Interventional Techniques

Anatomical study of the iliohypogastric, ilioinguinal, and genitofemoral nerves using high-resolution ultrasound

INTRODUCTION

In this study we aimed to determine whether high-resolution ultrasound (US) can identify the iliohypogastric (IH), ilioinguinal (II), and genitofemoral (GF) nerves and their relations.

METHODS

This investigation, initially undertaken in cadavers, was followed by a high-resolution US study in 30 healthy adult volunteers (180 nerves) by 2 musculoskeletal radiologists on separate occasions, using 2 different approaches (proximal to distal and distal to proximal). A 0-3 scale was used to assess nerve visibility. Location and course of the IH, II, and GF nerves and their relations to adjacent anatomical structures were analyzed.

RESULTS

Nerves and their terminal branches were better visualized with the distal-to-proximal approach (P < 0.05). Visualization of the terminal branches was possible in up to 60% of volunteers.

CONCLUSIONS

High-resolution ultrasound (US) can identify the IH, II, and GF nerves at the level of the abdominal wall and the terminal branches in the majority of volunteers.

High-Resolution ultrasound of the pudendal nerve: normal anatomy

INTRODUCTION

In this study we aimed to determine whether high-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches. We also attempted to identify the best approach for visualizing these structures.

METHODS

Normal anatomy of the pudendal nerve was evaluated in 3 cadavers and 20 healthy volunteers proximally at the level of the ischial spine and distally with low-frequency (2-5-MHZ) and high-frequency (12-7-MHZ and 17-5-MHZ) transducers. Two musculoskeletal radiologists performed the examinations and evaluations. Volunteers were placed in 3 different positions, which allowed different approaches (posterior, medial, and anterior transperineal). A 0-3 scale was used to assess nerve visibility.

RESULTS

Visualization of the pudendal nerve at the ischial spine was best when using a medial approach (P < 0.004); the terminal branches were seen best with the anterior approach (P < 0.002).

CONCLUSION

High-resolution ultrasound (US) can identify the pudendal nerve and its terminal branches.

Ultrasonography-guided osteopathic manipulative treatment for a patient with thoracic outlet syndrome

Patients with thoracic outlet syndrome can be treated with osteopathic manipulative treatment (OMT) to alleviate dysfunction and restriction of the pectoralis minor muscle (PMM) and the resulting compression of the brachial plexus. Neuromuscular ultrasonography (US) can demonstrate abnormalities in the thoracic outlet that are amenable to OMT and can be used to monitor intervention. The present report identifies PMM deformation and brachial plexus compression in a 32-year-old woman with thoracic outlet syndrome who was treated successfully with OMT. Neuromuscular US results were used to measure the degree of PMM deformation with the pectoral bowing ratio and confirm the diagnosis. Osteopathic manipulative treatment was applied and monitored using neuromuscular US to confirm that the operator's manipulating hand had direct contact with the PMM. Symptoms abated immediately after treatment. Results of a second neuromuscular US examination showed that the pectoral bowing ratio decreased into the normal range and thus confirmed that PMM deformation had resolved.