripheral nerve US, guidelines for its current use and future directions. Advantages of using nerve US alongside EDX studies are outlined along with current limitations of testing. The role of US in the diagnosis of entrapment neuropathy is emphasized, particularly in carpal tunnel syndrome (CTS). US assisted diagnosis of peripheral nerve tumors, hereditary neuropathy and dysimmune neuropathy and traumatic injuries is also described. EXPERT OPINION US is a powerful tool in the assessment of peripheral nerve disease. Nerve US is an evolving, young discipline. There is still much to learn, but current evidence supports US imaging of all patients presenting for evaluation of possible mononeuropathy. With improvements in resolution, the introduction of US contrast agents and objective measures of nerve echogenicity, there is promise for further expanding its role in the diagnosis of all peripheral neuropathies.
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Affiliation(s)
- Lisa D Hobson-Webb
- Duke University Medical Center, Department of Neurology , Durham, NC 27710 , USA +1 919 668 2277 ; +1 919 660 3853 ;
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92
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Visser LH, Jain S, Lokesh B, Suneetha S, Subbanna J. Morphological changes of the epineurium in leprosy: A new finding detected by high-resolution sonography. Muscle Nerve 2012; 46:38-41. [DOI: 10.1002/mus.23269] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2011] [Indexed: 11/07/2022]
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93
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Boom J, Visser LH. Quantitative assessment of nerve echogenicity: comparison of methods for evaluating nerve echogenicity in ulnar neuropathy at the elbow. Clin Neurophysiol 2012; 123:1446-53. [PMID: 22217961 DOI: 10.1016/j.clinph.2011.10.050] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 10/05/2011] [Accepted: 10/24/2011] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective is to evaluate different methods to assess nerve echogenicity in a quantitative way by comparing a group of patients with ulnar neuropathy at the elbow (UNE) and a healthy control group, subsequently selecting the best tests for quantitative assessment of nerve echogenicity. METHODS We included 56 patients with UNE and 37 healthy controls. High-resolution ultrasonography images of the ulnar nerve at the level of the medial epicondyle were saved in JPEG, TIFF or DICOM format, with a 19 pixels/mm resolution. Hypoechoic fraction was calculated by using 1 manual and 16 automatic thresholding methods. RESULTS A significant difference in mean hypoechoic fraction between patients and controls was found using the following automatic thresholding methods: MaxEntropy 82% versus 74% (p < 0.001), RenyiEntropy 80% versus 69% (p < 0.001), Shanbhag 76% versus 68% (p = 0.002), Triangle 45% versus 58% (p = 0.036) and Yen 79% versus 67% (p < 0.001). Of these five tests a significant correlation between hypoechoic fraction and the cross-sectional area was found for: MaxEntropy 0.542 (p < 0.001), RenyiEntropy 0.558 (p < 0.001), Shanbhag 0.219 (p = 0.035) and Yen 0.513 (p < 0.001). The manual thresholding method did not detect a significant difference in hypoechoic fraction between patients and controls, and inter-rater agreement in hypoechoic fraction for manual thresholding was poor. CONCLUSION Quantitative nerve echogenicity assessment can be successfully used to distinguish between a group of patients with UNE and a healthy control group, preferably by using the MaxEntropy, RenyiEntropy or Yen methods. SIGNIFICANCE Automatic thresholding techniques using the MaxEntropy, RenyiEntropy or Yen methods are the best quantitative tests, and these quantitative measures can probably be used in further studies evaluating echogenicity in mono- and polyneuropathies.
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Affiliation(s)
- J Boom
- Department of Neurology, St Elisabeth Hospital, Tilburg, The Netherlands
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94
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Boon AJ, Harper CM. Ultrasound in the diagnosis of mononeuropathy: Future directions. Muscle Nerve 2011; 44:851-3. [DOI: 10.1002/mus.22242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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