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Levidy MF, Lindell K, Taylor KF. Isolated Palsy of the Anterior Interosseous Nerve to Flexor Pollicis Longus, Magnetic Resonance Imaging and Clinical Correlation: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00024. [PMID: 38709910 DOI: 10.2106/jbjs.cc.24.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
CASE Anterior interosseous nerve (AIN) palsy is an uncommon, though well-described, clinical entity. When isolated to the thumb, it can be confused with atraumatic rupture of the flexor pollicis longus (FPL) tendon. A 57-year-old man experienced atraumatic onset of difficulty flexing the distal interphalangeal thumb joint. Magnetic resonance imaging (MRI) demonstrated denervation edema of the FPL, suggesting atypical AIN palsy. Resolution of symptoms and MRI findings occurred concomitantly with nonoperative treatment. CONCLUSION Atypical AIN palsy limited to the FPL is a rare clinical entity whose diagnosis can be supported with MRI. Here, we report a successful case of nonoperative management.
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Affiliation(s)
- Michael F Levidy
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kenneth Lindell
- Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Kenneth F Taylor
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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2
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Kumar S, Mangi MD, Zadow S, Lim W. Nerve entrapment syndromes of the lower limb: a pictorial review. Insights Imaging 2023; 14:166. [PMID: 37782348 PMCID: PMC10545616 DOI: 10.1186/s13244-023-01514-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Peripheral nerves of the lower limb may become entrapped at various points during their anatomical course. While clinical assessment and nerve conduction studies are the mainstay of diagnosis, there are multiple imaging options, specifically ultrasound and magnetic resonance imaging (MRI), which offer important information about the potential cause and location of nerve entrapment that can help guide management. This article overviews the anatomical course of various lower limb nerves, including the sciatic nerve, tibial nerve, medial plantar nerve, lateral plantar nerve, digital nerves, common peroneal nerve, deep peroneal nerve, superficial peroneal nerve, sural nerve, obturator nerve, lateral femoral cutaneous nerve and femoral nerve. The common locations and causes of entrapments for each of the nerves are explained. Common ultrasound and MRI findings of nerve entrapments, direct and indirect, are described, and various examples of the more commonly observed cases of lower limb nerve entrapments are provided.Critical relevance statement This article describes the common sites of lower limb nerve entrapments and their imaging features. It equips radiologists with the knowledge needed to approach the assessment of entrapment neuropathies, which are a critically important cause of pain and functional impairment.Key points• Ultrasound and MRI are commonly used to investigate nerve entrapment syndromes.• Ultrasound findings include nerve hypo-echogenicity, calibre changes and the sonographic Tinel's sign.• MRI findings include increased nerve T2 signal, muscle atrophy and denervation oedema.• Imaging can reveal causative lesions, including scarring, masses and anatomical variants.
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Affiliation(s)
- Shanesh Kumar
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia
| | - Mohammad Danish Mangi
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Steven Zadow
- Department of Medical Imaging, Flinders Medical Centre, Flinders Drive, Bedford Park, Australia
- Jones Radiology, Eastwood, Australia
| | - WanYin Lim
- Department of Radiology, Royal Adelaide Hospital, Port Rd, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Jones Radiology, Eastwood, Australia
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3
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Taneja AK, Chhabra A. Neuropathy Score Reporting and Data System (NS-RADS): A Practical Review of MRI-Based Peripheral Neuropathy Assessment. Semin Ultrasound CT MR 2023; 44:386-397. [PMID: 37437974 DOI: 10.1053/j.sult.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
The Neuropathy Score Reporting and Data System (NS-RADS) is a newly developed MR imaging-based classification that standardizes reporting and multidisciplinary communication for MR imaging diagnosis and follow-up of peripheral neuropathies. NS-RADS classification has shown to be accurate and reliable across different centers, readers' experience levels, and degrees of peripheral neuropathies, which include nerve injury, entrapment, neoplasm, diffuse neuropathy, post-interventional status, and temporal changes in muscle denervation. This article brings a practical review of NS-RADS classification, representative MR cases, and a step-by-step tutorial on how to approach this staging system. Readers can gain knowledge and apply it in their practice, aiming to standardize the communications between specialties and improve patient management.
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Affiliation(s)
- Atul K Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Avneesh Chhabra
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX; Johns Hopkins University, Baltimore, MD; Walton Center of Neuroscience, Liverpool, UK; University of Dallas, Richardson, TX; Johns Hopkins University, Maryland, MD; Walton Centre for Neuroscience, Liverpool, UK.
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4
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Węgiel A, Karauda P, Zielinska N, Tubbs RS, Olewnik Ł. Radial nerve compression: anatomical perspective and clinical consequences. Neurosurg Rev 2023; 46:53. [PMID: 36781706 PMCID: PMC9925568 DOI: 10.1007/s10143-023-01944-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 02/15/2023]
Abstract
The radial nerve is the biggest branch of the posterior cord of the brachial plexus and one of its five terminal branches. Entrapment of the radial nerve at the elbow is the third most common compressive neuropathy of the upper limb after carpal tunnel and cubital tunnel syndromes. Because the incidence is relatively low and many agents can compress it along its whole course, entrapment of the radial nerve or its branches can pose a considerable clinical challenge. Several of these agents are related to normal or variant anatomy. The most common of the compressive neuropathies related to the radial nerve is the posterior interosseus nerve syndrome. Appropriate treatment requires familiarity with the anatomical traits influencing the presenting symptoms and the related prognoses. The aim of this study is to describe the compressive neuropathies of the radial nerve, emphasizing the anatomical perspective and highlighting the traps awaiting physicians evaluating these entrapments.
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Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, USA
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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5
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Fort NM, Victoria C, Ko L, Wolfe SW, Lee SK, Nwawka OK. High resolution ultrasound for the evaluation of radial nerve pathology adjacent to metallic hardware. J Orthop Res 2022; 40:2557-2564. [PMID: 35088459 DOI: 10.1002/jor.25278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 02/04/2023]
Abstract
Accurate localization and characterization of peripheral nerve injuries adjacent to metallic hardware is difficult with magnetic resonance imaging (MRI) due to susceptibility artifact. This study sought to present the use of high-resolution ultrasound (US) in accurate characterization of radial nerve injury adjacent to metallic hardware, using findings at the time of operative exploration as confirmation of the US assessment. A retrospective chart review of cases with clinically identified radial nerve injuries evaluated by the high-resolution US was performed from January 2015 through December 2019. Preoperative clinical data, US reports, MRI reports, electrodiagnostic (EDx) reports, and operative reports were reviewed for each case. Preoperative US correctly characterized the affected nerve component, type, and location of injury in all 13 cases (100%), when correlated with intraoperative findings. Nerve injury was directly adjacent to metallic hardware in 12 cases (92%). Out of the seven cases evaluated by both US and MRI, US correctly accurately diagnosed radial nerve injuries in all cases, whereas MRI accurately diagnosed in four cases (57%). In 3/7 cases (43%) MRI was nondiagnostic due to susceptibility artifact. MRI evaluation of the nerve was limited to some degree by metallic artifact in 6/7 cases (85%).
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Affiliation(s)
- Nicholas M Fort
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Christian Victoria
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Steve K Lee
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
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6
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Khodatars D, Gupta A, Welck M, Saifuddin A. An update on imaging of tarsal tunnel syndrome. Skeletal Radiol 2022; 51:2075-2095. [PMID: 35562562 DOI: 10.1007/s00256-022-04072-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/02/2023]
Abstract
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the tibial nerve (TN) within the tarsal tunnel (TT) at the level of the tibio-talar and/or talo-calcaneal joints. Making a diagnosis of TTS can be challenging, especially when symptoms overlap with other conditions and electrophysiological studies lack specificity. Imaging, in particular MRI, can help identify causative factors in individuals with suspected TTS and help aid surgical management. In this article, we review the anatomy of the TT, the diagnosis of TTS, aetiological factors implicated in TTS and imaging findings, with an emphasis on MRI.
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Affiliation(s)
- Davoud Khodatars
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Ankur Gupta
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Matthew Welck
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK
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7
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Gunio D, Babaa A, Bencardino JT. Imaging of Nerve Disorders in the Elbow. Semin Musculoskelet Radiol 2022; 26:123-139. [PMID: 35609574 DOI: 10.1055/s-0042-1743407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neuropathies of the elbow represent a spectrum of disorders that involve more frequently the ulnar, radial, and median nerves. Reported multiple pathogenic factors include mechanical compression, trauma, inflammatory conditions, infections, as well as tumor-like and neoplastic processes. A thorough understanding of the anatomy of these peripheral nerves is crucial because clinical symptoms and imaging findings depend on which components of the affected nerve are involved. Correlating clinical history with the imaging manifestations of these disorders requires familiarity across all diagnostic modalities. This understanding allows for a targeted imaging work-up that can lead to a prompt and accurate diagnosis.
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Affiliation(s)
- Drew Gunio
- Division of Clinical Radiology, Department of Radiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Ahmad Babaa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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8
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Jo SY, Khurana N, Shabshin N. Imaging of Entrapment Neuropathies in the Ankle. Semin Musculoskelet Radiol 2022; 26:163-171. [PMID: 35609577 DOI: 10.1055/s-0042-1743406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Entrapment neuropathies of the ankle and foot pose a major diagnostic challenge and thus remain underdiagnosed. Recent advancements in imaging modalities, including magnetic resonance neurography (MRN), have resulted in considerable improvement in the anatomical localization and identification of pathologies leading to nerve entrapment. MRN supplements clinical examination and electrophysiologic studies in the diagnosis of neuropathies, aids in assessing disease severity, and helps formulate management strategies. A comprehensive understanding of the anatomy and imaging features of the ankle is essential to diagnose and manage entrapment neuropathies accurately. Advancements in imaging and their appropriate utilization will ultimately lead to better diagnoses and improved patient outcomes.
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Affiliation(s)
- Stephanie Y Jo
- Division of Musculoskeletal Imaging, Department of Radiology, Penn Musculoskeletal Center, Philadelphia, Pennsylvania
| | - Navpreet Khurana
- Division of Musculoskeletal Imaging, Department of Radiology, Penn Musculoskeletal Center, Philadelphia, Pennsylvania
| | - Nogah Shabshin
- Division of Musculoskeletal Imaging, Department of Radiology, Penn Musculoskeletal Center, Philadelphia, Pennsylvania.,Emek Medical Center, Clalit Healthcare Services, Afula, Israel
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9
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Lo L, Duarte A, Bencardino JT. Nerve Entrapments in the Pelvis and Hip. Semin Musculoskelet Radiol 2022; 26:153-162. [PMID: 35609576 DOI: 10.1055/s-0042-1750211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Clinical symptoms of pelvic entrapment neuropathies are widely variable and frequently nonspecific, thus rendering it difficult to localize and diagnose. Magnetic resonance imaging (MRI), and in particular MR neurography, has become increasingly important in the work-up of entrapment neuropathies involving the pelvic and hip nerves of the lumbosacral plexus. The major sensory and motor peripheral nerves of the pelvis and hip include the sciatic nerve, superior and inferior gluteal nerves, femoral nerve, lateral femoral cutaneous nerve, obturator nerve, and pudendal nerve. Familiarity with the anatomy and imaging appearance of normal and pathologic nerves in combination with clinical presentation is crucial in the diagnosis of entrapment neuropathies.
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Affiliation(s)
- Lawrence Lo
- Department of Radiology, University of Pennsylvania, Penn Medicine at University City, Philadelphia, Pennsylvania
| | - Alejandra Duarte
- Division of Musculoskeletal Radiology, Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Jenny T Bencardino
- Division of Musculoskeletal Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Ghetti CB, Mitchell BC, Shah VJ, Onodera K, Berger GK, Huang B, Foran IM, Kent WT. An Anatomic Study of the Lateral Dorsal Cutaneous Nerve Using 3-Tesla MRI: A Comparison to Cadaveric Data With Surgical Applications. Foot Ankle Int 2022; 43:717-724. [PMID: 35073767 DOI: 10.1177/10711007211069132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The lateral dorsal cutaneous nerve (LDCN) and the anastomotic branch of the sural nerve (AB) are cutaneous sensory nerves at risk of iatrogenic injury during lateral foot surgery. This study is the first to use a large cohort of high-resolution magnetic resonance images (MRIs) of the ankle to better describe the course of these nerves in vivo in order to aid surgeons intraoperatively. Our study intends to build on the "high and inside" approach to the proximal 5MT by accounting for variations in course of the LDCN and AB. METHODS One hundred twenty-five 3-tesla (T) MRI studies of the ankle were analyzed. Three reviewers measured the distance from the LDCN and AB to landmarks including the most proximal aspect of the fifth metatarsal tuberosity (5MT) and the peroneus brevis tendon (PBT). RESULTS Mean vertical distance from the LDCN to the 5MT was 0.8 ± 0.2 cm. Presence of an AB was visualized in 59 of 125 studies (47.2%) and was found 2.2 ± 0.5 cm dorsal to the 5MT. The AB was found to become superior to PBT at a horizontal distance 1.9 ± 0.5 cm proximal to the 5MT. The LDCN was found superior to the PBT at its insertion onto the 5MT in approximately 10% (n = 12) of our studies. During these instances, the LDCN was located an average of 0.3 cm dorsal to the PBT. CONCLUSION Our proposed "safe zone" for the approach to the proximal 5MT remains superior to the LDCN and inferior to the AB and avoids crossing directly over either nerve in >95% of analyzed MRI studies. This incision begins 1.5 cm dorsal to the most proximal aspect of the 5MT and extends no more than 1 cm posteriorly. Careful dissection and identification of the LDCN and possible AB is necessary prior to further extension of incision. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Claudio B Ghetti
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Brendon C Mitchell
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Vrajesh J Shah
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Keenan Onodera
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Garrett K Berger
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Brady Huang
- Department of Radiology, University of California-San Diego, San Diego, CA, USA
| | - Ian M Foran
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - William T Kent
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
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11
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Ghetti CB, Mitchell BC, Shah VJ, Wang W, Huang B, Kent WT, Foran IM. An Anatomic Study of the Sural Nerve Using 3-Tesla MRI: A Comparison to Cadaveric Data With Surgical Applications. Foot Ankle Int 2022; 43:540-550. [PMID: 34794357 DOI: 10.1177/10711007211051750] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The sural nerve (SN) is a sensory cutaneous nerve that is at risk of iatrogenic injury during surgery at the lateral ankle. Prior anatomic studies of the SN are limited primarily to cadaveric studies with small sample sizes. Our study analyzed a large cohort of magnetic resonance images (MRIs) of the ankle to obtain a more generalizable, in vivo sample of distal SN course. METHODS A total of 204 3-tesla MRI studies of the ankle were analyzed. Three reviewers measured the distance from the SN to various landmarks including the distal tip of the lateral malleolus (DTLM) and the lateral border of the Achilles tendon (LBA). RESULTS Mean vertical distance from SN to DTLM was 2.2 cm (range, 0.9-3.6 cm). Mean horizontal distance from SN to DTLM and to LBA at the level of DTLM was 1.7 cm (range, 0.8-3.0 cm) and 1.9 cm (range, 1.0-2.9 cm), respectively. Mean horizontal distance from SN to LBA at the level of superior Achilles tendon insertion onto the calcaneus (SAI) was 2.6 cm (range, 1.4-3.7 cm), and mean horizontal distance from SN to LBA at 5 cm above SAI was 0.9 cm (range, 0.4-1.8 cm). CONCLUSION The variation in SN course observed in our study allowed us to propose "safe zones" for several surgical approaches including the extensile lateral approach to the calcaneus (ELAC), the sinus tarsi approach (STA), the direct lateral approach to the lateral malleolus (DLA), and the posterolateral approach to the ankle (PLA), which we hope will minimize iatrogenic injury to the SN. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Claudio B Ghetti
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Brendon C Mitchell
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Vrajesh J Shah
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Wilbur Wang
- Department of Musculoskeletal Radiology, University of California-San Diego, San Diego, CA, USA
| | - Brady Huang
- Department of Musculoskeletal Radiology, University of California-San Diego, San Diego, CA, USA
| | - William T Kent
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
| | - Ian M Foran
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA
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12
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Wakefield CJ, Hamid KS, Lee S, Lin J, Holmes GB, Bohl DD. Transfer of the Posterior Tibial Tendon for Chronic Peroneal Nerve Palsy. JBJS Rev 2021; 9:01874474-202107000-00014. [PMID: 34297700 DOI: 10.2106/jbjs.rvw.20.00208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The common peroneal nerve (CPN) is one of the most frequently injured nerves of the lower extremity. » One-third of patients who develop CPN palsy proceed to chronic impairment without signs of recovery. » Ankle-foot orthoses can provide improvement with respect to gait dysfunction and are useful as a nonsurgical treatment option. » Severe cases of CPN palsy demonstrating no signs of recovery may require operative intervention with tendon transfer.
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Affiliation(s)
- Connor J Wakefield
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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13
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Naik AA, Bawa A, Arya A, Gulihar A. Nerve entrapment around elbow. J Clin Orthop Trauma 2021; 19:209-215. [PMID: 34150493 PMCID: PMC8190494 DOI: 10.1016/j.jcot.2021.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022] Open
Abstract
Entrapment neuropathy around elbow is a common cause of disability across all age groups. The major nerves that traverse the elbow are ulnar, median and radial nerves and their branches. Cubital tunnel syndrome leading to ulnar nerve compression can often present with significant pain, paresthesia or weakness. Median and Radial nerve compression around the elbow, albeit less frequent, can also lead to significant morbidity and must be kept in the differential diagnosis when dealing with patients complaining of persistent pain around the elbow and weakness of forearm/hand muscles. Electrodiagnostic studies can be a useful adjunct to clinical examination, to help localize the site and quantify the grade of compression. Management should involve a trial of conservative treatment and failing that, surgical treatment should be considered. We hereby provide an overview of nerve entrapments around the elbow including their applied anatomy, etiology, clinical assessment and overview of the current concepts in surgical treatment.
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Affiliation(s)
- Arjun Ajith Naik
- Corresponding author. Trauma and Orthopaedics, Princess Royal University hospital- KCH NHS trust, Farnborough common, Orpington, BR68ND, UK.
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14
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Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - Part 2 Lower limb. Eur J Radiol 2020; 135:109482. [PMID: 33360825 DOI: 10.1016/j.ejrad.2020.109482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 06/15/2020] [Accepted: 12/14/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies. METHODS The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb. RESULTS The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. This leads to diverse clinical manifestations making them difficult to diagnose with traditional methods such as clinical examination and electrodiagnostic studies. Moreover, some of these may mimic other common conditions such as disc pain or fibromyalgia leading to delay in diagnosis and increasing morbidity. Addition of imaging improves the diagnostic accuracy and also help in correct treatment of these entities. Magnetic resonance imaging is very useful for deeply situated nerves in pelvis and thigh while ultrasound is well validated for superficial entrapment neuropathies. CONCLUSION The rapidly changing concepts in these conditions accompanied by the advances in imaging has made it essential for a clinical radiologist to be well-informed with the current best practices.
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Affiliation(s)
- Dinesh Manoharan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipin Sudhakaran
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Mohd Tahir Ansari
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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15
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Kim BR, Ha DH, Kim JK, Kim YH. Comparison of MR findings of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model. PLoS One 2020; 15:e0240911. [PMID: 33211695 PMCID: PMC7676645 DOI: 10.1371/journal.pone.0240911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The treatment strategy is different for acute traumatic peripheral nerve injury and acute compressive neuropathy. This study aimed to compare magnetic resonance imaging (MRI) features of acute traumatic peripheral nerve injury and acute compressive neuropathy in a rat model. Materials and methods Twenty female Sprague-Dawley rats were divided into two groups. In the crush injury group (n = 10), the unilateral sciatic nerve was crushed using forceps to represent acute traumatic peripheral nerve injury. In the compression injury group (n = 10), the unilateral sciatic nerve was ligated using silk to represent acute compressive neuropathy. The MRI of eight rats from each group were acquired on postoperative days 3 and 10. Fat-suppressed T2-weighted images were acquired. Changes in the injured nerve were divided into three grades. A Fisher’s exact test was used to compare the changes in the nerves of the two groups. Histological staining and a western blot analysis were performed on one rat in each group on day 3. Neurofilament, myelin basic protein (MBP), and p75NTR staining were performed. Expression of neurofilament, MBP, p75NTR, and c-jun was evaluated by western blot analysis. Results MR neurography revealed substantial nerve changes in the compression injury group compared with the crush injury group at two-time points (p = 0.001 on day 3, p = 0.026 on day 10). The histopathological analysis indicated the destruction of the axon and myelin, mainly at the injury site and the distal portion of the injury in the crush injury group. It was prominent in the proximal portion, the injury site, and the distal portion of the injury in the compression injury group. The degree of axonal and myelin destruction was more pronounced in the compression injury group than in the crush injury group. Conclusion MR neurography showed prominent and long-segmental changes associated with the injured nerve in acute compressive neuropathy compared with acute traumatic peripheral nerve injury.
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Affiliation(s)
- Bo Ra Kim
- Department of Radiology, Dong-A University Medical Center, Busan, Republic of Korea
| | - Dong-Ho Ha
- Department of Radiology, Dong-A University Medical Center, Busan, Republic of Korea
- * E-mail:
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University Medical Center, Busan, Republic of Korea
- Peripheral Neuropathy Research Center (PNRC), Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Hee Kim
- Peripheral Neuropathy Research Center (PNRC), Dong-A University College of Medicine, Busan, Republic of Korea
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16
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Abstract
Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much underutilized in evaluating the peripheral nervous system (PNS). This underutilization is generally due to two perceived weaknesses in MRI: first, the need for very high resolution to image the small structures within the peripheral nerves to visualize morphological changes; second, the lack of normative data in MRI of the PNS and this makes reliable interpretation of the data difficult. This article reviews current state-of-the-art capabilities in
in vivo MRI of human peripheral nerves. It aims to identify areas where progress has been made and those that still require further improvement. In particular, with many new therapies on the horizon, this review addresses how MRI can be used to provide non-invasive and objective biomarkers in the evaluation of peripheral neuropathies. Although a number of techniques are available in diagnosing and tracking pathologies in the PNS, those techniques typically target the distal peripheral nerves, and distal nerves may be completely degenerated during the patient’s first clinic visit. These techniques may also not be able to access the proximal nerves deeply embedded in the tissue. Peripheral nerve MRI would be an alternative to circumvent these problems. In order to address the pressing clinical needs, this review closes with a clinical protocol at 3T that will allow high-resolution, high-contrast, quantitative MRI of the proximal peripheral nerves.
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Affiliation(s)
- Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - E Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Jun Li
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Center for Molecular Medicine & Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,John D. Dingell VA Medical Center, Detroit, MI, 48201, USA
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17
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Garwood ER, Duarte A, Bencardino JT. MR Imaging of Entrapment Neuropathies of the Lower Extremity. Radiol Clin North Am 2018; 56:997-1012. [DOI: 10.1016/j.rcl.2018.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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18
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Paluch Ł, Noszczyk B, Nitek Ż, Walecki J, Osiak K, Pietruski P. Shear-wave elastography: a new potential method to diagnose ulnar neuropathy at the elbow. Eur Radiol 2018; 28:4932-4939. [PMID: 29858636 PMCID: PMC6223854 DOI: 10.1007/s00330-018-5517-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 02/06/2023]
Abstract
Objectives The primary aim of this study was to verify if shear-wave elastography (SWE) can be used to diagnose ulnar neuropathy at the elbow (UNE). The secondary objective was to compare the cross-sectional areas (CSA) of the ulnar nerve in the cubital tunnel and to determine a cut-off value for this parameter accurately identifying persons with UNE. Methods The study included 34 patients with UNE (mean age, 59.35 years) and 38 healthy controls (mean age, 57.42 years). Each participant was subjected to SWE of the ulnar nerve at three levels: in the cubital tunnel (CT) and at the distal arm (DA) and mid-arm (MA). The CSA of the ulnar nerve in the cubital tunnel was estimated by means of ultrasonographic imaging. Results Patients with UNE presented with significantly greater ulnar nerve stiffness in the cubital tunnel than the controls (mean, 96.38 kPa vs. 33.08 kPa, p < 0.001). Ulnar nerve stiffness of 61 kPa, CT to DA stiffness ratio equal 1.68, and CT to MA stiffness ratio of 1.75 provided 100% specificity, sensitivity, positive and negative predictive value in the detection of UNE. Mean CSA of the ulnar nerve in the cubital tunnel turned out to be significantly larger in patients with UNE than in healthy controls (p < 0.001). A weak positive correlation was found in the UNE group between the ulnar nerve CSA and stiffness (R = 0.31, p = 0.008). Conclusions SWE seems to be a promising, reliable and simple quantitative adjunct test to support the diagnosis of UNE. Key Points • SWE enables reliable detection of cubital tunnel syndrome • Significant increase of entrapped ulnar nerve stiffness is observed in UNE • SWE is a perspective screening tool for early detection of compressive neuropathies
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Affiliation(s)
- Łukasz Paluch
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Bartłomiej Noszczyk
- Department of Plastic and Reconstructive Surgery, Medical Centre of Postgraduate Education, Prof. W. Orlowski Memorial Hospital, Czerniakowska 231 Street, 00-416, Warsaw, Mazowieckie, Poland.
| | - Żaneta Nitek
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Jerzy Walecki
- Department of Radiology, Medical Centre of Postgraduate Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
| | - Katarzyna Osiak
- Department of Plastic and Reconstructive Surgery, Medical Centre of Postgraduate Education, Prof. W. Orlowski Memorial Hospital, Czerniakowska 231 Street, 00-416, Warsaw, Mazowieckie, Poland
| | - Piotr Pietruski
- Department of Plastic and Reconstructive Surgery, Medical Centre of Postgraduate Education, Prof. W. Orlowski Memorial Hospital, Czerniakowska 231 Street, 00-416, Warsaw, Mazowieckie, Poland.,Department of Applied Pharmacy and Bioengineering, Medical University of Warsaw, Warsaw, Poland
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Wadhwa V, Hamid AS, Kumar Y, Scott KM, Chhabra A. Pudendal nerve and branch neuropathy: magnetic resonance neurography evaluation. Acta Radiol 2017; 58:726-733. [PMID: 27664277 DOI: 10.1177/0284185116668213] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pudendal neuralgia is being increasingly recognized as a cause of chronic pelvic pain, which may be related to nerve injury or entrapment. Due to its complex anatomy and branching patterns, the pudendal nerve abnormalities are challenging to illustrate. High resolution 3 T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathies. In this article, the authors discuss the normal pudendal nerve anatomy and its variations, technical considerations of pudendal nerve imaging, and highlight the normal and abnormal appearances of the pudendal nerve and its branches with illustrative case examples.
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Affiliation(s)
- Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aws S Hamid
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Kelly M Scott
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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20
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Sievert C, Richter H, Gascho D, Kircher PR, Carrera I. 3 Tesla magnetic resonance imaging study of the normal canine femoral and sciatic nerves. Vet Radiol Ultrasound 2017; 58:598-606. [PMID: 28444825 DOI: 10.1111/vru.12511] [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: 12/12/2016] [Revised: 02/08/2017] [Accepted: 03/13/2017] [Indexed: 11/28/2022] Open
Abstract
Understanding the normal course and optimizing visualization of the canine peripheral nerves of the lumbar plexus, in particular the sciatic and the femoral nerves, is essential when interpreting images of patients with suspected peripheral neuropathies such as inflammatory or neoplastic conditions. The purpose of this prospective, anatomic study was to describe the magnetic resonance imaging (MRI) anatomy of the normal canine femoral and sciatic nerves and to define the sequences in which the nerves are best depicted. A preliminary postmortem cadaver study was performed to determine optimal sequences and imaging protocol. In a second step the optimized technique was implemented on 10 healthy Beagle dogs, included in the study. The applied protocol included the following sequences: T1-weighted, T2-weighted, T2-Spectral Attenuated Inversion Recovery, T1-weighted postcontrast and T1-Spectral Presaturated Inversion Recovery postcontrast. All sequences had satisfactory signal-to-noise ratio and contrast resolution in all patients. The sciatic and femoral nerves were seen in all images. They were symmetric and of homogeneous signal intensity, being iso- to mildly hyperintense to muscle on T2-weighted, mildly hyperintense in T2-Spectral Attenuated Inversion Recovery, and iso- to mildly hypointense in T1-weighted images. No evidence of contrast enhancement in T1-weighted and T1-Spectral Presaturated Inversion Recovery postcontrast sequences was observed. The anatomic landmarks helpful to identify the course of the femoral and sciatic nerves are described in detail. This study may be used as an anatomical reference, depicting the normal canine femoral and sciatic nerves at 3 Tesla MRI.
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Affiliation(s)
- Christine Sievert
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Henning Richter
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Dominic Gascho
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland
| | - Patrick R Kircher
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
| | - Inés Carrera
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, 8057, Zurich, Switzerland
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21
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Marquez Neto OR, Leite MS, Freitas T, Mendelovitz P, Villela EA, Kessler IM. The role of magnetic resonance imaging in the evaluation of peripheral nerves following traumatic lesion: where do we stand? Acta Neurochir (Wien) 2017; 159:281-290. [PMID: 27999953 DOI: 10.1007/s00701-016-3055-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peripheral nerve injury is a common and important cause of morbidity and disability in patients who have suffered a traumatic injury, particularly younger people. Various different injuries can result in damage to specific nerves. In patients with multiple trauma, the prevalence of peripheral nerve injury is estimated at 2.8%, but can reach 5% with the inclusion of brachial plexus involvement. Physical examination, as well as the origin and location of the trauma, can indicate the nerve involved and the type of nerve damage. However, the depth and severity of damage, and the structures involved often cannot be determined initially, but depend on longer periods of observation to reach a definitive and accurate diagnosis for which treatment can be proposed. Current approaches to locate and assess the severity of traumatic nerve injury involve clinical and electrodiagnostic studies. From a clinical and neurophysiological point of view, nerve injuries are classified in an attempt to correlate the degree of injury with symptoms, type of pathology, and prognosis, as well as to determine the therapy to be adopted. OBJECTIVES MRI in the diagnosis of traumatic peripheral nerve injury has increasingly been used by surgeons in clinical practice. In this article, we analyze the use of magnetic resonance (MR) for the evaluation of traumatic peripheral nerve diseases that are surgically treatable. We also consider basic concepts in the evaluation of technical and MR signs of peripheral nerve injuries. MATERIALS AND METHODS Studies were identified following a computerized search of MEDLINE (1950 to present), EMBASE (1980 to present), and the Cochrane database. The MEDLINE search was conducted on PUBMED, the EMBASE search was conducted on OVID, and the Cochrane database was conducted using their online library. A set was created using the terms: 'traumatic', 'nerve', and 'resonance'. RESULTS The included articles were identified using a computerized search and the resulting databases were then sorted according to the inclusion and exclusion criteria. This yielded 10,340 articles (MEDLINE, n = 758; EMBASE, n = 9564; and Cochrane, n = 18). A search strategy was then built by excluding articles that only concern plexus injury and adding the terms 'neuropathies', 'DTI' and 'neurotmesis'. In total, seven studies were included in the review effectively addressing the role of MRI in the evaluation of traumatic peripheral nerve injury. We extracted all relevant information on the imaging findings and the use of magnetic resonance in trauma. We did not include technical or specific radiological aspects of the imaging techniques. CONCLUSIONS These seven articles were subsequently evaluated by analyzing their results, methodological approach, and conclusions presented.
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Affiliation(s)
- Oswaldo Ribeiro Marquez Neto
- Department of Neurosurgery, University Hospital of Brasilia, UnB, Secretaria de Clínica Cirurgica SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil.
| | - Matheus Silva Leite
- Department of Neurosurgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil
| | - Tiago Freitas
- Department of Neurosurgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil
| | - Paulo Mendelovitz
- Department of Radiology, University Hospital of Brasilia, UnB, Radiologia SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil
| | - Eric Arruda Villela
- Department of Hand Surgery, Hospital de Base do Distrito Federal, SMHS - Área Especial- Q. 101, Brasília, DF, CEP :70330-150, Brazil
| | - Iruena Moraes Kessler
- Department of Neurosurgery, University Hospital of Brasilia, UnB, Secretaria de Clínica Cirurgica SGAN 605, Av. L2 Norte, Brasilia, DF, CEP: 70.830200, Brazil
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Samanci Y, Karagöz Y, Yaman M, Atçı İB, Emre U, Kılıçkesmez NÖ, Çelik SE. Evaluation of median nerve T2 signal changes in patients with surgically treated carpal tunnel syndrome. Clin Neurol Neurosurg 2016; 150:152-158. [PMID: 27668859 DOI: 10.1016/j.clineuro.2016.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/24/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the accuracy of median nerve T2 evaluation and its relation with Boston Questionnaire (BQ) and nerve conduction studies (NCSs) in pre-operative and post-operative carpal tunnel syndrome (CTS) patients in comparison with healthy volunteers. METHODS Twenty-three CTS patients and 24 healthy volunteers underwent NCSs, median nerve T2 evaluation and self-administered BQ. Pre-operative and 1st year post-operative median nerve T2 values and cross-sectional areas (CSAs) were compared both within pre-operative and post-operative CTS groups, and with healthy volunteers. The relationship between MRI findings and BQ and NCSs was analyzed. The ROC curve analysis was used for determining the accuracy. RESULTS The comparison of pre-operative and post-operative T2 values and CSAs revealed statistically significant improvements in the post-operative patient group (p<0.001 for all parameters). There were positive correlations between T2 values at all levels and BQ values, and positive and negative correlations were also found regarding T2 values and NCS findings in CTS patients. The receiver operating characteristic curve analysis for defined cut-off levels of median nerve T2 values in hands with severe CTS yielded excellent accuracy at all levels. However, this accuracy could not be demonstrated in hands with mild CTS. CONCLUSION This study is the first to analyze T2 values in both pre-operative and post-operative CTS patients. The presence of increased T2 values in CTS patients compared to controls and excellent accuracy in hands with severe CTS indicates T2 signal changes related to CTS pathophysiology and possible utilization of T2 signal evaluation in hands with severe CTS.
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Affiliation(s)
- Yavuz Samanci
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Yeşim Karagöz
- Diagnostic and Interventional Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yaman
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - İbrahim Burak Atçı
- Neurosurgery Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Emre
- Neurology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nuri Özgür Kılıçkesmez
- Diagnostic and Interventional Radiology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Suat Erol Çelik
- Neurosurgery Clinic, Okmeydani Training and Research Hospital, Istanbul, Turkey
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Bernabeu Á, López-Celada S, Alfaro A, Mas JJ, Sánchez-González J. Is diffusion tensor imaging useful in the assessment of the sciatic nerve and its pathologies? Our clinical experience. Br J Radiol 2016; 89:20150728. [PMID: 27459247 DOI: 10.1259/bjr.20150728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness of diffusion tensor imaging (DTI) in the clinical setting as a complementary tool to conventional MRI in the study and assessment of the sciatic nerve and its pathologies. METHODS 17 patients diagnosed with different types of sciatic neuropathy and 10 healthy controls underwent a conventional MRI and a DTI study in a 3-T MR scanner (Achieva(®) 3-T X-Series; Philips Healthcare, Netherlands). RESULTS In the control group, we were able to track and visualize the common sciatic nerve and its main branches from hip to foot. In the patient group, the affected sciatic nerves presented statistically significant lower fractional anisotropy values and higher apparent diffusion coefficient values when compared with controls, suggesting nerve damage. In all cases, DTI offered complementary information for diagnosis and/or confirmation of the suspected pathology. When compared with conventional MRI, DTI showed higher sensitivity for nerve damage detection. CONCLUSION DTI offers a significant improvement and an important complement to visualize the sciatic nerve and its main branches. In patients with sciatic nerve pathology DTI allows to a better detection and characterization of the nerve damage. ADVANCES IN KNOWLEDGE DTI enables in vivo dissection of the sciatic nerve white matter fibres; its use offers a significant improvement and complement to conventional MRI.
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Affiliation(s)
- Ángela Bernabeu
- 1 Magnetic Resonance Department, Inscanner SL, Alicante, Spain
| | | | - Arantxa Alfaro
- 2 Department of Neurology, Hospital Vega Baja de Orihuela, Alicante, Spain.,3 CIBER-BBN, Madrid, Spain
| | - Jesús J Mas
- 4 Orthopaedic Surgery Department, Clinica Vistahermosa, Alicante, Spain
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Cho KJ, Kang S, Ko S, Baek J, Kim Y, Park NK. Neurovascular Compression Caused by Popliteus Muscle Enlargement Without Discrete Trauma. Ann Rehabil Med 2016; 40:545-50. [PMID: 27446794 PMCID: PMC4951376 DOI: 10.5535/arm.2016.40.3.545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/11/2015] [Indexed: 11/05/2022] Open
Abstract
Popliteal entrapment syndrome caused by isolated popliteus muscle enlargement is very rare, although its occurrence has been reported after discrete trauma. However, popliteal artery stenosis with combined peroneal and proximal tibial neuropathy caused by popliteus muscle enlargement without preceding trauma has not been reported. A 57-year-old man presented with a tingling sensation and pain in his left calf. He had no previous history of an injury. The symptoms were similar to those of lumbosacral radiculopathy. Calf pain became worse despite treatment, and the inability to flex his toes progressed. Computed tomography angiography and magnetic resonance imaging of the lower extremity showed popliteal artery stenosis caused by popliteus muscle enlargement and surrounding edema. An electrodiagnostic study confirmed combined peroneal and proximal tibial neuropathy at the popliteal fossa. Urgent surgical decompression was performed because of the progressive neurologic deficit and increasing neuropathic pain. The calf pain disappeared immediately after surgery, and he was discharged after the neurologic functions improved.
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Affiliation(s)
- Kyoung Jin Cho
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Sangkuk Kang
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Sanghyung Ko
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Junghyun Baek
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
| | - Yeongkyun Kim
- Department of Vascular Surgery, Sun General Hospital, Daejeon, Korea
| | - Noh Kyoung Park
- Department of Physical Medicine and Rehabilitation, Sun General Hospital, Daejeon, Korea
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Understand the pathophysiology of chronic nerve compression. 2. Describe the evaluation of a patient presenting with compression neuropathy. 3. Discuss the current controversies in the management of compression neuropathies. 4. Describe the treatment of common compression neuropathies, including carpal and cubital tunnel syndromes. SUMMARY Nerve entrapment syndromes are common in the general population, and are managed by a wide variety of medical and surgical specialists. A thorough understanding of the pathophysiology of nerve compression and appropriate clinical workup are critical in the overall management of these conditions. There remain several topics of controversy regarding the surgical management of nerve entrapment syndromes, including multiple points of nerve compression, carpal tunnel release under local anesthesia, open versus endoscopic decompression surgery, the "best" operation for primary cubital tunnel surgery, and revision decompression surgery. This article attempts to provide a concise summary of the advances in the basic and clinical science of peripheral nerve entrapment.
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Evans M, Manji H. Progress in peripheral nerve disease research in the last two years. J Neurol 2013; 260:3188-92. [PMID: 24154508 DOI: 10.1007/s00415-013-7121-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
Peripheral nerve disorders have been a Cinderella subspecialty for neurologists because of the limited treatment options and difficulties in obtaining a genetic diagnosis. In the last decade, there has been great progress in the management of patients with peripheral nerve disease. In this paper, we review a selection of diagnostic and therapeutic papers in this area published in the Journal of Neurology over the last 24 months.
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Affiliation(s)
- Matthew Evans
- The MRC Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK,
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Eppenberger P, Andreisek G, Chhabra A. Magnetic resonance neurography: diffusion tensor imaging and future directions. Neuroimaging Clin N Am 2013; 24:245-56. [PMID: 24210323 DOI: 10.1016/j.nic.2013.03.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance (MR) neurography has progressed in the past 2 decades because of rapid technological developments in both hardware and software. In addition to improvements in high-resolution anatomic pulse sequences, functional techniques are becoming feasible. This article presents the current state-of-the-art three-dimensional anatomic techniques, discusses the advantages of functional techniques being exploited, and portrays novel contrast types and molecular techniques that are under development and promise a bright future for this rapidly evolving technique.
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Affiliation(s)
- Patrick Eppenberger
- Department of Radiology, University Hospital Zurich, Ramistrasse 100, Zurich CH - 8091, Switzerland
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28
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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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29
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High resolution (3T) magnetic resonance neurography of the sciatic nerve. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Neurografía por resonancia magnética de alta resolución (3Tesla) del nervio ciático. RADIOLOGIA 2013; 55:195-202. [DOI: 10.1016/j.rx.2012.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 11/23/2022]
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Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80:1634-40. [PMID: 23553474 DOI: 10.1212/wnl.0b013e3182904f3f] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To compare accuracy of ultrasound and MRI for detecting focal peripheral nerve pathology, excluding idiopathic carpal or cubital tunnel syndromes. METHODS We performed a retrospective review of patients referred for neuromuscular ultrasound to identify patients who had ultrasound and MRI of the same limb for suspected brachial plexopathy or mononeuropathies, excluding carpal/cubital tunnel syndromes. Ultrasound and MRI results were compared to diagnoses determined by surgical or, if not performed, clinical/electrodiagnostic evaluation. RESULTS We identified 53 patients who had both ultrasound and MRI of whom 46 (87%) had nerve pathology diagnosed by surgical (n = 39) or clinical/electrodiagnostic (n = 14) evaluation. Ultrasound detected the diagnosed nerve pathology (true positive) more often than MRI (43/46 vs 31/46, p < 0.001). Nerve pathology was correctly excluded (true negative) with equal frequency by MRI and ultrasound (both 6/7). In 25% (13/53), ultrasound was accurate (true positive or true negative) when MRI was not. These pathologies were typically (10/13) long (>2 cm) and only occasionally (2/13) outside the MRI field of view. MRI missed multifocal pathology identified with ultrasound in 6 of 7 patients, often (5/7) because pathology was outside the MRI field of view. CONCLUSIONS Imaging frequently detects peripheral nerve pathology and contributes to the differential diagnosis in patients with mononeuropathies and brachial plexopathies. Ultrasound is more sensitive than MRI (93% vs 67%), has equivalent specificity (86%), and better identifies multifocal lesions than MRI. In sonographically accessible regions ultrasound is the preferred initial imaging modality for anatomic evaluation of suspected peripheral nervous system lesions.
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Affiliation(s)
- Craig M Zaidman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. Radiol Res Pract 2012; 2012:230679. [PMID: 23125929 PMCID: PMC3483739 DOI: 10.1155/2012/230679] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/30/2012] [Accepted: 09/25/2012] [Indexed: 01/01/2023] Open
Abstract
Peripheral nerve entrapment occurs at specific anatomic locations. Familiarity with the anatomy and the magnetic resonance imaging (MRI) features of nerve entrapment syndromes is important for accurate diagnosis and early treatment of entrapment neuropathies. The purpose of this paper is to illustrate the normal anatomy of peripheral nerves in the upper and lower limbs and to review the MRI features of common disorders affecting the peripheral nerves, both compressive/entrapment and noncompressive, involving the suprascapular nerve, the axillary nerve, the radial nerve, the ulnar nerve, and the median verve in the upper limb and the sciatic nerve, the common peroneal nerve, the tibial nerve, and the interdigital nerves in the lower limb.
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Duckett J, Baranowski A. Pain after suburethral sling insertion for urinary stress incontinence. Int Urogynecol J 2012; 24:195-201. [DOI: 10.1007/s00192-012-1863-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 06/10/2012] [Indexed: 11/28/2022]
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Chhabra A, Faridian-Aragh N, Chalian M, Soldatos T, Thawait SK, Williams EH, Andreisek G. High-resolution 3-T MR neurography of peroneal neuropathy. Skeletal Radiol 2012; 41:257-71. [PMID: 21416383 DOI: 10.1007/s00256-011-1146-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/22/2011] [Accepted: 02/28/2011] [Indexed: 02/02/2023]
Abstract
The common peroneal nerve (CPN), a major terminal branch of the sciatic nerve, can be subject to a variety of pathologies, which may affect the nerve at any level from the lumbar plexus to its distal branches. Although the diagnosis of peripheral neuropathy is traditionally based on a patient's clinical findings and electrodiagnostic tests, magnetic resonance neurography (MRN) is gaining an increasing role in the definition of the type, site, and extent of peripheral nerve disorders. Current high-field MR scanners enable high-resolution and excellent soft-tissue contrast imaging of peripheral nerves. In the lower extremities, MR neurography has been employed in the demonstration of the anatomy and pathology of the CPN, as well as in the detection of associated secondary muscle denervation changes. This article reviews the normal appearance of the CPN as well as typical pathologies and abnormal findings at 3.0-T MR neurography of the lower extremity.
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Affiliation(s)
- Avneesh Chhabra
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline Street, JHOC 3262, Baltimore, MD 21287, USA.
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Thawait SK, Wang K, Subhawong TK, Williams EH, Hashemi SS, Machado AJ, Thawait GK, Soldatos T, Carrino JA, Chhabra A. Peripheral nerve surgery: the role of high-resolution MR neurography. AJNR Am J Neuroradiol 2012; 33:203-10. [PMID: 21527571 DOI: 10.3174/ajnr.a2465] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
High-resolution MRN is becoming increasingly available due to recent technical advancements, including higher magnetic field strengths (eg, 3T), 3D image acquisition, evolution of novel fat-suppression methods, and improved coil design. This review describes the MRN techniques for obtaining high-quality images of the peripheral nerves and their small branches and imaging findings in normal as well as injured nerves with relevant intraoperative correlations. Various microsurgical techniques in peripheral nerves, such as neurolysis, nerve repairs by using nerve grafts, and conduits are discussed, and MRN findings of surgically treated nerves are demonstrated.
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Affiliation(s)
- S K Thawait
- Department of Radiology, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Connecticut, USA
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Chalian M, Soldatos T, Faridian-Aragh N, Williams EH, Rosson GD, Eng J, Carrino JA, Chhabra A. 3T magnetic resonance neurography of tibial nerve pathologies. J Neuroimaging 2012; 23:296-310. [PMID: 22243916 DOI: 10.1111/j.1552-6569.2011.00676.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Diagnosis of tibial neuropathy has been traditionally based on clinical examination and electrodiagnostic studies; however, cross-sectional imaging modalities have been used to increase the diagnostic accuracy and provide anatomic mapping of the abnormalities. In this context, magnetic resonance neurography (MRN) offers high-resolution imaging of the tibial nerve (TN), its branches and the adjacent soft tissues, and provides an objective assessment of the neuromuscular anatomy, abnormality, and the surrounding pathology. This review describes the pathologies affecting the TN and illustrates their respective 3 Tesla (T) MRN appearances with relevant case examples.
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Affiliation(s)
- Majid Chalian
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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Kim SJ, Hong SH, Jun WS, Choi JY, Myung JS, Jacobson JA, Lee JW, Choi JA, Kang HS. MR imaging mapping of skeletal muscle denervation in entrapment and compressive neuropathies. Radiographics 2011; 31:319-32. [PMID: 21415181 DOI: 10.1148/rg.312105122] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The diagnoses of entrapment and compressive neuropathies have been based on the findings from clinical examinations and electrophysiologic tests, such as electromyography and nerve conduction studies. The use of magnetic resonance (MR) imaging for the diagnosis of entrapment or compressive neuropathies is increasing because MR imaging is particularly useful for discerning potential causes and for identifying associated muscle denervation. However, it is sometimes difficult to localize nerve entrapment or demonstrate nerve compression lesions with MR imaging. Nevertheless, even in these cases, MR imaging may show denervation-associated changes in specific muscles innervated by the affected nerves. The analysis of denervated muscle distributions by using MR imaging, with a knowledge of nerve innervation patterns, would be helpful for determining the nerves involved and the levels of nerve entrapment or compression. In this context, the mapping of skeletal muscle denervation with MR imaging has a supplementary or even a primary role in the diagnosis of entrapment and compressive neuropathies.
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Affiliation(s)
- Su-Jin Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Martinoli C, Miguel-Perez M, Padua L, Gandolfo N, Zicca A, Tagliafico A. Imaging of neuropathies about the hip. Eur J Radiol 2011; 82:17-26. [PMID: 21549536 DOI: 10.1016/j.ejrad.2011.04.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 12/27/2022]
Abstract
Neuropathies about the hip may be cause of chronic pain and disability. In most cases, these conditions derive from mechanical or dynamic compression of a segment of a nerve within a narrow osteofibrous tunnel, an opening in a fibrous structure, or a passageway close to a ligament or a muscle. Although the evaluation of nerve disorders primarily relies on neurological examination and electrophysiology, diagnostic imaging is currently used as a complement to help define the site and aetiology of nerve compression and exclude other disease possibly underlying the patient' symptoms. Diagnosis of entrapment neuropathies about the hip with US and MR imaging requires an in-depth knowledge of the normal imaging anatomy and awareness of the anatomic and pathologic factors that may predispose or cause a nerve injury. Accordingly, the aim of this article is to provide a comprehensive review of hip neuropathies with an emphasis on the relevant anatomy, aetiology, clinical presentation, and their imaging appearance. The lateral femoral cutaneous neuropathy (meiralgia paresthetica), femoral neuropathy, sciatic neuropathy, obturator neuropathy, superior and inferior gluteal neuropathies and pudendal neuropathy will be discussed.
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Affiliation(s)
- Carlo Martinoli
- Radiologia - DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa, Italy.
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Merlini L, Vargas MI, Anooshiravani M, Viallon M, Fluss J, Hanquinet S. Look for the nerves! MR neurography adds essential diagnostic value to routine MRI in pediatric practice: a pictorial overview. J Neuroradiol 2011; 38:141-7. [PMID: 21232798 DOI: 10.1016/j.neurad.2010.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 08/25/2010] [Accepted: 09/21/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aimed to assess the feasibility of magnetic resonance (MR) neurography in children, and the potential roles of diffusion-weighted imaging (DWI) and fiber-tracking (FT) techniques. METHODS Five pediatric patients (age range: 6-12 years) underwent magnetic resonance imaging (MRI) for various clinical indications: neurogenic bladder (case 1); persistent hand pain following minor trauma (case 2); progressive atrophy of the lower left extremity muscles (case 3); bilateral hip pain (case 4); and palpable left supraclavicular mass (case 5). All studies were performed using a 1.5-T Avanto MRI scanner (Siemens, Erlangen, Germany). The protocol included 3D T2-weighted STIR and SPACE imaging, T1-weighted fat-saturation post-gadolinium imaging and diffusion tensor imaging (DTI) with tractography. ADC (N×10(-3) mm(2)/s) and FA values were calculated from regions of interest (ROIs) centered on the nerves. Nerve-fiber tracks were calculated using a fourth-order Runge-Kutta algorithm (NeuroD software). RESULTS MR neurography allowed satisfactory visualization of all neural structures, and FA and ADC measurements were feasible. The final diagnoses were Tarlov cysts, median-nerve compression, sciatic perineurioma, Charcot-Marie-Tooth disease and plexiform neurofibroma in a patient with NF-1. DISCUSSION FA and ADC measurements are of little value because of the lack of normal reference values. Nerve-fiber tractography (FT) may be of value in the characterization of tumor pathology, and is also helpful in the planning of surgical treatments. CONCLUSION MR neurography is feasible in pediatric patients. However, a considerable amount of work has yet to be done to establish its role in the clinical management of the wide range of peripheral nerve diseases.
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Affiliation(s)
- Laura Merlini
- Unit of Pediatric Radiology, Geneva University Hospital HUG, 6, Willy-Donzé, 1205 Geneva, Switzerland.
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Thawait SK, Chaudhry V, Thawait GK, Wang KC, Belzberg A, Carrino JA, Chhabra A. High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol 2010; 32:1365-72. [PMID: 20966057 DOI: 10.3174/ajnr.a2257] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
High-resolution MR imaging of peripheral nerves is becoming more common and practical with the increasing availability of 3T magnets. There are multiple reports of MR imaging of peripheral nerves in compression and entrapment neuropathies. However, there is a relative paucity of literature on MRN appearance of diffuse peripheral nerve lesions. We attempted to highlight the salient imaging features of myriad diffuse peripheral nerve disorders and imaging techniques for MRN. Using clinical and pathologically proved relevant examples, we present the MRN appearance of various types of diffuse peripheral nerve lesions, such as traumatic, inflammatory, infectious, hereditary, radiation-induced, neoplastic, and tumor variants.
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Affiliation(s)
- S K Thawait
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Hébert-Blouin MN, Amrami KK, Spinner RJ. The normal and pathologic MRI appearance of the tibialis anterior proximal motor branch. Clin Anat 2010; 23:992-9. [DOI: 10.1002/ca.21032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Lower limb peripheral neuropathy may have a variety of causes. This article focuses on focal neural lesions because of neural entrapment associated with static mechanical compression or dynamic compression/stretching. Mechanical compression may relate to direct blunt trauma, surgical injury, mass effect associated with adjacent mass lesions, and frictional effects associated with fibrous bands. Stretching neural injury may be associated with abnormalities in alignment such as plano-valgus hindfoot and hindfoot pronation. Recurrent inversion ankle injuries may also cause neural injury. Neural injury may be associated with denervation of the muscles supplied by the nerve. Electromyography (EMG) remains the gold standard for diagnosis of denervation. Diagnostic imaging plays a complementary role to EMG in difficult cases, the anticoagulated patient, and in clarifying the etiology of an EMG-demonstrated neuropathy. Magnetic resonance imaging and ultrasound can be used in peripheral nerve imaging to demonstrate extrinsic compressive lesions, focal neural lesions such as neural edema and swelling, focal neural scarring (posttraumatic neuroma in continuity) and intraneural ganglia. Imaging can also demonstrate the effects of muscle denervation. Focal areas of tenderness can be highlighted using skin markers for magnetic resonance imaging and by transducer palpation on ultrasound. Ultrasound can be particularly useful in assessing for intrinsic lesions in small peripheral nerves because of the superior spatial resolution of ultrasound in assessing superficial structures. Plain x-rays (and sometimes computed tomography scanning) may show significant bone changes and should be the initial imaging modality.
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Affiliation(s)
- Donald Neil Simmons
- Musculoskeletal Ultrasound Centre of Excellence, Dr Jones and Partners, Adelaide, South Australia, Australia.
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Schmid DT, Hodler J, Mengiardi B, Pfirrmann CWA, Espinosa N, Zanetti M. Fatty Muscle Atrophy: Prevalence in the Hindfoot Muscles on MR Images of Asymptomatic Volunteers and Patients with Foot Pain. Radiology 2009; 253:160-6. [DOI: 10.1148/radiol.2531090035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Highly reliable evidence for piriformis syndrome and other pelvic sciatic syndromes arises from three major categories of data: magnetic resonance neurography diagnostic imaging, open magnetic resonance-guided injection studies, and patient treatment outcome studies. This article reviews the evidence in each category. This is part of a Point-Counterpoint discussion with Dr. Robert Tiel's presentation of "Myth and Fallacy".
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Affiliation(s)
- Aaron G Filler
- Institute for Nerve Medicine, 2716 Ocean Park Boulevard, Suite 3082, Santa Monica, CA 90405, USA.
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Imaging of Peripheral Nerve Lesions in the Lower Limb. TECHNIQUES IN FOOT AND ANKLE SURGERY 2008. [DOI: 10.1097/btf.0b013e31818f3620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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