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Telleman JA, Sneag DB, Visser LH. The role of imaging in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:19-42. [PMID: 38697740 DOI: 10.1016/b978-0-323-90108-6.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic testing (EDX) has been the diagnostic tool of choice in peripheral nerve disease for many years, but in recent years, peripheral nerve imaging has been used ever more frequently in daily clinical practice. Nerve ultrasound and magnetic resonance (MR) neurography are able to visualize nerve structures reliably. These techniques can aid in localizing nerve pathology and can reveal significant anatomical abnormalities underlying nerve pathology that may have been otherwise undetected by EDX. As such, nerve ultrasound and MR neurography can significantly improve diagnostic accuracy and can have a significant effect on treatment strategy. In this chapter, the basic principles and recent developments of these techniques will be discussed, as well as their potential application in several types of peripheral nerve disease, such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy, brachial and lumbosacral plexopathy, neuralgic amyotrophy (NA), fibular, tibial, sciatic, femoral neuropathy, meralgia paresthetica, peripheral nerve trauma, tumors, and inflammatory neuropathies.
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Affiliation(s)
- Johan A Telleman
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States
| | - Leo H Visser
- Department of Neurology and Clinical Neurophysiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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Expert consensus on the combined investigation of carpal tunnel syndrome with electrodiagnostic tests and neuromuscular ultrasound. Clin Neurophysiol 2022; 135:107-116. [DOI: 10.1016/j.clinph.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/18/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022]
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Yamanaka Y, Tajima T, Tsujimura Y, Kosugi K, Mano Y, Zenke Y, Hachisuka A, Aoki T, Sakai A. Molecular and Clinical Elucidation of the Mechanism of Action of Steroids in Idiopathic Carpal Tunnel Syndrome. J Bone Joint Surg Am 2021; 103:1777-1787. [PMID: 34398862 DOI: 10.2106/jbjs.20.02096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Carpal tunnel steroid injection is a nonoperative intervention for the treatment for idiopathic carpal tunnel syndrome (CTS). The antifibrotic, anti-inflammatory, and antiedematous properties of steroids account for their therapeutic effects in the context of CTS; however, their relative contribution has not been clarified. METHODS Fibroblasts from subsynovial connective tissues (SSCT) were intraoperatively collected from patients with idiopathic CTS and were incubated with or without the steroid triamcinolone acetonide (TA) for 1, 3, and 7 days; the expression of fibrosis-related genes and inflammatory cytokines was evaluated using quantitative reverse transcription-polymerase chain reaction. A clinical prospective study was conducted with patients who received carpal tunnel TA injections. We performed clinical and electrophysiological evaluations before and 1, 3, and 5 months after TA injection; and we compared the median nerve, flexor tendon, and SSCT areas and the median nerve flattening ratio before and 1 month after TA injection using 3-T magnetic resonance imaging (MRI). RESULTS TA induced downregulation of the fibrosis-related genes Col1A1 (collagen type I alpha 1 chain), Col1A2, and Col3A1 but not the inflammation-related genes. The nerve flattening ratio did not change after TA injection according to the MRI-based observation of the median nerve, flexor tendon, and SSCT areas. CONCLUSIONS The therapeutic effects of injected TA are apparently mediated by its antifibrotic rather than its anti-inflammatory and antiedematous properties. TA probably alters the properties but not the morphology of SSCT. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Takafumi Tajima
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshitaka Tsujimura
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kenji Kosugi
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yosuke Mano
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yukichi Zenke
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Akiko Hachisuka
- Department of Rehabilitation Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Takatoshi Aoki
- Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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Tadokoro N, Hashimoto K, Yanagawa Y, Maehara H, Sano T. Nerve root morphological and functional changes after degenerative cervical myelopathy surgery: preliminary study using ultrasound and electrophysiology. Spinal Cord 2021; 60:301-305. [PMID: 34556821 DOI: 10.1038/s41393-021-00707-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A prospective observational study. OBJECTIVES To depict morphological and functional changes in the cervical nerve roots before and after spinal cord decompression surgery for degenerative cervical myelopathy (DCM). SETTING A general hospital in Japan. METHODS Thirteen DCM patients who underwent posterior spinal cord decompression surgery, laminoplasty or laminectomy, were included in this study. The neural foramen shown on MRI and the cross-sectional area (CSA) of the nerve roots on ultrasound were used to evaluate the C5 and C6 nerve roots. The compound muscle action potentials (CMAPs) of deltoid and biceps muscle were also recorded. RESULTS All patients showed sensorimotor functional improvement without the postoperative C5 palsy after surgery. Foraminal stenosis and preoperative CSA of the nerve root: C4/5 foramen and C5 nerve root, C5/6 foramen and C6 nerve root, had no significant correlation (P = 0.53 and 0.08). CSA of the C5 nerve root displayed no significant change before and after surgery (P = 0.2), however, that of the C6 nerve root reduced significantly after surgery (P = 0.038). The amplitude of the deltoid and biceps CMAPs displayed no significant change before and after surgery (P = 0.05 and 0.05). CONCLUSION The C6 nerve root CSA change was observed after spinal cord decompression surgery with functional recovery. However, deltoid and biceps CMAPs amplitude showed no significant change. Independent CSA changes on ultrasound might be useful when conducting a functional evaluation of the postoperative nerve root. SPONSORSHIP The Grant of Japan Orthopaedics and Traumatology Research Foundation No. 395.
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Affiliation(s)
- Nobuaki Tadokoro
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Kyuichi Hashimoto
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Yuki Yanagawa
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Haruka Maehara
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan
| | - Toshihiro Sano
- Department of Orthopaedic surgery, Kochi prefectural Hata Kenmin hospital, Sukumo, Kochi, Japan.
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Lin MT, Liu IC, Syu WT, Kuo PL, Wu CH. Effect of Perineural Injection with Different Dextrose Volumes on Median Nerve Size, Elasticity and Mobility in Hands with Carpal Tunnel Syndrome. DIAGNOSTICS (BASEL, SWITZERLAND) 2021; 11:diagnostics11050849. [PMID: 34065073 PMCID: PMC8150286 DOI: 10.3390/diagnostics11050849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the effect of different injectate volumes on ultrasonographic parameters and the correlation to clinical outcomes under perineural dextrose injection (PDI). In this post hoc analysis of the randomized, double-blinded, three-arm trial, ultrasound-guided PDI with either 1 mL, 2 mL, and 4 mL 5% dextrose water was administered, respectively, in 14, 14, and 17 patients. Ultrasound outcomes included mobility, shear-wave elastography (SWE), and cross-sectional area (CSA) of the median nerve; clinical outcomes were Visual Analog Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ) score. Outcomes were measured before injection, and after injection at the 1st, 4th, 12th, and 24th week. For ultrasound outcomes, CSA decreased significantly from baseline data at all follow-up time-points in the 2 mL group (p = 0.005) and the 4 mL group (p = 0.015). The mean change of mobility from baseline showed a greater improvement on the 4 mL group than the other groups at the 1st week post-injection. For clinical outcomes, negative correlation between the VAS and mobility at the 1st (p = 0.046) and 4th week (p = 0.031) post-injection in the 4 mL group were observed. In conclusion, PDI with higher volume yielded better nerve mobility and decreased CSA of median nerve, but no changes of nerve elasticity.
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Affiliation(s)
- Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan;
| | - I-Chun Liu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (I.-C.L.); (P.-L.K.)
| | - Wei-Ting Syu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 100, Taiwan;
| | - Po-Ling Kuo
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (I.-C.L.); (P.-L.K.)
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 100, Taiwan;
- Department of Electrical Engineering, National Taiwan University, Taipei 100, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan; (I.-C.L.); (P.-L.K.)
- Correspondence:
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Abstract
Advances in high-resolution ultrasound have provided clinicians with unique opportunities to study diseases of the peripheral nervous system. Ultrasound complements the clinical and electrophysiology exam by showing the degree of abnormalities in myopathies, as well as spontaneous muscle activities in motor neuron diseases and other disorders. In experienced hands, ultrasound is more sensitive than MRI in detecting peripheral nerve pathologies. It can also guide needle placement for electromyography exam, therapeutic injections, and muscle biopsy. Ultrasound enhances the ability to detect carpal tunnel syndrome and other focal nerve entrapment, as well as pathological nerve enlargements in genetic and acquired neuropathies. Furthermore, ultrasound can potentially be used as a biomarker for muscular dystrophy and spinal muscular atrophy. The combination of electromyography and ultrasound can increase the diagnostic certainty of amyotrophic lateral sclerosis, aid in the localization of brachial plexus or peripheral nerve trauma and allow for surveillance of nerve tumor progression in neurofibromatosis. Potential limitations of ultrasound include an inability to image deeper structures, with lower sensitivities in detecting neuromuscular diseases in young children and those with mitochondrial myopathies, due to subtle changes or early phase of the disease. As well, its utility in detecting critical illness neuromyopathy remains unclear. This review will focus on the clinical applications of neuromuscular ultrasound. The diagnostic values of ultrasound for screening of myopathies, neuropathies, and motor neuron diseases will be presented.
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Wang JC, Lin KP, Liao KK, Chang YC, Wang KA, Huang YF, Chiu JW. Sonographic median nerve change after steroid injection for carpal tunnel syndrome. Muscle Nerve 2018; 58:402-406. [DOI: 10.1002/mus.26171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation; Taipei Veterans General Hospital; No. 201, Section 2, Shih-Pai Road, Beitou District Taipei City, 11217 Taiwan
- Department of Physical Medicine & Rehabilitation; National Yang Ming University; Taipei Taiwan
| | - Kon-Ping Lin
- Department of Neurology; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; National Yang-Ming University School of Medicine; Taipei Taiwan
| | - Kwong-Kum Liao
- Department of Neurology; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; National Yang-Ming University School of Medicine; Taipei Taiwan
| | - Yue-Cune Chang
- Department of Mathematics; Tamkang University; Tamsui Taiwan
| | - Kevin A. Wang
- Division of General Surgery, Department of Surgery; Shin-Kong Memorial Hospital; Taipei Taiwan
| | - Yu-Fang Huang
- Department of Physical Medicine and Rehabilitation; Taipei Veterans General Hospital; No. 201, Section 2, Shih-Pai Road, Beitou District Taipei City, 11217 Taiwan
| | - Jan-Wei Chiu
- Department of Physical Medicine and Rehabilitation; Taipei Veterans General Hospital; No. 201, Section 2, Shih-Pai Road, Beitou District Taipei City, 11217 Taiwan
- Department of Physical Medicine & Rehabilitation; National Yang Ming University; Taipei Taiwan
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