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Median Nerve Block. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Agarwal A, Chandra A, Jaipal U, Saini N. A panorama of radial nerve pathologies- an imaging diagnosis: a step ahead. Insights Imaging 2018; 9:1021-1034. [PMID: 30397879 PMCID: PMC6269333 DOI: 10.1007/s13244-018-0662-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 12/23/2022] Open
Abstract
Abstract The radial nerve has a long and tortuous course in the upper limb. Injury to the nerve can occur due to a multitude of causes at many potential sites along its course. The most common site of involvement is in the proximal forearm affecting the posterior interosseous branch while the main branch of the radial nerve is injured in fractures of the humeral shaft. Signs and symptoms of radial neuropathy depend upon the site of injury. Injury to the nerve distal to innervation of triceps brachii results in loss of extensor function with sparing of function of the triceps resulting in the characteristic ‘wrist drop’. Injury in the mid-arm is associated with loss of sensation in the dorsolateral aspect of the hand, the dorsal aspect of the radial three-and-a-half digits and in the first web space. Involvement of only the posterior interosseous nerve (PIN) results in weakness of the wrist and digit extensors. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of the exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft-tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of radial neuropathy and emphasises the importance of imaging modalities in diagnosis of neuropathies. Teaching Points • Radial nerve injuries are assessed by clinical examination and diagnosed using electrodiagnostic and imaging studies. • Knowledge of anatomical relations and course of the nerve is necessary to identify the nerve at pre-determined anatomical locations. • Altered echogenicity and signal intensity, discontinuity of the nerve, focal thickening and cause of compression can be assessed by imaging modalities. • MR imaging helps in confirmation of the ultrasound findings, differentiating similar appearing lesions and provides additional soft-tissue details.
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Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis and Modern Imaging, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India.
| | - Abhishek Chandra
- Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiodiagnosis and Modern Imaging, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
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Eng HY, Gunio DA, Benitez CL. Quantitative magnetic resonance imaging analysis of the cross-sectional areas of the anconeus epitrochlearis muscle, cubital tunnel, and ulnar nerve with the elbow in extension in patients with and without ulnar neuropathy. J Shoulder Elbow Surg 2018; 27:1306-1310. [PMID: 29754844 DOI: 10.1016/j.jse.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the cross-sectional area of the anconeus epitrochlearis muscle (AEM), cubital tunnel, and ulnar nerve with the elbow in extension in patients with and without ulnar neuropathy. METHODS We performed a retrospective, level IV review of elbow magnetic resonance imaging (MRI) studies. Elbow MRI studies of 32 patients with an AEM (26 men and 6 women, aged 18-60 years), 32 randomly selected patients without an AEM (aged 16-71 years), and 32 patients with clinical ulnar neuritis (22 men and 10 women, aged 24-76 years) were reviewed. We evaluated the ulnar nerve cross-sectional area proximal to, within, and distal to the cubital tunnel; AEM cross-sectional area; and cubital tunnel cross-sectional area. RESULTS We found no significant difference in the nerve caliber between patients with and without an AEM. No correlation was found between the AEM cross-sectional area and ulnar nerve cross-sectional area within the cubital tunnel (r = 0.14). The mean cubital tunnel cross-sectional area was larger in patients with an AEM. Only 4 of the 32 patients with an AEM had findings of ulnar neuritis on MRI. Of the 32 patients with a clinical diagnosis of ulnar neuritis, only 2 had an AEM. CONCLUSIONS With the elbow in extension, the presence or cross-sectional area of an AEM does not correlate with the area of the ulnar nerve or cubital tunnel. Only a small number of individuals with MRI evidence of an AEM had clinical evidence of ulnar neuropathy. Likewise, MRI evidence of an AEM was found in only a small number of individuals with clinical evidence of ulnar neuropathy.
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Affiliation(s)
- Hing Y Eng
- Department of Diagnostic Radiology, Mount Sinai West St. Luke's, New York, NY, USA
| | - Drew A Gunio
- Department of Diagnostic Radiology, Mount Sinai West St. Luke's, New York, NY, USA.
| | - Carlos L Benitez
- Department of Diagnostic Radiology, Mount Sinai West St. Luke's, New York, NY, USA
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Babaei-Ghazani A, Roomizadeh P, Sanaei G, Najarzadeh-Mehdikhani S, Habibi K, Nikmanzar S, Kheyrollah Y. Ultrasonographic reference values for the deep branch of the radial nerve at the arcade of Frohse. J Ultrasound 2018; 21:225-231. [PMID: 29909505 DOI: 10.1007/s40477-018-0303-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The deep branch of the radial nerve (DBRN) enters the forearm as it passes under the arcade of Frohse. This is the most common entrapment site of the DBRN in the forearm. In this study, we investigated the ultrasonographic reference values for the diameters and cross-sectional area (CSA) of the DBRN at the level of the arcade of Frohse in a healthy sample of the population. METHODS Sixty-five healthy Caucasian volunteers (130 nerves) were recruited for this study. The reference range [mean ± 2 standard deviations (SD); 2.5th-97.5th quintiles] and the upper limit of the side-to-side difference were determined. The effects of age, gender, handedness, height, and body mass index were examined. RESULTS The mean age was 41.8 ± 11.2 years (range 18-75 years). The mean ± 2SD of the CSA was 0.50-1.42 mm2. The upper limit of the normal side-to-side difference was 0.35 mm2. The differences between males and females and between the dominant and non-dominant arms were not significant. The mean anteroposterior and transverse diameters were 0.83 ± 0.13 and 1.23 ± 0.29 mm, respectively. A significant correlation between the dominant-side CSA and age (r = 0.41; p < 0.001) was observed. The correlations between CSA and height (r = 0.19; p = 0.12) and body mass index (r = 0.22; p = 0.07) were not significant. CONCLUSION The measurements obtained in this study are valuable for examining DBRN pathologies using high-frequency ultrasound. The findings showed that age was associated with the DBRN CSA, while gender, height, and body mass index were not.
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Affiliation(s)
- Arash Babaei-Ghazani
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Firozgar Hospital, Iran University of Medical Sciences, Valieasr Square, Tehran, Iran
| | - Peyman Roomizadeh
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Firozgar Hospital, Iran University of Medical Sciences, Valieasr Square, Tehran, Iran.
| | - Golshan Sanaei
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Firozgar Hospital, Iran University of Medical Sciences, Valieasr Square, Tehran, Iran
| | - Saeideh Najarzadeh-Mehdikhani
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Firozgar Hospital, Iran University of Medical Sciences, Valieasr Square, Tehran, Iran
| | - Kimia Habibi
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Firozgar Hospital, Iran University of Medical Sciences, Valieasr Square, Tehran, Iran
| | - Shahin Nikmanzar
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | - Yadollah Kheyrollah
- Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, Firozgar Hospital, Iran University of Medical Sciences, Valieasr Square, Tehran, Iran
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Abstract
The median nerve (MN) may be affected by various peripheral neuropathies, each of which may be categorized according to its cause, as either an extrinsic (due to an entrapment or a nerve compression) or an intrinsic (including neurogenic tumors) neuropathy. Entrapment neuropathies are characterized by alterations of the nerve function that are caused by mechanical or dynamic compression. It occurs because of anatomic constraints at specific locations including sites where the nerve courses through fibro-osseous or fibromuscular tunnels or penetrates a muscle. For the diagnosis of peripheral neuropathies, physicians traditionally relied primarily on clinical findings and electrodiagnostic testing with electromyography. However, if further doubt exists, clinicians may ask for an additional imaging evaluation.
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Aggarwal A, Srivastava DN, Jana M, Sharma R, Gamanagatti S, Kumar A, Kumar V, Malhotra R, Goyal V, Garg K. Comparison of Different Sequences of Magnetic Resonance Imaging and Ultrasonography with Nerve Conduction Studies in Peripheral Neuropathies. World Neurosurg 2017; 108:185-200. [DOI: 10.1016/j.wneu.2017.08.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 02/08/2023]
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Olewnik Ł, Podgórski M, Polguj M, Wysiadecki G, Topol M. Anatomical variations of the pronator teres muscle in a Central European population and its clinical significance. Anat Sci Int 2017; 93:299-306. [PMID: 28849397 PMCID: PMC5797209 DOI: 10.1007/s12565-017-0413-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/07/2017] [Indexed: 12/31/2022]
Abstract
The pronator teres (PT) muscle is a forearm flexor with radial and ulnar heads. It is innervated by the median nerve (MN), which passes between these heads. Nerve entrapment, known as “PT syndrome”, may occur in this passage. Anatomical variations in this region may be potential risk factors of this pathology. Therefore, the aim of the study was to determine the relationship between morphologic variations of the PT and the MN. In 50 isolated, formalin-fixed upper limbs, the cubital region and the forearm were dissected. The following measurements were taken: origin of the PT muscle heads, the length of these heads, the length of the forearm, diameter of the MN and the number of its muscular branches to the pronator teres muscle. The forearms with the humeral head originating from the medial humeral epicondyle and medial intermuscular septum (72%) were significantly shorter (p = 0.0088) than those where the humeral head originated only from the medial humeral epicondyle. Moreover, in these specimens, the MN was significantly thinner (p = 0.003). The ulnar head was present in 43 limbs (86%). The MN passed between the heads of the PT muscle (74%) or under the muscle (26%). In the majority of cases, it provided two motor branches (66%). There is an association between the morphologic variation of the PT muscle heads and the course and branching pattern of the MN. Both are related to differences in forearm length. This may have an impact on the risk of PT syndrome and the performance of MN electrostimulation.
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Affiliation(s)
- Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.
| | - Michał Podgórski
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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Kim Y, Ha DH, Lee SM. Ultrasonographic findings of posterior interosseous nerve syndrome. Ultrasonography 2017; 36:363-369. [PMID: 28494524 PMCID: PMC5621806 DOI: 10.14366/usg.17007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ultrasonographic findings associated with posterior interosseous nerve (PIN) syndrome. Methods Approval from the Institutional Review Board was obtained. A retrospective review of 908 patients' sonographic images of the upper extremity from January 2001 to October 2010 revealed 10 patients suspicious for a PIN abnormality (7 male and 3 female patients; mean age of 51.8±13.1 years; age range, 32 to 79 years). The ultrasonographic findings of PIN syndrome, including changes in the PIN and adjacent secondary changes, were evaluated. The anteroposterior diameter of the pathologic PIN was measured in eight patients and the anteroposterior diameter of the contralateral asymptomatic PIN was measured in six patients, all at the level immediately proximal to the proximal supinator border. The size of the pathologic nerves and contralateral asymptomatic nerves was compared using the Mann-Whitney U test. Results Swelling of the PIN proximal to the supinator canal by compression at the arcade of Fröhse was observed in four cases. Swelling of the PIN distal to the supinator canal was observed in one case. Loss of the perineural fat plane in the supinator canal was observed in one case. Four soft tissue masses were noted. Secondary denervation atrophy of the supinator and extensor muscles was observed in two cases. The mean anteroposterior diameter of the pathologic nerves (n=8, 1.79±0.43 mm) was significantly larger than that of the contralateral asymptomatic nerves (n=6, 1.02±0.22 mm) (P=0.003). Conclusion Ultrasonography provides high-resolution images of the PIN and helps to diagnose PIN syndrome through visualization of its various causes and adjacent secondary changes.
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Affiliation(s)
- Youdong Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Doo Hoe Ha
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Min Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Granger A, Sardi JP, Iwanaga J, Wilson TJ, Yang L, Loukas M, Oskouian RJ, Tubbs RS. Osborne's Ligament: A Review of its History, Anatomy, and Surgical Importance. Cureus 2017; 9:e1080. [PMID: 28405530 PMCID: PMC5383373 DOI: 10.7759/cureus.1080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
When discussing the pathophysiology of ulnar neuropathy, Geoffrey Vaughan Osborne described a fibrous band that can be responsible for the symptoms seen in this disorder. In this paper, we take a glimpse at the life of Osborne and review the anatomy and surgical significance of Osborne’s ligament. This band of tissue connects the two heads of the flexor carpi ulnaris and thus forms the roof of the cubital tunnel. To our knowledge, no prior publication has reviewed the history of this ligament, and very few authors have studied its anatomy in any detail. Therefore, the aim of the present paper is to elucidate this structure that is often implicated and surgically transected to decompress the ulnar nerve at the elbow.
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Affiliation(s)
- Andre Granger
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | | | | | - Thomas J Wilson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynda Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University School of Medicine, Grenada, West Indies
| | - Rod J Oskouian
- Neurosurgery, Complex Spine, Swedish Neuroscience Institute
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Mitchell CH, Fayad LM, Ahlawat S. Magnetic Resonance Imaging of the Digital Nerves of the Hand: Anatomy and Spectrum of Pathology. Curr Probl Diagn Radiol 2017; 47:42-50. [PMID: 28438411 DOI: 10.1067/j.cpradiol.2017.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 01/20/2023]
Abstract
Digital nerves are intrinsic to the sensory and motor function of the hand. These nerves represent the terminal ramifications of the ulnar, median, and radial nerves and are located distal to the carpal tunnel and Guyon canal. With magnetic resonance imaging, traumatic and nontraumatic abnormalities of the digital nerves can be shown with high contrast as well as high spatial resolution. Digital nerve abnormalities are most commonly posttraumatic in nature; however, infection, inflammatory, vascular malformations, and neoplasms can rarely occur. Magnetic resonance imaging is playing an increasing role in the assessment of peripheral nerve injury throughout the body, and in the hand, which can accurately identify the extent and character of digital nerve abnormalities before operative intervention.
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Affiliation(s)
- Charles H Mitchell
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Baltimore, MD.
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61
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Lunate dislocation causing median nerve entrapment. Med J Armed Forces India 2017; 73:88-90. [PMID: 28123252 DOI: 10.1016/j.mjafi.2015.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/27/2015] [Indexed: 11/20/2022] Open
Abstract
Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy.
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Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the Peripheral Nerves of the Upper Extremity: A Landmark Approach. Radiographics 2017; 36:452-63. [PMID: 26963456 DOI: 10.1148/rg.2016150088] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ultrasonography (US) has become a first-line modality for the evaluation of the peripheral nerves of the upper extremity. The benefits of US over magnetic resonance (MR) imaging include higher soft-tissue resolution, cost effectiveness, portability, real-time and dynamic imaging, and the ability to scan an entire extremity quickly and efficiently. US can be performed on patients who are not eligible for MR imaging. Metallic implant artifacts are usually not problematic. US has been shown to have equal specificity and greater sensitivity than MR imaging in the evaluation of peripheral nerves. Any abnormal findings can be easily compared with the contralateral side. The published literature has shown that US has demonstrated clinical utility in patients with suspected peripheral nerve disease by guiding diagnostic and therapeutic decisions as well as by confirming electrodiagnostic findings. Common indications for upper extremity peripheral nerve US are the evaluation for injury due to penetrating trauma, entrapment by scar tissue, and tumor. US of the upper extremity is most commonly performed to evaluate carpal and cubital tunnel syndrome. It is important for the radiologist or sonographer to have a detailed knowledge of anatomy and specific anatomic landmarks for each nerve to efficiently and accurately perform an examination. The goal of this article is to introduce readers to the basics of US of the peripheral nerves of the upper extremity with a focus on the median, ulnar, and radial nerves. Common sites of disease and the location of important anatomic landmarks will be reviewed.
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Affiliation(s)
- Jordan M Brown
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Corrie M Yablon
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Yoav Morag
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Catherine J Brandon
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Jon A Jacobson
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
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Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series. Radiology 2016; 279:674-92. [PMID: 27183404 DOI: 10.1148/radiol.2016150995] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hand and wrist injuries are common occurrences in amateur and professional sports and many of them are sport-specific. These can be divided into two categories: traumatic injuries and overuse injuries. The aim of this article is to review the most common hand and wrist sports-related lesions. Acute wrist injuries are predominantly bone fractures, such as those of the scaphoid, hamate hook, and ulnar styloid. Ligament lesions are more challenging for radiologists and may lead to carpal instability if undiagnosed. Overuse wrist injuries are mainly represented by tendinous disorders, with De Quervain syndrome and extensor carpi ulnaris tendon disorders being the most common among them; however, there are other possible disorders such as impaction syndromes, stress fractures, and neurovascular lesions. Finally, finger lesions, including closed-tendon injuries (mallet and boutonniere injuries, jersey finger, and boxer's knuckle), flexor pulley injuries, and skier's thumb, should also be detected. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Eric Cockenpot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Guillaume Lefebvre
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Xavier Demondion
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Christophe Chantelot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Anne Cotten
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
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Raval SB, Zhao T, Krishnamurthy N, Santini T, Britton C, Gorantla VS, Ibrahim TS. Ultra-high-field RF coil development for evaluating upper extremity imaging applications. NMR IN BIOMEDICINE 2016; 29:1768-1779. [PMID: 27809383 PMCID: PMC5929486 DOI: 10.1002/nbm.3582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this study is to develop and evaluate a custom-designed 7 T MRI coil and explore its use for upper extremity applications. An RF system composed of a transverse electromagnetic transmit coil and an eight-channel receive-only array was developed for 7 T upper extremity applications. The RF system was characterized and evaluated using scattering parameters and B1+ mapping. Finite difference time domain simulations were performed to evaluate the B1+ field distribution and specific absorption rate for the forearm region of the upper extremity. High-resolution 7 T images were acquired and compared with those at 3 T. The simulation and experimental results show very good B1+ field homogeneity across the forearm. High-resolution images of musculotendinous, osseocartilaginous, and neurovascular structures in the upper extremity are presented with T1 volumetric interpolated breath-hold examination, T2 double-echo steady state, T2 * susceptibility weighted imaging (SWI), diffusion tensor imaging, and time-of-flight sequences. Comparison between 3 T and 7 T is shown. Intricate contextual anatomy can be delineated in synovial, fibrocartilaginous, interosseous, and intraosseous trabecular structures of the forearm, as well as palmar and digital vascular anatomy (including microvascular detail in SWI). Ultra-high-field 7 T imaging holds great potential in improving the sensitivity and specificity of upper extremity imaging, especially in wrist and hand pathology secondary to bone, ligament, nerve, vascular, and other soft or hard tissue etiology.
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Affiliation(s)
- Shailesh B. Raval
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tiejun Zhao
- Siemens Medical Solutions, Pittsburgh, PA, USA
| | | | - Tales Santini
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia Britton
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tamer S. Ibrahim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
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66
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Elbow Ultrasound. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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67
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Nwawka OK, Miller TT, Jawetz ST, Saboeiro GR. Ultrasound-guided perineural injection for nerve blockade: Does a single-sided injection produce circumferential nerve coverage? JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:465-469. [PMID: 27155542 DOI: 10.1002/jcu.22364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/01/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Our current clinical technique for sonographic-guided perineural injection consists of two-sided perineural needle placement to obtain circumferential distribution of the injectate. This study aimed to determine if a single-side needle position will produce circumferential nerve coverage. METHODS Fresh-frozen cadaveric specimens were used for this study. In six upper extremities, a needle was positioned along the deep surface of median, radial, and ulnar nerves in the carpal tunnel, radial tunnel, and cubital tunnel, respectively, and 2 ml of contrast was injected for each nerve. In three pelvic specimens, a needle was positioned deep to the sciatic nerves bilaterally, and 5 ml of contrast was injected. An additional four median nerve injections were performed using superficial surface needle position. The specimens then underwent CT scanning to assess the distribution of the perineural contrast medium. RESULTS One hundred percent of the radial, ulnar, and sciatic nerves demonstrated circumferential distribution on CT. Only 50% of the median nerve injections with the needle placed deep to the nerve produced circumferential coverage, whereas 100% of median nerves injected with the needle between the nerve and retinaculum demonstrated circumferential coverage. The average length of spread of perineural injectate was 11.6 cm in the upper extremity and 10.3 cm for the sciatic nerves. CONCLUSIONS Using clinical volumes of fluid, needle positioning at the deep surface of upper extremity and sciatic nerves was sufficient to produce circumferential coating of the nerve, except in the carpal tunnel, where placement of the needle between the nerve and flexor retinaculum is recommended. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:465-469, 2016.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
- Weill Cornell Medical College of Cornell University, New York, New York.
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College of Cornell University, New York, New York
| | - Shari T Jawetz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College of Cornell University, New York, New York
| | - Gregory R Saboeiro
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
- Weill Cornell Medical College of Cornell University, New York, New York
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Abstract
Elbow pain is a frequent presenting symptom in athletes, particularly athletes who throw. The elbow can be injured as a result of acute trauma, such as a direct blow or a fall onto an outstretched hand or from chronic microtrauma. In particular, valgus extension overload during the throwing motion can precipitate a cascade of chronic injuries that can be debilitating for both casual and high-performance athletes. Prompt imaging evaluation facilitates accurate diagnosis and appropriate targeted interventions.
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Affiliation(s)
- Matthew D Bucknor
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Kathryn J Stevens
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
| | - Lynne S Steinbach
- From the Department of Radiology and Biomedical Imaging, University of California-San Francisco, 185 Berry St, Lobby 6, Suite 350, San Francisco, CA 94158
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69
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Abstract
CONTEXT Musculoskeletal ultrasound (US) research is expanding due to increased clinical utility of sonography. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Ultrasound is widely applied in musculoskeletal imaging and sports medicine. The real-time capabilities and favorable cost profile of US make it ideal for use in diagnosis of musculoskeletal conditions. The enthusiasm for the use of US in musculoskeletal imaging has led to an increase in US research to broaden its applications. CONCLUSION Several recent advances have been made in conventional and novel US imaging techniques, quantitative US imaging, and US-guided interventions. STRENGTH OF RECOMMENDATIONS TAXONOMY SORT C.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York Weill Cornell Medical College of Cornell University, New York, New York
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70
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High-Resolution Axonal Bundle (Fascicle) Assessment and Triple-Echo Steady-State T2 Mapping of the Median Nerve at 7 T. Invest Radiol 2016; 51:529-35. [DOI: 10.1097/rli.0000000000000265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
The elbow is a complex joint. Magnetic resonance imaging (MRI) is often the imaging modality of choice in the workup of elbow pain, especially in sports injuries and younger patients who often have either a history of a chronic repetitive strain such as the throwing athlete or a distinct traumatic injury. Traumatic injuries and alternative musculoskeletal pathologies can affect the ligaments, musculotendinous, cartilaginous, and osseous structures of the elbow as well as the 3 main nerves to the upper limb, and these structures are best assessed with MRI.Knowledge of the complex anatomy of the elbow joint as well as patterns of injury and disease is important for the radiologist to make an accurate diagnosis in the setting of elbow pain. This chapter will outline elbow anatomy, basic imaging parameters, compartmental pathology, and finally applications of some novel MRI techniques.
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73
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Reckelhoff KE, Li J, Kaeser MA, Haun DW, Kettner NW. Ultrasound Evaluation of the Normal Ulnar Nerve in Guyon's Tunnel: Cross-sectional Area and Anthropometric Measurements. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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74
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Roodt T, Van Dyk B, Jacobs S. Ultrasound diagnosis of ulnar nerve entrapment by confirming baseline cross-sectional area measurement for normal and abnormal nerves. SA J Radiol 2015. [DOI: 10.4102/sajr.v19i1.747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Magnetic resonance imaging is most commonly employed, alongside electrodiagnostic studies, in the diagnosis of ulnar nerve entrapment. It is expensive, time consuming, not readily available to the general public, and limits imaging to a segment of the nerve at any given time. In contrast, high-frequency ultrasound is an inexpensive imaging modality with a flexible field of view through which the nerve can be traced. An ultrasound cross-sectional area (CSA) >0.075 cm² has previously been suggested as indicative of nerve entrapment. Objectives: To confirm the suggested CSA measurement of 0.075 cm² and discuss the difference in CSA measurement between abnormal nerves, nerves in the contra-lateral elbow of the same participant, and those of asymptomatic participants. Methods: Ultrasonography was performed on both elbows of 25 patients with confirmed unilateral ulnar nerve entrapment and on 25 healthy controls for comparison. Three CSA measurements were taken of the ulnar nerve along its course, and the mean measurement was recorded.Results: CSA measurements were significantly different between patients with ulnar nerve entrapment and healthy controls (p < 0.05). In our study, a CSA >0.070 cm² defined ulnar nerve entrapment at the elbow. Conclusion: Ultrasound CSA measurement of the ulnar nerve is accurate in the diagnosis of ulnar nerve entrapment. The range of values and varied criteria previously reported call for standardisation of the procedure and CSA measurement. We suggest that a measurement of 0.070 cm² be considered as a new baseline for the optimal diagnosis of ulnar nerve entrapment.[PDF to follow]
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75
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Kollmer J, Bendszus M, Pham M. MR Neurography: Diagnostic Imaging in the PNS. Clin Neuroradiol 2015; 25 Suppl 2:283-9. [DOI: 10.1007/s00062-015-0412-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/11/2015] [Indexed: 12/11/2022]
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76
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Meng S, Tinhofer I, Weninger WJ, Grisold W. Ultrasound and anatomical correlation of the radial nerve at the arcade of Frohse. Muscle Nerve 2015; 51:853-8. [DOI: 10.1002/mus.24483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Stefan Meng
- Department of Radiology; KFJ Hospital; Vienna Austria
- Center for Anatomy and Cell Biology, Medical University Vienna; Vienna Austria
| | - Ines Tinhofer
- Center for Anatomy and Cell Biology, Medical University Vienna; Vienna Austria
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77
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De Maeseneer M, Brigido MK, Antic M, Lenchik L, Milants A, Vereecke E, Jager T, Shahabpour M. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol 2015; 84:671-81. [DOI: 10.1016/j.ejrad.2014.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/05/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
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Dale AM, Agboola F, Yun A, Zeringue A, Al-Lozi MT, Evanoff B. Comparison of automated versus traditional nerve conduction study methods for median nerve testing in a general worker population. PM R 2015; 7:276-82. [PMID: 25463687 PMCID: PMC4372480 DOI: 10.1016/j.pmrj.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/10/2014] [Accepted: 10/06/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the validity of automated nerve conduction studies compared to traditional electrodiagnostic studies (EDS) for testing median nerve abnormalities in a working population. DESIGN Agreement study and sensitivity investigation from 2 devices. SETTING Field research testing laboratory. PARTICIPANTS Active workers from several industries participating in a longitudinal study of carpal tunnel syndrome. METHODS Sixty-two subjects received bilateral median and ulnar nerve conduction testing across the wrist with a traditional device and the NC-stat automated device. We compared the intermethod agreement of analogous measurements. MAIN OUTCOME MEASUREMENT Nerve conduction study parameters. RESULTS Median motor and sensory latency comparisons showed excellent agreement (intraclass correlation coefficients 0.85 and 0.80, respectively). Areas under the receiver operating characteristic curves were 0.97 and 0.96, respectively, using the optimal thresholds of 4.4-millisecond median motor latency (sensitivity 100%, specificity 86%) and 3.9-millisecond median sensory latency (sensitivity 100%, specificity 87%). Ulnar nerve testing results were less favorable. CONCLUSION The automated NC-stat device showed excellent agreement with traditional EDS for detecting median nerve conduction abnormalities in a general population of workers, suggesting that this automated nerve conduction device can be used to ascertain research case definitions of carpal tunnel syndrome in population health studies. Further study is needed to determine optimal thresholds for defining median conduction abnormalities in populations that are not seeking clinical care.
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Affiliation(s)
- Ann Marie Dale
- Divisions of General Medical Sciences and Neurology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8005, St. Louis, MO 63110(∗).
| | - Folasade Agboola
- Divisions of General Medical Sciences and Neurology, Washington University School of Medicine, St. Louis, MO; and Saint Louis University School of Public Health, St Louis, MO(†)
| | - Amber Yun
- Saint Louis University School of Public Health, St Louis, MO; and Washington State Hospital Association, Seattle, WA(‡)
| | - Angelique Zeringue
- Divisions of General Medical Sciences and Neurology, Washington University School of Medicine, St. Louis, MO; and Saint Louis University School of Public Health, St Louis, MO(§)
| | - Muhammed T Al-Lozi
- Divisions of General Medical Sciences and Neurology, Washington University School of Medicine, St. Louis, MO(‖)
| | - Bradley Evanoff
- Divisions of General Medical Sciences and Neurology, Washington University School of Medicine, St. Louis, MO(¶)
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79
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Wong CS, Hui GK, Chung EK, Wong SH. Diagnosis and management of neuropathic pain. Pain Manag 2015; 4:221-31. [PMID: 24953074 DOI: 10.2217/pmt.14.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A recent revision in the definition of neuropathic pain has highlighted this condition as a distinct disease entity. More accurate search for a lesion in the somatosensory nervous system as the pain-generating mechanism will help target the treatment by pharmacological agents. A multidisciplinary approach is recommended, with pharmacotherapy supplemented by psychological therapy and physical rehabilitation, and appropriate interventional treatment for selected refractory cases.
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Affiliation(s)
- Clara Sm Wong
- Department of Anaesthesiology, Queen Elizabeth Hospital, Hong Kong
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80
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Choi SJ, Ahn JH, Ryu DS, Kang CH, Jung SM, Park MS, Shin DR. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography 2015; 34:275-91. [PMID: 25682987 PMCID: PMC4603206 DOI: 10.14366/usg.14060] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 01/21/2023] Open
Abstract
Nerve compression syndromes commonly involve the nerves in the upper extremity. High-resolution ultrasonography (US) can satisfactorily assess these nerves and may detect the morphological changes of the nerves. US can also reveal the causes of nerve compression when structural abnormalities or space-occupying lesions are present. The most common US finding of compression neuropathy is nerve swelling proximal to the compression site. This article reviews the normal anatomic location and US appearances of the median, ulnar, and radial nerves. Common nerve compression syndromes in the upper extremity and their US findings are also reviewed.
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Affiliation(s)
- Soo-Jung Choi
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jae Hong Ahn
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dae Shik Ryu
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Chae Hoon Kang
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Seung Mun Jung
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Man Soo Park
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Dong-Rock Shin
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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81
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Wang KC, Salunkhe AR, Morrison JJ, Lee PP, Mejino JLV, Detwiler LT, Brinkley JF, Siegel EL, Rubin DL, Carrino JA. Ontology-based image navigation: exploring 3.0-T MR neurography of the brachial plexus using AIM and RadLex. Radiographics 2015; 35:142-51. [PMID: 25590394 PMCID: PMC4319494 DOI: 10.1148/rg.351130072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 07/11/2014] [Accepted: 07/11/2014] [Indexed: 11/11/2022]
Abstract
Disorders of the peripheral nervous system have traditionally been evaluated using clinical history, physical examination, and electrodiagnostic testing. In selected cases, imaging modalities such as magnetic resonance (MR) neurography may help further localize or characterize abnormalities associated with peripheral neuropathies, and the clinical importance of such techniques is increasing. However, MR image interpretation with respect to peripheral nerve anatomy and disease often presents a diagnostic challenge because the relevant knowledge base remains relatively specialized. Using the radiology knowledge resource RadLex®, a series of RadLex queries, the Annotation and Image Markup standard for image annotation, and a Web services-based software architecture, the authors developed an application that allows ontology-assisted image navigation. The application provides an image browsing interface, allowing users to visually inspect the imaging appearance of anatomic structures. By interacting directly with the images, users can access additional structure-related information that is derived from RadLex (eg, muscle innervation, muscle attachment sites). These data also serve as conceptual links to navigate from one portion of the imaging atlas to another. With 3.0-T MR neurography of the brachial plexus as the initial area of interest, the resulting application provides support to radiologists in the image interpretation process by allowing efficient exploration of the MR imaging appearance of relevant nerve segments, muscles, bone structures, vascular landmarks, anatomic spaces, and entrapment sites, and the investigation of neuromuscular relationships.
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Affiliation(s)
- Kenneth C. Wang
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - Aditya R. Salunkhe
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - James J. Morrison
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - Pearlene P. Lee
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - José L. V. Mejino
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - Landon T. Detwiler
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - James F. Brinkley
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - Eliot L. Siegel
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - Daniel L. Rubin
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
| | - John A. Carrino
- From the Imaging Service, Baltimore VA Medical Center, 10 N Greene St, Room C1-24, Baltimore, MD 21201 (K.C.W., E.L.S.); Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (K.C.W., P.P.L.); Department of Computer Science, University of Maryland, Baltimore County, Baltimore, Md (A.R.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (J.J.M., E.L.S.); Departments of Biological Structure (J.L.V.M., L.T.D., J.F.B.) and Biomedical Informatics and Medical Education (L.T.D., J.F.B.), University of Washington, Seattle, Wash; Department of Radiology, Stanford University School of Medicine, Stanford, Calif (D.L.R.); and Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY (J.A.C.)
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Chalian M, Behzadi AH, Williams EH, Shores JT, Chhabra A. High-Resolution Magnetic Resonance Neurography in Upper Extremity Neuropathy. Neuroimaging Clin N Am 2014; 24:109-25. [DOI: 10.1016/j.nic.2013.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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83
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Abstract
This article discusses an alternative approach to general anesthesia with the use of local anesthesia in minor operating procedure suites when performing in situ decompression of cubital tunnel syndrome for those patients who have mild to moderately severe symptoms and for those who fail to respond to conservative measures. Anterior transposition can easily be performed in the same setting if indicated all with local anesthesia.
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84
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Konin GP, Nazarian LN, Walz DM. US of the Elbow: Indications, Technique, Normal Anatomy, and Pathologic Conditions. Radiographics 2013; 33:E125-47. [DOI: 10.1148/rg.334125059] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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85
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Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol 2012; 41:369-86. [PMID: 22205505 DOI: 10.1007/s00256-011-1343-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 12/05/2011] [Accepted: 12/07/2011] [Indexed: 02/02/2023]
Abstract
The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.
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Affiliation(s)
- Nikhil A Kotnis
- Department of Radiology, McMaster University, Hamilton, ON, Canada
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86
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Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ, Carrino JA, Chhabra A. High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol 2012; 41:15-31. [PMID: 21479520 PMCID: PMC3158963 DOI: 10.1007/s00256-011-1143-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 02/02/2023]
Abstract
Peripheral nerves often traverse confined fibro-osseous and fibro-muscular tunnels in the extremities, where they are particularly vulnerable to entrapment and compressive neuropathy. This gives rise to various tunnel syndromes, characterized by distinct patterns of muscular weakness and sensory deficits. This article focuses on several upper and lower extremity tunnels, in which direct visualization of the normal and abnormal nerve in question is possible with high resolution 3T MR neurography (MRN). MRN can also serve as a useful adjunct to clinical and electrophysiologic exams by discriminating adhesive lesions (perineural scar) from compressive lesions (such as tumor, ganglion, hypertrophic callous, or anomalous muscles) responsible for symptoms, thereby guiding appropriate treatment.
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Affiliation(s)
- Ty K Subhawong
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 601 N. Caroline Street, Room 4214, Baltimore, MD 21287, USA.
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