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Kang J, Wu W, Kong X, Su Y, Liu D, Li C, Gao N, Wang Y, Zheng C, Weng Y, Wang L. Improved visualization of median, ulnar nerves, and small branches in the wrist and palm using contrast-enhanced magnetic resonance neurography. Ther Adv Neurol Disord 2024; 17:17562864241239739. [PMID: 38532801 PMCID: PMC10964438 DOI: 10.1177/17562864241239739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background Magnetic resonance imaging of peripheral nerves in the wrist and palm is challenging due to the small size, tortuous course, complex surrounding tissues, and accompanying blood vessels. The occurrence of carpal palmar lesions leads to edema, swelling, and mass effect, which may further interfere with the display and identification of nerves. Objective To evaluate whether contrast-enhanced magnetic resonance neurography (ceMRN) improves the visualization of the morphology and pathology of the median, ulnar nerves, and their small branches in the wrist and palm. Design An observational study. Methods In total 57 subjects, including 36 volunteers and 21 patients with carpal palmar lesions, were enrolled and underwent ceMRN and non-contrast MRN (ncMRN) examination at 3.0 Tesla. The degree of vascular suppression, nerve visualization, diagnostic confidence, and lesion conspicuity was qualitatively assessed by two radiologists. Kappa statistics were obtained for inter-reader agreement. The signal-to-noise ratio, contrast ratio (CR), and contrast-to-noise ratio (CNR) of the median nerve were measured. The subjective ratings and quantitative measurements were compared between ncMRN and ceMRN. Results The inter-reader agreement was excellent (k > 0.8) for all qualitative assessments and visualization assessment of each nerve segment. Compared with ncMRN, ceMRN significantly improved vascular suppression in volunteers and patients (both p < 0.001). The ceMRN significantly enhanced nerve visualization of each segment (all p < 0.05) and diagnostic confidence in volunteers and patients (both p < 0.05). The ceMRN improved lesion conspicuity (p = 0.003) in patients. Quantitatively, ceMRN had significantly higher CRs of nerve versus subcutaneous fat, bone marrow, and vessels and CNR of nerve versus vessel than ncMRN (all p < 0.05). Conclusion The ceMRN significantly improves the visualization of peripheral nerves and pathology in the wrist and palm by robustly suppressing the signals of fat, bone marrow, and especially vessels in volunteers and patients.
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Affiliation(s)
- Jiamin Kang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjun Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yu Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dingxi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chungao Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Nan Gao
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youzhi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuxiong Weng
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lixia Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Serhal A, Lee SK, Michalek J, Serhal M, Omar IM. Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity. J Ultrason 2023; 23:e313-e327. [PMID: 38020515 PMCID: PMC10668945 DOI: 10.15557/jou.2023.0037] [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: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Upper extremity entrapment neuropathies are common conditions in which peripheral nerves are prone to injury at specific anatomical locations, particularly superficial regions or within fibro-osseous tunnels, resulting in pain and potential disability. Although neuropathy is primarily diagnosed clinically by physical examination and electrophysiology, imaging evaluation with ultrasound and magnetic resonance neurography are valuable complementary non-invasive and accurate tools for evaluation and can help define the site and cause of nerve dysfunction which ultimately leads to precise and timely treatment. Ultrasound, which has higher spatial resolution, can quickly and comfortably characterize the peripheral nerves in real time and can evaluate for denervation related muscle atrophy. Magnetic resonance imaging on the other hand provides excellent contrast resolution between the nerves and adjacent tissues, also between pathologic and normal segments of peripheral nerves. It can also assess the degree of muscle denervation and atrophy. As a prerequisite for nerve imaging, radiologists and sonographers should have a thorough knowledge of anatomy of the peripheral nerves and their superficial and deep branches, including variant anatomy, and the motor and sensory territories innervated by each nerve. The purpose of this illustrative article is to review the common neuropathy and nerve entrapment syndromes in the upper extremities focusing on ultrasound and magnetic resonance neurography imaging.
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Affiliation(s)
- Ali Serhal
- Department of Radiology, Northwestern University, Chicago, USA
| | | | - Julia Michalek
- Department of Radiology, Northwestern Memorial Hospital, Chicago, USA
| | - Muhamad Serhal
- Department of Radiology, Northwestern University, Chicago, USA
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Xiao R, Chen J, Zeng C, Feng X, Li T, Das SK, Li B, Zhang C, Yang H. Development of magnetic resonance imaging of brachial plexus neuralgia. Neurol Sci 2022; 43:1685-1693. [DOI: 10.1007/s10072-022-05915-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
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Bjorklund KA, West JM, Nopkhun W, Moore AM. Surgical Innovations to Restore Function in Pediatric Peripheral Nerve Conditions. Pediatrics 2021; 148:183394. [PMID: 34851416 DOI: 10.1542/peds.2021-052556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Peripheral nerve injuries in children can result in devastating lifelong deficits. Because of the time-sensitive nature of muscle viability and the limited speed of nerve regeneration, early recognition and treatment of nerve injuries are essential to restore function. Innovative surgical techniques have been developed to combat the regenerative length and speed; these include nerve transfers. Nerve transfers involve transferring a healthy, expendable donor nerve to an injured nerve to restore movement and sensation. Nerve transfers are frequently used to treat children affected by conditions, including UE trauma, brachial plexus birth injury, and acute flaccid myelitis. Pediatricians play an important role in the outcomes of children with these conditions through early diagnosis and timely referrals. With this review, we aim to provide awareness of state-of-the-art surgical treatment options that significantly improve the function of children with traumatic nerve injuries, brachial plexus birth injury, and acute flaccid myelitis.
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Affiliation(s)
| | | | - Wilawan Nopkhun
- Department of Physical Medicine and Rehabilitation, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Amy M Moore
- Section of Plastic and Reconstructive Surgery
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Khodarahmi I, Fritz J. The Value of 3 Tesla Field Strength for Musculoskeletal Magnetic Resonance Imaging. Invest Radiol 2021; 56:749-763. [PMID: 34190717 DOI: 10.1097/rli.0000000000000801] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Musculoskeletal magnetic resonance imaging (MRI) is a careful negotiation between spatial, temporal, and contrast resolution, which builds the foundation for diagnostic performance and value. Many aspects of musculoskeletal MRI can improve the image quality and increase the acquisition speed; however, 3.0-T field strength has the highest impact within the current diagnostic range. In addition to the favorable attributes of 3.0-T field strength translating into high temporal, spatial, and contrast resolution, many 3.0-T MRI systems yield additional gains through high-performance gradients systems and radiofrequency pulse transmission technology, advanced multichannel receiver technology, and high-end surface coils. Compared with 1.5 T, 3.0-T MRI systems yield approximately 2-fold higher signal-to-noise ratios, enabling 4 times faster data acquisition or double the matrix size. Clinically, 3.0-T field strength translates into markedly higher scan efficiency, better image quality, more accurate visualization of small anatomic structures and abnormalities, and the ability to offer high-end applications, such as quantitative MRI and magnetic resonance neurography. Challenges of 3.0-T MRI include higher magnetic susceptibility, chemical shift, dielectric effects, and higher radiofrequency energy deposition, which can be managed successfully. The higher total cost of ownership of 3.0-T MRI systems can be offset by shorter musculoskeletal MRI examinations, higher-quality examinations, and utilization of advanced MRI techniques, which then can achieve higher gains and value than lower field systems. We provide a practice-focused review of the value of 3.0-T field strength for musculoskeletal MRI, practical solutions to challenges, and illustrations of a wide spectrum of gainful clinical applications.
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Affiliation(s)
- Iman Khodarahmi
- From the Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, NY
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Gould L, Li WW. Defining complete wound closure: Closing the gap in clinical trials and practice. Wound Repair Regen 2019; 27:201-224. [DOI: 10.1111/wrr.12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/11/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Lisa Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
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Garg B, Manhas V, Vardhan A, Srivastava DN, Das CJ, Vibha D, Gupta V, Malhotra R, Kotwal P. Thumb Opposition Recovery Following Surgery for Severe Carpal Tunnel Syndrome: A Clinical, Radiological, and Electrophysiological Pilot Study. J Hand Surg Am 2019; 44:157.e1-157.e5. [PMID: 29934085 DOI: 10.1016/j.jhsa.2018.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/31/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To objectively assess recovery of thumb opposition in patients with carpal tunnel syndrome (CTS) after open carpal tunnel release and to evaluate electrophysiological and magnetic resonance (MR) neurography findings as predictors of thumb opposition recovery. METHODS A total of 22 patients with severe CTS and thenar atrophy were included in this study. A detailed clinical, electrophysiological, and MR neurography evaluation was done both before and after surgery at 6 months to assess thumb opposition recovery. RESULTS The median duration of symptoms was 12 months (interquartile range, 12-20 months). The compound muscle action potential of the abductor pollisis brevis (CMAP-APB) also showed statistically significant improvement of 0.5 + 0.2 mV after surgery. Tip-tip pulp pinch strength increased from 1.2 ± 0.4 to 2.0 ± 0.4 kg at 6-month follow-up, lateral pulp pinch strength increased from 1.9 ± 0.6 to 2.8 ± 0.9 kg at 6-month follow-up, and 3-point pulp pinch also improved from 1.9 ± 0.5 to 2.8 ± 0.9 at final follow-up. On MR neurogram, the proportion of patients with abnormal median nerve morphology decreased from 81.8% to 68.2%, abnormal thenar branch morphology decreased from 63.6% to 36.4% and denervation edema deceased from 59.1% to 13.6%. CONCLUSIONS Patients suffering from severe CTS with thenar atrophy and detectable CMAP-APB showed promising improvement following open carpal tunnel release. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
| | - Anand Vardhan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Gupta
- Department of Community Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash Kotwal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Bordalo-Rodrigues M. Magnetic Resonance Neurography in Musculoskeletal Disorders. Magn Reson Imaging Clin N Am 2018; 26:615-630. [DOI: 10.1016/j.mric.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Terayama Y, Uchiyama S, Ueda K, Iwakura N, Ikegami S, Kato Y, Kato H. Optimal Measurement Level and Ulnar Nerve Cross-Sectional Area Cutoff Threshold for Identifying Ulnar Neuropathy at the Elbow by MRI and Ultrasonography. J Hand Surg Am 2018; 43:529-536. [PMID: 29622409 DOI: 10.1016/j.jhsa.2018.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/09/2018] [Accepted: 02/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Imaging criteria for diagnosing compressive ulnar neuropathy at the elbow (UNE) have recently been established as the maximum ulnar nerve cross-sectional area (UNCSA) upon magnetic resonance imaging (MRI) and/or ultrasonography (US). However, the levels of maximum UNCSA and diagnostic cutoff values have not yet been established. We therefore analyzed UNCSA by MRI and US in patients with UNE and in controls. METHODS We measured UNCSA at 7 levels in 30 patients with UNE and 28 controls by MRI and at 15 levels in 12 patients with UNE and 24 controls by US. We compared UNCSA as determined by MRI or US and determined optimal diagnostic cutoff values based on receiver operating characteristic curve analysis. RESULTS The UNCSA was significantly larger in the UNE group than in controls at 3, 2, 1, and 0 cm proximal and 1, 2, and 3 cm distal to the medial epicondyle for both modalities. The UNCSA was maximal at 1 cm proximal to the medial epicondyle for MRI (16.1 ± 3.5 mm2) as well as for US (17 ± 7 mm2). A cutoff value of 11.0 mm2 for MRI and US was found to be optimal for differentiating between patients with UNE and controls, with an area under the receiver operating characteristic curve of 0.95 for MRI and 0.96 for US. The UNCSA measured by MRI was not significantly different from that by US. Intra-rater and interrater reliabilities for UNCSA were all greater than 0.77. The UNCSA in the severe nerve dysfunction group of 18 patients was significantly larger than that in the mild nerve dysfunction group of 12 patients. CONCLUSIONS By measuring UNCSA with MRI or US at 1 cm proximal to the ME, patients with and without UNE could be discriminated at a cutoff threshold of 11.0 mm2 with high sensitivity, specificity, and reliability. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Yasushi Terayama
- Department of Orthopedic Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan.
| | - Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiko Ueda
- Department of Diagnostic Radiology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nahoko Iwakura
- Department of Orthopedic Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiharu Kato
- Department of Orthopaedic Surgery, Kitashinagawa Third Hospital, Tokyo, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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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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Bowler's thumb: ultrasound diagnosis of a neuroma of the ulnar digital nerve of the thumb. Skeletal Radiol 2016; 45:1589-92. [PMID: 27600139 DOI: 10.1007/s00256-016-2469-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/15/2016] [Accepted: 08/19/2016] [Indexed: 02/02/2023]
Abstract
Bowler's thumb is a rare traumatic neuropathy of the ulnar digital nerve of the thumb. We present a case of bowler's thumb in a 21-year-old male recreational bowler who presented with a painful mass on the ulnar side of the right thumb. Magnetic resonance (MR) imaging of the hand was inconclusive. However, subsequent ultrasound (US) showed asymmetric enlargement of the ulnar digital nerve of the thumb with marked epineural thickening corresponding to the palpable mass, confirming the clinical diagnosis of bowler's thumb. Although this condition is typically diagnosed clinically, imaging can help to clarify clinical findings. In our experience, MR imaging is a clinician's preferred choice when further evaluating physical findings of digital nerve pathology despite the lack of evidence to support MR as a primary imaging modality for these patients. This case illustrates the role that US can play as an initial imaging modality for the evaluation of small peripheral nerves.
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Skedros JG, Kiser CJ, Hill BB. Florid Suprascapular Neuropathy after Primary Rotator Cuff Repair Attributed to Suprascapular Notch Constriction in the Setting of Double Crush Syndrome. J Brachial Plex Peripher Nerve Inj 2015; 10:e66-e73. [PMID: 27917243 DOI: 10.1055/s-0035-1567807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/21/2015] [Indexed: 01/07/2023] Open
Abstract
This report describes a patient who had an open repair of a small supraspinatus tendon tear performed 6 months after an arthroscopic acromioplasty with debridement had failed to provide pain relief. Three months prior to the tendon repair, he had a two-level cervical spine discectomy and fusion (C4-5, C5-6) that improved his neck pain. Florid suprascapular neuropathy was detected 10 weeks after the open rotator cuff repair. Evidence of some nerve recovery resulted in a long period of observation. But unsatisfactory improvement warranted decompression of the suprascapular notch, which was found to be very stenotic. At surgery, there was no evidence of neuroma, cyst, or other compressing lesion or tissue. Therefore, it was ultimately hypothesized that there was an exacerbation of a preexisting, but clinically unrecognized, entrapment of the suprascapular nerve in the suprascapular notch in the setting of cervical radiculopathy (primarily C5). Retrospectively it was also concluded that had this compressive etiology been recognized, it would have favored prompt decompression rather than the long observation period. Three years was required to achieve a good result following suprascapular notch decompression. The underlying C5 radiculopathy may have created a "double crush syndrome" that contributed to the propensity for injury and the prolonged recovery. There should be heightened awareness of this problem in patients who do not have satisfactory improvement in shoulder pain from previous shoulder and neck surgery.
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Affiliation(s)
- John G Skedros
- Intermountain Medical Center, Salt Lake City, Utah, United States; University of Utah Department of Orthopaedics, Salt Lake City, Utah, United States
| | - Casey J Kiser
- Intermountain Medical Center, Salt Lake City, Utah, United States
| | - Bryce B Hill
- Intermountain Medical Center, Salt Lake City, Utah, United States
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Diffusion Tensor Imaging Adds Diagnostic Accuracy in Magnetic Resonance Neurography. Invest Radiol 2015; 50:498-504. [DOI: 10.1097/rli.0000000000000156] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lateral Antebrachial Cutaneous Nerve Entrapment After Shoulder Arthroscopy: A Case Report. PM R 2015; 7:889-894. [DOI: 10.1016/j.pmrj.2015.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 11/23/2022]
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