1
|
Martín-Noguerol T, Montesinos P, Hassankhani A, Bencardino DA, Barousse R, Luna A. Technical Update on MR Neurography. Semin Musculoskelet Radiol 2022; 26:93-104. [PMID: 35609571 DOI: 10.1055/s-0042-1742753] [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
Imaging evaluation of peripheral nerves (PNs) is challenging. Magnetic resonance imaging (MRI) and ultrasonography are the modalities of choice in the imaging assessment of PNs. Both conventional MRI pulse sequences and advanced techniques have important roles. Routine MR sequences are the workhorse, with the main goal to provide superb anatomical definition and identify focal or diffuse nerve T2 signal abnormalities. Selective techniques, such as three-dimensional (3D) cranial nerve imaging (CRANI) or 3D NerveVIEW, allow for a more detailed evaluation of normal and pathologic states. These conventional pulse sequences have a limited role in the comprehensive assessment of pathophysiologic and ultrastructural abnormalities of PNs. Advanced functional MR neurography sequences, such as diffusion tensor imaging tractography or T2 mapping, provide useful and robust quantitative parameters that can be useful in the assessment of PNs on a microscopic level. This article offers an overview of various technical parameters, pulse sequences, and protocols available in the imaging of PNs and provides tips on avoiding potential pitfalls.
Collapse
Affiliation(s)
| | | | - Alvand Hassankhani
- Department of Radiology, Division of Neuroradiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina
| | - Antonio Luna
- MRI Unit, Radiology Department, HT Médica, Jaén, Spain
| |
Collapse
|
2
|
Strakowski JA. Ultrasound Evaluation of Peripheral Nerve Trauma. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
3
|
Stratchko L, Rosas H. Imaging of Elbow Injuries. Clin Sports Med 2021; 40:601-623. [PMID: 34509201 DOI: 10.1016/j.csm.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Familiarity with throwing mechanics during elbow range of motion allows accurate diagnosis of sports-related elbow injuries, which occur in predictable patterns. In addition, repetitive stress-related injuries are often clinically apparent; however, imaging plays an important role in determining severity as well as associated injuries that may affect clinical management. A detailed understanding of elbow imaging regarding anatomy and mechanism of injury results in prompt and precise treatment.
Collapse
Affiliation(s)
- Lindsay Stratchko
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Humberto Rosas
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| |
Collapse
|
4
|
Scarborough A, MacFarlane RJ, Klontzas M, Zhou R, Waseem M. Compression neuropathies of the forearm: anatomy, clinical features and management. Br J Hosp Med (Lond) 2021; 82:1-10. [PMID: 34431339 DOI: 10.12968/hmed.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The upper limb consists of four major parts: a girdle formed by the clavicle and scapula, the arm, the forearm and the hand. Peripheral nerve lesions of the upper limb are divided into lesions of the brachial plexus or the nerves arising from it. Lesions of the nerves arising from the brachial plexus are further divided into upper (proximal) or lower (distal) lesions based on their location. Peripheral nerves in the forearm can be compressed in various locations and by a wide range of pathologies. A thorough understanding of the anatomy and clinical presentations of these compression neuropathies can lead to prompt diagnosis and management, preventing possible permanent damage. This article discusses the aetiology, anatomy, clinical presentation and surgical management of compressive neuropathies of the upper limb.
Collapse
Affiliation(s)
- Alexander Scarborough
- Department of Oral and Maxillofacial Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - Robert J MacFarlane
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Michail Klontzas
- Department of Radiology, University Hospital of Heraklion, Irákleio, Greece
| | - Rui Zhou
- Department of Trauma and Orthopaedic Surgery, Peterborough City Hospital, Peterborough, UK
| | - Mohammad Waseem
- Department of Trauma and Orthopaedic Surgery, East Cheshire NHS Trust, Macclesfield, UK
| |
Collapse
|
5
|
Kim IJ, Cho H, Yi MS, Park YH, Kim S, Kim DK, Shin HY. Diagnosis and treatment of nerve injury following venipuncture - A report of two cases. Anesth Pain Med (Seoul) 2021; 16:299-304. [PMID: 34289298 PMCID: PMC8342828 DOI: 10.17085/apm.21010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Venipuncture is one of the one of the most commonly performed, minimally-invasive procedures; however, it may lead to peripheral nerve injury. Here, we describe the diagnosis, treatment, and prognosis of two self-reported cases of nerve injury during venipuncture with the aim of drawing attention to possible needle-related nerve injuries. CASE Two anesthesiologists in our hospital experienced an injury of the lateral antebrachial cutaneous branch of the musculocutaneous nerve during venipuncture. Immediately, they underwent ultrasound examinations and nerve blocks with oral medication, resulting in full recovery. CONCLUSIONS Ultrasonography is important for the early and confirmative diagnosis of a nerve injury during venipuncture, and for immediate treatment with a nerve block. Moreover, it is imperative for both the practitioner and the patient to be aware of the possible complication of nerve injury after venipuncture.
Collapse
Affiliation(s)
- In Jung Kim
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hana Cho
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Myung Sub Yi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Yong Hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Hwa-Yong Shin
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Spalkit S, Sinha A, Prakash M, Tripathy S. Primary elbow osteoarthritis presenting as ulnar nerve palsy with claw hand. BMJ Case Rep 2021; 14:14/5/e242773. [PMID: 33958369 PMCID: PMC8103949 DOI: 10.1136/bcr-2021-242773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old woman was referred with weakness, paraesthesia, numbness and clawing of the little and ring fingers for the last 2 years. MRI of the cervical spine was normal and nerve conduction velocity revealed abnormality of the ulnar nerve. Ultrasound and MRI showed medial osteophytes and effusion of the elbow joint with stretched and thinned ulnar nerve in the cubital tunnel. The patient underwent release and anterior transposition of the ulnar nerve with significant relief of symptoms.
Collapse
Affiliation(s)
- Stanzin Spalkit
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anindita Sinha
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh Prakash
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyaswarup Tripathy
- Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Maeda A, Suzuki T, Hayakawa K, Funahashi T, Kuroiwa T, Fujita N. T2 mapping of the median nerve in patients with carpal tunnel syndrome and healthy volunteers. Muscle Nerve 2021; 63:774-777. [PMID: 33580888 DOI: 10.1002/mus.27205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We investigated the changes in MRI T2 mapping values in subjects with carpal tunnel syndrome (CTS) compared to healthy controls. METHODS We enrolled 71 patients with CTS and 26 healthy controls. Median nerve T2 values were measured at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels. These were compared between patients and controls and correlated with median nerve cross-sectional area (CSA) and nerve conduction measurements. RESULTS The mean T2 values at the proximal carpal tunnel levels were higher in the CTS group (56.7 ms) than in the control group (51.2 ms, P = .02) and also were higher than at the distal carpal tunnel (51.0 ms, P < .001) and forearm levels (47.6 ms, P < .001). T2 values were not significantly associated with CSA or nerve conduction measurements. DISCUSSION T2 mapping of the carpal tunnel provides qualitative information on median nerve pathology but does not reflect CTS severity.
Collapse
Affiliation(s)
- Atsushi Maeda
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Takuya Funahashi
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Japan
| | - Takashi Kuroiwa
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Japan
| |
Collapse
|
8
|
Vij N, Kiernan H, Miller-Gutierrez S, Agusala V, Kaye AD, Imani F, Zaman B, Varrassi G, Viswanath O, Urits I. Etiology Diagnosis and Management of Radial Nerve Entrapment. Anesth Pain Med 2021; 11:e112823. [PMID: 34221946 PMCID: PMC8236840 DOI: 10.5812/aapm.112823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 02/06/2023] Open
Abstract
Context The anatomy of the radial nerve is prone to entrapment, each with different symptomology. Compression of entrapment of the radial nerve can occur near the radiocapitellar joint, the spiral groove, the arcade of Frohse, the tendon of the extensor carpi radialis brevis (ECRB), and at the radial tunnel. Those who require repetitive motions are at increased risk of peripheral neuropathy syndromes, including repetitive pronation and supination, trauma, or systemic disease; however, t the influence of all risk factors is not well understood. Depending on the location of entrapment, radial nerve entrapment syndrome presents different symptoms. It may include both a motor component and a sensory component. The motor component includes a dropped arm, and the sensory component can include pain and paresthesia in the distribution of the radial nerve that resolves with rest and exacerbates by repetitive pronation and supination. Evidence Acquisition Diagnostic evaluation for radial nerve entrapment, apart from clinical symptoms and physical exam, includes electromyography, nerve conduction studies, ultrasonography, and magnetic resonance imaging. Conservative management for radial nerve entrapment includes oral anti-inflammatory medications, activity modification, and splinting. Some recently performed studies mentioned promising minimally invasive techniques, including corticosteroid injections, peripheral nerve stimulation, and pulsed radiofrequency. Results When minimally invasive techniques fail, open or endoscopic surgery can be performed to release the nerve Conclusions Endoscopic surgery has the benefit of decreasing incision size and reducing time to functional recovery.
Collapse
Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Corresponding Author: University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
| | - Hayley Kiernan
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sam Miller-Gutierrez
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | - Veena Agusala
- Texas Tech University Health Sciences Center, School of Medicine in Lubbock, TX, USA
| | - Alan David Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Zaman
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | | | - Omar Viswanath
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, USA
| | - Ivan Urits
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
- Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA, USA
| |
Collapse
|
9
|
Vij N, Traube B, Bisht R, Singleton I, Cornett EM, Kaye AD, Imani F, Mohammadian Erdi A, Varrassi G, Viswanath O, Urits I. An Update on Treatment Modalities for Ulnar Nerve Entrapment: A Literature Review. Anesth Pain Med 2020; 10:e112070. [PMID: 34150581 PMCID: PMC8207847 DOI: 10.5812/aapm.112070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Ulnar nerve entrapment is a relatively common entrapment syndrome second only in prevalence to carpal tunnel syndrome. The potential anatomic locations for entrapment include the brachial plexus, cubital tunnel, and Guyon's canal. Ulnar nerve entrapment is more so prevalent in pregnancy, diabetes, rheumatoid arthritis, and patients with occupations involving periods of prolonged elbow flexion and/or wrist dorsiflexion. Cyclists are particularly at risk of Guyon's canal neuropathy. Patients typically present with sensory deficits of the palmar aspect of the fourth and fifth digits, followed by motor symptoms, including decreased pinch strength and difficulty fastening shirt buttons or opening bottles. EVIDENCE ACQUISITION Literature searches were performed using the below MeSH Terms using Mendeley version 1.19.4. Search fields were varied until further searches revealed no new articles. All articles were screened by title and abstract. Decision was made to include an article based on its relevance and the list of final articles was approved three of the authors. This included reading the entirety of the artice. Any question regarding the inclusion of an article was discussed by all authors until an agreement was reached. RESULTS X-ray and CT play a role in diagnosis when a bony injury is thought to be related to the pathogenesis (i.e., fracture of the hook of the hamate.) MRI plays a role where soft tissue is thought to be related to the pathogenesis (i.e., tumor or swelling.) Electromyography and nerve conduction also play a role in diagnosis. Medical management, in conjunction with physical therapy, shows limited promise. However, minimally invasive techniques, including peripheral percutaneous electrode placement and ultrasound-guided electrode placement, have all been recently studied and show great promise. When these techniques fail, clinicians should resort to decompression, which can be done endoscopically or through an open incision. Endoscopic ulnar decompression shows great promise as a surgical option with minimal incisions. CONCLUSIONS Clinical diagnosis of ulnar nerve entrapment can often be delayed and requires the suspicion as well as a thorough neurological exam. Early recognition and diagnois are important for early institution of treatment. A wide array of diagnostic imaging can be useful in ruling out bony, soft tissue, or vascular etiologies, respectively. However, clinicians should resort to electrodiagnostic testing when a definitive diagnois is needed. Many new minimally invasive techniques are in the literature and show great promise; however, further large scale trials are needed to validate these techniques. Surgical options remains as a gold standard when adequate symptom relief is not achieved through minimally invasive means.
Collapse
Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Blake Traube
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Roy Bisht
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Ian Singleton
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Elyse M. Cornett
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, Louisiana
| | - Alan D. Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, Louisiana
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammadian Erdi
- Department of Anesthesiology, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Omar Viswanath
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
- Creighton University School of Medicine, Department of Anesthesiology, Omaha, Nebraska
- Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, Arizona
| | - Ivan Urits
- Southcoast Health Physicians Group Pain Medicine, Wareham, Massachusetts
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Bhattacharya AK, Awan OA, Fenerty S, Taqi I, Jonnalagadda P, Ling S, Ali S. Repetitive Strain Injuries of the Upper Extremity: Imaging of Tendon Pathology and Compressive Neuropathies. Curr Probl Diagn Radiol 2020; 50:512-522. [PMID: 32826098 DOI: 10.1067/j.cpradiol.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022]
Abstract
Repetitive strain injuries (RSIs) encompass a broad clinicopathologic spectrum which includes discrete patterns of tissue injury involving tendons, bursae and nerves although an element of subjective symptomatology may be contributory. Upper extremity RSIs include De Quervain's tenosynovitis, intersection syndromes, epicondylitis, ulnar, and median neuritis as well as other compressive neuropathies. It is estimated that RSIs cost the US economy over $60 billion annually and while detailed clinical examination remains the diagnostic mainstay, imaging can aid in diagnosis, guide management and reduce costs.
Collapse
Affiliation(s)
| | - Omer A Awan
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sarah Fenerty
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Irfan Taqi
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | | | - Stephen Ling
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, PA
| |
Collapse
|
12
|
Casaletto E, Lin B, Wolfe SW, Lee SK, Sneag DB, Feinberg JH, Nwawka OK. Ultrasound imaging of nerves in the neck: Correlation with MRI, EMG, and clinical findings. Neurol Clin Pract 2019; 10:415-421. [PMID: 33299669 DOI: 10.1212/cpj.0000000000000767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/25/2019] [Indexed: 01/15/2023]
Abstract
Objective We evaluated the performance of ultrasound in the detection of neuropathy of the suprascapular nerve (SSN), long thoracic nerve (LTN), spinal accessory nerve (SAN), and phrenic nerve and compared this performance with MRI. Methods A retrospective review of 56 patients who had undergone ultrasound imaging of the SSN, LTN, SAN, and phrenic nerve was performed. Diagnoses made by ultrasound, MRI, EMG reports, and clinical and operative notes were recorded. Results Ultrasound was successful in visualizing nerves in the neck in the overwhelming majority of cases. Sonographic findings were typically in agreement with MRI and clinical findings. Conclusion Ultrasound is effective in the visualization and diagnostic evaluation of the SSN, LTN, SAN, and phrenic nerve. Classification of evidence This study provides Class IV evidence that ultrasound can effectively visualize and diagnose neuropathy of the SSN, LTN, SAN, and phrenic nerve in the neck.
Collapse
Affiliation(s)
- Emily Casaletto
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Bin Lin
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Scott W Wolfe
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Steve K Lee
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Darryl B Sneag
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - Joseph H Feinberg
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| | - O Kenechi Nwawka
- Department of Radiology and Imaging (EC, BL, DBS, OKN), Department of Orthopedic Surgery (SWW, SKL), and Department of Physiatry (JHF), Hospital for Special Surgery, New York
| |
Collapse
|
13
|
Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment. Radiographics 2019; 39:427-446. [DOI: 10.1148/rg.2019180112] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
14
|
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
Collapse
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
| |
Collapse
|
15
|
Raducha JE, Gil JA, DeFroda SF, Wawrzynski J, Weiss APC. An Evidence-Based Approach to the Differentiation of Compressive Neuropathy from Polysensory Neuropathy in the Upper Extremity. JBJS Rev 2017; 5:e9. [DOI: 10.2106/jbjs.rvw.17.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Hassanien OA, Younes RL, Dawoud RM, Younis LM, Hamoda IM. Reliable MRI and MRN signs of nerve and muscle injury following trauma to the shoulder with EMG and Clinical correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
18
|
Roy EA, Cheyne I, Andrews GT, Forster BB. Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder. Radiology 2016; 278:316-32. [PMID: 26789600 DOI: 10.1148/radiol.2015150364] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.
Collapse
Affiliation(s)
- Elizabeth A Roy
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Ian Cheyne
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Gordon T Andrews
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Bruce B Forster
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| |
Collapse
|
19
|
Study on the use of quantitative ultrasound evaluation of diabetic neuropathy in the rat sciatic nerve. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:997-1005. [DOI: 10.1007/s13246-016-0448-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/26/2016] [Indexed: 01/19/2023]
|
20
|
Wang L, Niu Y, Kong X, Yu Q, Kong X, Lv Y, Shi H, Li C, Wu W, Wang B, Liu D. The application of paramagnetic contrast-based T2 effect to 3D heavily T2W high-resolution MR imaging of the brachial plexus and its branches. Eur J Radiol 2016; 85:578-84. [DOI: 10.1016/j.ejrad.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 11/30/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
|
21
|
Kraus E, Tenforde AS, Beaulieu CF, Ratliff J, Fredericson M. Piriformis Syndrome With Variant Sciatic Nerve Anatomy: A Case Report. PM R 2016; 8:176-9. [DOI: 10.1016/j.pmrj.2015.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
|
22
|
Deniel A, Causeret A, Moser T, Rolland Y, Dréano T, Guillin R. Entrapment and traumatic neuropathies of the elbow and hand: An imaging approach. Diagn Interv Imaging 2015; 96:1261-78. [PMID: 26573067 DOI: 10.1016/j.diii.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/15/2015] [Indexed: 12/14/2022]
Abstract
Ultrasound and magnetic resonance imaging currently offer a detailed analysis of the peripheral nerves. Compressive and traumatic nerve injuries are the two main indications for imaging investigation of nerves with several publications describing the indications, technique and diagnostic capabilities of imaging signs. Investigation of entrapment neuropathies has three main goals, which are to confirm neuronal distress, search for the cause of nerve compression and exclude a differential diagnosis on the entire nerve. For traumatic nerve injuries, imaging, predominantly ultrasound, occasionally provides essential information for management including the type of nerve lesion, its exact site and local extension.
Collapse
Affiliation(s)
- A Deniel
- Department of Medical Imaging, Rennes University Hospitals, Sud Hospital, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France.
| | - A Causeret
- Department of Medical Imaging, Rennes University Hospitals, Sud Hospital, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| | - T Moser
- Department of Radiology, Montreal University Hospital Centre, 1560, rue Sherbrooke-Est, Montreal, Quebec H2 4M1, Canada
| | - Y Rolland
- Department of Medical Imaging, Eugène Marquis Centre, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - T Dréano
- Department of Orthopaedics and Traumatology, Rennes University Hospitals, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - R Guillin
- Department of Medical Imaging, Rennes University Hospitals, Sud Hospital, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| |
Collapse
|
23
|
Muellner J, Kaelin-Lang A, Pfeiffer O, El-Koussy MM. Neurogenic thoracic outlet syndrome due to subclavius posticus muscle with dynamic brachial plexus compression: a case report. BMC Res Notes 2015; 8:351. [PMID: 26268814 PMCID: PMC4535788 DOI: 10.1186/s13104-015-1317-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 08/04/2015] [Indexed: 11/17/2022] Open
Abstract
Background Neurogenic thoracic outlet syndrome is an underestimated cause of brachial weakness and pain. The subclavius posticus muscle (SPM) is an aberrant muscle originating from the medial aspect of the first rib reaching to superior border of the scapula, which may cause, depending on its activation, dynamic compression of the brachial plexus. Case presentation In the present study, we report about a 32-year-old male caucasian patient with weakness in radial deviation of his left hand. An isolated macrodactyly of his left middle finger had been operated twice. Electroneurography showed a carpal-tunnel-syndrome (CTS) on the left side. MRI of the brachial plexus revealed an additional muscle in the costoclavicular space, identified as SPM. To our knowledge, this is the second case report of a neurogenic thoracic outlet syndrome due to SPM, and the first case described with isolated macrodactyly and CTS in the same patient. Conclusion If complaints about hand weakness are only reported in cases of distinct hand positions, a dynamic compression of the brachial plexus by SPM may be the cause. A neurogenic thoracic outlet syndrome may facilitate the development of CTS.
Collapse
Affiliation(s)
- Julia Muellner
- Department of Neurology, University Hospital Bern, Freiburgstrasse 100, 3010, Bern, Switzerland.
| | - Alain Kaelin-Lang
- Neurocenter of Southern Switzerland, Opsedale Civico, Via Tesserete 46, 6900, Lugano, Switzerland.
| | - Oliver Pfeiffer
- Department of Neuroradiology, University Hospital Bern, Bern, Switzerland.
| | | |
Collapse
|
24
|
Usefulness of IDEAL T2 imaging for homogeneous fat suppression and reducing susceptibility artefacts in brachial plexus MRI at 3.0 T. Radiol Med 2015; 121:45-53. [DOI: 10.1007/s11547-015-0576-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
|
25
|
Raeburn K, Burns D, Hage R, Tubbs RS, Loukas M. Cross-sectional sonographic assessment of the posterior interosseous nerve. Surg Radiol Anat 2015; 37:1155-60. [PMID: 25968614 DOI: 10.1007/s00276-015-1487-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/03/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Cross-sectional sonographic measurements are considered first-line confirmatory tests in diagnosing peripheral nerve entrapment syndromes. Our aim is to establish normal values of cross-sectional area of the posterior interosseous nerve (PIN) at the arcade of Frohse, the most common site of compression of this nerve. METHODS The PIN was identified with ultrasound on 50 healthy adults and 30 cadavers. Measurements of the cross-sectional area (CSA), antero-posterior (AP) and lateral (L) distances were taken immediately proximal and distal to the arcade of Frohse. RESULTS The mean AP and L distances of the PIN proximal to the arcade of Frohse were 0.111 cm (0 ± 0.021) and 0.266 cm (±0.058), respectively, while the mean AP and L distances of the PIN distal to the arcade of Frohse were 0.085 cm (±0.019) and 0.343 cm (±0.057), respectively. P squared testing showed a statistically significant difference between the AP and lateral distances of the PIN when comparing proximal and distal to the arcade (p ≤ 0.001). However, the mean CSA of the PIN measured immediately proximal to the arcade of Frohse was 0.022 cm(2) (±0.005); immediately distal to the arcade of Frohse, it was 0.023 cm(2) (±0.004). t test showed no statistical difference between the two regions (p = 0.11). CONCLUSIONS Our study has provided reference values for the PIN in healthy individuals at the arcade of Frohse. Although, there is a flattening of the nerve as it enters the supinator muscle, this should not be mistaken for nerve entrapment as the size of the nerve remains consistent.
Collapse
Affiliation(s)
- Kazzara Raeburn
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada, West Indies
| | - Danny Burns
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada, West Indies
| | - Robert Hage
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada, West Indies
| | - R Shane Tubbs
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada, West Indies.,Pediatric Neurosurgery, Children's Hospital of Alabama, Birmingham, AL, USA
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada, West Indies.
| |
Collapse
|
26
|
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.
Collapse
|
27
|
Göçmen S, Topuz AK, Atabey C, Şimşek H, Keklikçi K, Rodop O. Peripheral nerve injuries due to osteochondromas: analysis of 20 cases and review of the literature. J Neurosurg 2014; 120:1105-12. [DOI: 10.3171/2013.11.jns13310] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Nerve compressions due to osteochondromas are extremely rare. The aim of this retrospective study was to investigate the mechanisms, diagnostic evaluations, and treatment of nerve lesions due to osteochondromas, and to review the literature.
Methods
The authors retrospectively reviewed their clinic data archive from 1998 through 2008, and 20 patients who were operated on due to peripheral nerve injuries caused by osseous growth were enrolled in the study. Patients' age, duration of symptoms, localizations, intraoperative findings, and modified British Medical Research Council (MRC) and electromyography data obtained from hospital records were evaluated. The literature on this topic available in PubMed was also reviewed. All 20 patients underwent surgery, which consisted of tumor excision performed by orthopedic surgeons and nerve decompression performed by neurosurgeons.
Results
There were 17 men and 3 women included in the study, with a mean age of 21 years (range 18–25 years). Three patients had multiple hereditary exostoses, and 17 had a solitary exostosis. All of the patients underwent en bloc resection. The most common lesion site was the distal femur (45%). The peroneal and posterior tibial nerves were the structures that were affected the most frequently. The mean follow-up was 3.9 years (range 2–7 years). After the surgery, all patients (100%) experienced good sensory recovery (modified MRC Grade S4 or S5).
Conclusions
To the authors' knowledge, no large series have reported peripheral nerve compression due to exostoses. The authors have several recommendations as a result of their findings. First, all patients with peripheral nerve compression due to an osteochondroma should undergo surgery. Second, preoperative electromyographic examinations and radiographic evaluation, consisting of MRI and CT to provide optimal information about the lesion, are crucially important. Third, immediate treatment is mandatory to regain the best possible recovery. And fourth, performing nerve decompression first and en bloc resection of osteochondroma consecutively in a multidisciplinary fashion is strongly recommended to avoid peripheral nerve injury.
Collapse
Affiliation(s)
| | | | | | | | - Kenan Keklikçi
- 2Orthopedics, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Osman Rodop
- 2Orthopedics, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| |
Collapse
|
28
|
Jepsen JR. Can testing of six individual muscles represent a screening approach to upper limb neuropathic conditions? BMC Neurol 2014; 14:90. [PMID: 24767511 PMCID: PMC4006451 DOI: 10.1186/1471-2377-14-90] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 04/21/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It has previously been demonstrated that an extensive upper limb neurological examination of individual muscle function, sensation in homonymous innervated territories, and nerve trunk allodynia is reliable and that the outcome reflects symptoms. Since this approach may appear complicated and time consuming, this study deals with the value of an examination limited to manual testing of only six muscles. METHODS Two examiners blinded to symptom status performed manual muscle testing of six muscles in 82 upper limbs with or without pain, weakness, and/or numbness/tingling. The six muscles represent three antagonist pairs (pectoralis major/posterior deltoid, biceps/triceps, and radial flexor of wrist/short radial extensor of wrist). The inter-rater reliability of detecting muscular weaknesses and the relation of weakness to the mentioned symptoms were analysed by kappa-statistics. RESULTS The two examiners recognized weaknesses in 48 and 55 limbs, respectively, with moderate agreement (median kappa = 0.58). Out of these, 35 and 32 limbs, respectively, were symptomatic. There was good correlation between findings and symptoms for one examiner (kappa = 0.61) and fair correlation for the other one (kappa = 0.33). Both reached high sensitivity (0.92, 0.84) but less satisfactory specificity (0.70, 0.50). Weaknesses agreed upon by the two examiners correlated moderately with symptoms (kappa = 0.57). CONCLUSIONS Weakness in one or more muscles was present in almost all symptomatic limbs but in many non-symptomatic limbs as well. Manual testing of six muscles may represent a useful screening approach to upper limb neuropathic conditions, but a confirmative diagnosis requires further assessment.
Collapse
Affiliation(s)
- Jørgen Riis Jepsen
- Department of Occupational Medicine, Hospital of South-western Jutland, Østergade 81-83, Esbjerg DK-6700, Denmark.
| |
Collapse
|
29
|
Rehman I, Chokshi FH, Khosa F. MR Imaging of the Brachial Plexus. Clin Neuroradiol 2014; 24:207-16. [DOI: 10.1007/s00062-014-0297-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 02/06/2014] [Indexed: 12/26/2022]
|
30
|
Chalian M, Behzadi AH, Williams EH, Shores JT, Chhabra A. High-Resolution Magnetic Resonance Neurography in Upper Extremity Neuropathy. Neuroimaging Clin N Am 2014; 24:109-25. [DOI: 10.1016/j.nic.2013.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
31
|
Ohana M, Moser T, Moussaouï A, Kremer S, Carlier R, Liverneaux P, Dietemann JL. Current and future imaging of the peripheral nervous system. Diagn Interv Imaging 2014; 95:17-26. [DOI: 10.1016/j.diii.2013.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Kaufman MR, Elkwood AI, Colicchio AR, CeCe J, Jarrahy R, Willekes LJ, Rose MI, Brown D. Functional restoration of diaphragmatic paralysis: an evaluation of phrenic nerve reconstruction. Ann Thorac Surg 2013; 97:260-6. [PMID: 24266954 DOI: 10.1016/j.athoracsur.2013.09.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/10/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Unilateral diaphragmatic paralysis causes respiratory deficits and can occur after iatrogenic or traumatic phrenic nerve injury in the neck or chest. Patients are evaluated using spirometry and imaging studies; however, phrenic nerve conduction studies and electromyography are not widely available or considered; thus, the degree of dysfunction is often unknown. Treatment has been limited to diaphragmatic plication. Phrenic nerve operations to restore diaphragmatic function may broaden therapeutic options. METHODS An interventional study of 92 patients with symptomatic diaphragmatic paralysis assigned 68 (based on their clinical condition) to phrenic nerve surgical intervention (PS), 24 to nonsurgical (NS) care, and evaluated a third group of 68 patients (derived from literature review) treated with diaphragmatic plication (DP). Variables for assessment included spirometry, the Short-Form 36-Item survey, electrodiagnostics, and complications. RESULTS In the PS group, there was an average 13% improvement in forced expiratory volume in 1 second (p < 0.0001) and 14% improvement in forced vital capacity (p < 0.0001), and there was corresponding 17% (p < 0.0001) and 16% (p < 0.0001) improvement in the DP cohort. In the PS and DP groups, the average postoperative values were 71% for forced expiratory volume in 1 second and 73% for forced vital capacity. The PS group demonstrated an average 28% (p < 0.01) improvement in Short-Form 36-Item survey reporting. Electrodiagnostic testing in the PS group revealed a mean 69% (p < 0.05) improvement in conduction latency and a 37% (p < 0.0001) increase in motor amplitude. In the NS group, there was no significant change in Short-Form 36-Item survey or spirometry values. CONCLUSIONS Phrenic nerve operations for functional restoration of the paralyzed diaphragm should be part of the standard treatment algorithm in the management of symptomatic patients with this condition. Assessment of neuromuscular dysfunction can aid in determining the most effective therapy.
Collapse
Affiliation(s)
- Matthew R Kaufman
- Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey; The Institute for Advanced Reconstruction, Shrewsbury, New Jersey.
| | - Andrew I Elkwood
- Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey; The Institute for Advanced Reconstruction, Shrewsbury, New Jersey
| | - Alan R Colicchio
- Department of Neuroscience, Jersey Shore University Medical Center, Neptune, New Jersey
| | - John CeCe
- The Institute for Advanced Reconstruction, Shrewsbury, New Jersey
| | - Reza Jarrahy
- Department of Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | | | - Michael I Rose
- Department of Surgery, Jersey Shore University Medical Center, Neptune, New Jersey; The Institute for Advanced Reconstruction, Shrewsbury, New Jersey
| | - David Brown
- Department of Physical Medicine and Rehabilitation, JFK Medical Center, Edison, New Jersey
| |
Collapse
|
33
|
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
| |
Collapse
|
34
|
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]
|
35
|
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]
|
36
|
Blum A, Lecocq S, Louis M, Wassel J, Moisei A, Teixeira P. The nerves around the shoulder. Eur J Radiol 2013; 82:2-16. [DOI: 10.1016/j.ejrad.2011.04.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/29/2011] [Indexed: 11/27/2022]
|
37
|
Chen Y, Kumar N, Lim JWW, Smith EW. High-resolution sonography detects extraforaminal nerve pathology in patients initially diagnosed with cervical disc disease: a case series. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:46-54. [PMID: 22006670 DOI: 10.1002/jcu.20876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/16/2011] [Indexed: 05/31/2023]
Abstract
In patients presenting with neck and upper limb complaints, MRI changes suggestive of cervical disc disease do not exclude concomitant extraforaminal pathology, as shown in the series of three cases presented here. High-resolution ultrasound of the brachial plexus and peripheral nerves may be useful in identifying an extraforaminal pathology when (1) symptoms and signs are disproportionate to MRI findings of cervical disc disease; (2) there is obvious discordance between MRI and nerve conduction findings; (3) an entrapment neuropathy is suspected but the site of nerve lesion is unidentifiable on the basis of available investigations and clinical findings.
Collapse
|
38
|
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.
Collapse
|
39
|
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.
Collapse
Affiliation(s)
- S K Thawait
- Department of Radiology, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Connecticut, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Chhabra A, Lee PP, Bizzell C, Faridian-Aragh N, Hashemi S, Belzberg AJ, Carrino JA. High-resolution 3-Tesla magnetic resonance neurography of musculocutaneous neuropathy. J Shoulder Elbow Surg 2012; 21:e1-6. [PMID: 21885297 DOI: 10.1016/j.jse.2011.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/26/2011] [Accepted: 06/05/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Avneesh Chhabra
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | |
Collapse
|
41
|
Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ, Carrino JA, Chhabra A. High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol 2012; 41:15-31. [PMID: 21479520 PMCID: PMC3158963 DOI: 10.1007/s00256-011-1143-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 02/02/2023]
Abstract
Peripheral nerves often traverse confined fibro-osseous and fibro-muscular tunnels in the extremities, where they are particularly vulnerable to entrapment and compressive neuropathy. This gives rise to various tunnel syndromes, characterized by distinct patterns of muscular weakness and sensory deficits. This article focuses on several upper and lower extremity tunnels, in which direct visualization of the normal and abnormal nerve in question is possible with high resolution 3T MR neurography (MRN). MRN can also serve as a useful adjunct to clinical and electrophysiologic exams by discriminating adhesive lesions (perineural scar) from compressive lesions (such as tumor, ganglion, hypertrophic callous, or anomalous muscles) responsible for symptoms, thereby guiding appropriate treatment.
Collapse
Affiliation(s)
- Ty K Subhawong
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 601 N. Caroline Street, Room 4214, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Tagliafico A, Succio G, Emanuele Neumaier C, Serafini G, Ghidara M, Calabrese M, Martinoli C. MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience. Skeletal Radiol 2011; 40:717-24. [PMID: 20972564 DOI: 10.1007/s00256-010-1050-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare 1.5-T and 3-T magnetic resonance (MR) imaging of the brachial plexus. MATERIALS AND METHODS Institutional review board approval and informed consent were obtained from 30 healthy volunteers and 30 consecutive patients with brachial plexus disturbances. MR was prospectively performed with comparable sequence parameters and coils with a 1.5-T and a 3-T system. Imaging protocols at both field strengths included T1-weighted turbo spin-echo (tSE) sequences and T2-weighed turbo spin-echo (tSE) sequences with fat saturation. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between muscle and nerve were calculated for both field strengths. The visibility of brachial plexus nerve at various anatomic levels (roots, interscalene area, costoclavicular space, and axillary level) was analyzed with a four-point grading scale by two radiologists. MR imaging diagnoses and pathological findings were also compared qualitatively. RESULTS SNR and CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (Friedman test) for all sequences. Nerve visibility was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test). Pathological findings (n = 30/30) were seen equally well with both field strengths. MR imaging diagnoses did not differ for the 1.5- and 3-T protocols. CONCLUSIONS High-quality MR images of the brachial plexus can be obtained with 3-T MR imaging by using sequences similar to those used at 1.5-T MR imaging. In patients and healthy volunteers, the visibility of nerve trunks and cords at 3-T MR imaging appears to be superior to that at 1.5-T MR imaging.
Collapse
Affiliation(s)
- Alberto Tagliafico
- Department of Radiology, National Institute for Cancer Research, Genova, Italy.
| | | | | | | | | | | | | |
Collapse
|
43
|
Tagliafico A, Succio G, Neumaier CE, Baio G, Serafini G, Ghidara M, Calabrese M, Martinoli C. Brachial plexus assessment with three-dimensional isotropic resolution fast spin echo MRI: comparison with conventional MRI at 3.0 T. Br J Radiol 2011; 85:e110-6. [PMID: 21343321 DOI: 10.1259/bjr/28972953] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of our study was to determine whether a three-dimensional (3D) isotropic resolution fast spin echo sequence (FSE-cube) has similar image quality and diagnostic performance to a routine MRI protocol for brachial plexus evaluation in volunteers and symptomatic patients at 3.0 T. Institutional review board approval and written informed consent were guaranteed. METHODS In this prospective study FSE-cube was added to the standard brachial plexus examination protocol in eight patients (mean age, 50.2 years) with brachial plexus pathologies and in six volunteers (mean age, 54 years). Nerve visibility, tissue contrast, edge sharpness, image blurring, motion artefact and acquisition time were calculated for FSE-cube sequences and for the standard protocol on a standardised five-point scale. The visibility of brachial plexus nerve and surrounding tissues at four levels (roots, interscalene area, costoclavicular space and axillary level) was assessed. RESULTS Image quality and nerve visibility did not significantly differ between FSE-cube and the standard protocol (p>0.05). Acquisition time was statistically and clinically significantly shorter with FSE-cube (p<0.05). Pathological findings were seen equally well with FSE-cube and the standard protocol. CONCLUSION 3D FSE-cube provided similar image quality in a shorter acquisition time and enabled excellent visualisation of brachial plexus anatomy and pathology in any orientation, regardless of the original scanning plane.
Collapse
Affiliation(s)
- A Tagliafico
- Department of Radiology, National Institute for Cancer Research, Genoa, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Toussaint CP, Perry EC, Pisansky MT, Anderson DE. What's new in the diagnosis and treatment of peripheral nerve entrapment neuropathies. Neurol Clin 2011; 28:979-1004. [PMID: 20816274 DOI: 10.1016/j.ncl.2010.03.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Entrapment neuropathies can be common conditions with the potential to cause significant disability. Correct diagnosis is essential for proper management. This article is a review of recent developments related to diagnosis and treatment of various common and uncommon nerve entrapment disorders. When combined with classical peripheral nerve examination techniques, innovations in imaging modalities have led to more reliable diagnoses. Moreover, innovations in conservative and surgical techniques have been controversial as to their effects on patient outcome, but randomized controlled trials have provided important information regarding common operative techniques. Treatment strategies for painful peripheral neuropathies are also reviewed.
Collapse
Affiliation(s)
- Charles P Toussaint
- Department of Neurological Surgery, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL 60153, USA
| | | | | | | |
Collapse
|
45
|
Ducreux D, Lacour M, Cazejust J, Benoudiba F, Sarrazin J. [Traumatic cord and nerve root injuries: imaging features at the acute and chronic phases]. ACTA ACUST UNITED AC 2010; 91:1010-21. [PMID: 20814392 DOI: 10.1016/s0221-0363(10)70146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cord injuries are frequent and severe lesions resulting in significant disability, most frequently in younger subjects. The area of cord injured results in clinical syndromes (Brown-Sequard, motor and/or sensory deficit...). Cord and rootlet injuries are best depicted on MRI. Diffusion tensor imaging with tractography enables depiction of the most severe cord lesions and some prediction of tissue viability which may provide an idea of the potential functional prognosis and patient recovery. MRI is optimal to demonstrate areas of cord hemorrhage or compression, partial or complete cord transsection, nerve root avulsion...
Collapse
Affiliation(s)
- D Ducreux
- Service de Neuroradiologie, CHU Bicêtre, 78 rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France.
| | | | | | | | | |
Collapse
|
46
|
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.
Collapse
Affiliation(s)
- S K Thawait
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality Imaging of Peripheral Neuropathies of the Upper Limb and Brachial Plexus. Radiographics 2010; 30:1373-400. [DOI: 10.1148/rg.305095169] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
49
|
van den Ende KIM, Steinmann SP. Radial tunnel syndrome. J Hand Surg Am 2010; 35:1004-6. [PMID: 20434275 DOI: 10.1016/j.jhsa.2010.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 03/10/2010] [Accepted: 03/10/2010] [Indexed: 02/02/2023]
|
50
|
Tapadia M, Mozaffar T, Gupta R. Compressive neuropathies of the upper extremity: update on pathophysiology, classification, and electrodiagnostic findings. J Hand Surg Am 2010; 35:668-77. [PMID: 20223605 PMCID: PMC4715364 DOI: 10.1016/j.jhsa.2010.01.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 01/12/2010] [Indexed: 02/02/2023]
Abstract
Clinical examination and electrodiagnostic studies remain the gold standard for diagnosis of nerve injuries. Diagnosis of chronic nerve compression (CNC) injuries can be difficult in patients with confounding factors such as diabetes. The treatment of nerve entrapment ranges from medical to surgical management, depending on the nerve involved and on the severity and duration of compression. Considerable insights have been made at the molecular level, differentiating between nerve crush injuries and CNC injuries. Although the myelin changes after CNC injury were previously thought to be a mild form of Wallerian degeneration, recent evidence points to a distinct pathophysiology involving Schwann cell mechanosensitivity. Future areas of research include Schwann cell transplantation in the treatment regimen, the correlation between demyelination and the onset of pain, and the role of Schwann cell integrins in transducing the mechanical forces involved in nerve compression injuries to Schwann cells.
Collapse
Affiliation(s)
- Minal Tapadia
- Peripheral Nerve Research Laboratory, University of California, Irvine; Irvine, CA
| | - Tahseen Mozaffar
- Department of Neurology, University of California, Irvine; Irvine, CA
- Peripheral Nerve Research Laboratory, University of California, Irvine; Irvine, CA
| | - Ranjan Gupta
- Department of Orthopaedic Surgery, University of California, Irvine; Irvine, CA
- Department of Anatomy and Neurobiology, University of California, Irvine; Irvine, CA
- Department of Biomedical Engineering, University of California, Irvine; Irvine, CA
- Peripheral Nerve Research Laboratory, University of California, Irvine; Irvine, CA
| |
Collapse
|