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Murphy RNA, Rogers SK, Bhatti W, Wong JK, Reid AJ. A pilot prospective cohort study using experimental quantification of early peripheral nerve regeneration with high-frequency three-dimensional tomographic ultrasound (HFtUS). Sci Rep 2023; 13:15175. [PMID: 37704699 PMCID: PMC10499886 DOI: 10.1038/s41598-023-42230-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Abstract
Quantification of peripheral nerve regeneration after injury relies upon subjective outcome measures or electrophysiology assessments requiring fully regenerated neurons. Nerve surgeons and researchers lack objective, quantifiable information on the site of surgical repair and regenerative front. To address this need, we developed a quantifiable, visual, clinically available measure of early peripheral nerve regeneration using high-frequency, three-dimensional, tomographic ultrasound (HFtUS). We conducted a prospective, longitudinal study of adult patients with ulnar and/or median nerve injury of the arm undergoing direct epineurial repair within 5 days of injury. Assessment of morphology, volumetric and 3D grey-scale quantification of cross-sectional views were made at baseline up to 15 months post-surgery. Sensory and motor clinical outcome measures and patient reported outcome measures (PROMs) were recorded. Five participants were recruited to the study. Our data demonstrated grey-scale values (an indication of axonal density) increased in distal stumps within 2-4 months after repair, returning to normal as regeneration completed (4-6 months) with concomitant reduction in intraneural volume as surgical oedema resolved. Two patients with abnormal regeneration were characterized by increased intraneural volume and minimal grey-scale change. HFtUS may quantify early peripheral nerve regeneration offering a window of opportunity for surgical intervention where early abnormal regeneration is detected.
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Affiliation(s)
- Ralph N A Murphy
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK.
- Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK.
| | - Steven K Rogers
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, School of Medical Sciences, University of Manchester, Oxford Road, Manchester, M13 9WL, UK
- Manchester Academic Vascular Research and Innovation Centre (MAVRIC), Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Waqar Bhatti
- Department of Musculoskeletal Radiology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Jason K Wong
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK
- Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK
| | - Adam J Reid
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, M13 9PT, UK
- Department of Plastic Surgery and Burns, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester, M23 9LT, UK
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Toijala TM, Canapp DA, Canapp SO. Ultrasonography Findings in the Proximal Sciatic Nerve and Deep Gluteal Muscles in 29 Dogs With Suspected Sciatic Neuritis. Front Vet Sci 2021; 8:704904. [PMID: 34513972 PMCID: PMC8429782 DOI: 10.3389/fvets.2021.704904] [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: 05/04/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to describe the ultrasonography technique and analyze the ultrasonographic findings of the proximal sciatic nerve and deep gluteal muscles in dogs with suspected sciatic neuritis. The records of 29 dogs that underwent musculoskeletal ultrasound of the sciatic nerve and deep gluteal muscles were retrospectively evaluated. Both right and left sides were evaluated. Abnormal findings were unilateral in 28/29 (97%) of the dogs. The muscles examined included the piriformis muscle, gemelli muscles, internal obturator muscle, and medial gluteal muscle. Data included signalment, purpose of the dog, orthopedic examination findings, lameness examination findings, other diagnostic imaging findings, and ultrasonography findings. Irregular margins of the sciatic nerve were recorded in 76% of the dogs. The diameter of the sciatic nerve on the affected limb was significantly larger than the nerve on the contralateral, unaffected side (p < 0.00001). The mean ± standard deviation (SD) of the sciatic nerve inner diameter between the unaffected and affected limbs was 15 ± 14.66%. The mean ± SD in sciatic nerve outer diameter was 12 ± 7.71%. Abnormal ultrasonographic findings in at least one of the examined muscles were found in 28/29 (97%) of the dogs and included changes in echogenicity in 28/29 (97%) of the dogs, loss of detail in muscle fiber pattern in 5/29 (17%) of the dogs, and impingement between the sciatic nerve and piriformis muscle in 6/29 (21%) of the dogs. The most common underlying diagnosis was lumbosacral stenosis in 9/29 (31%) of the dogs. The most common sport was agility for 21/29 (71%) of the dogs. Repetitive jumping may predispose to both lumbosacral disease, through dynamic compression, and changes within the piriformis muscle, due to overuse of the muscle leading to irritation to sciatic nerve. Ultrasonography is considered a safe and non-invasive diagnostic method to evaluate the sciatic nerve and deep gluteal muscles of dogs, and provides additional guidance for diagnostics and rehabilitation planning. This is the first study documenting ultrasonography findings in a case series of the sciatic nerve and deep gluteal muscles and their pathology in dogs.
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Affiliation(s)
| | - Debra A Canapp
- Veterinary Orthopedic and Sports Medicine Group, Annapolis Junction, MD, United States
| | - Sherman O Canapp
- Veterinary Orthopedic and Sports Medicine Group, Annapolis Junction, MD, United States
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Palomba N, Vettorato E, De Gennaro C, Corletto F. Peripheral nerve block versus systemic analgesia in dogs undergoing tibial plateau levelling osteotomy: Analgesic efficacy and pharmacoeconomics comparison. Vet Anaesth Analg 2019; 47:119-128. [PMID: 31806432 DOI: 10.1016/j.vaa.2019.08.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/19/2019] [Accepted: 08/20/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the perioperative effects and pharmacoeconomics of peripheral nerve blocks (PNBs) versus fentanyl target-controlled infusion (fTCI) in dogs undergoing tibial plateau levelling osteotomy (TPLO). STUDY DESIGN Randomized clinical study. ANIMALS A total of 39 dogs undergoing unilateral TPLO. METHODS After acepromazine and methadone, anaesthesia was induced with propofol and maintained with isoflurane. Dogs were allocated to group fTCI [target plasma concentration (TPC) 1 ng mL-1] or group PNB (nerve stimulator-guided femoral-sciatic block using 0.2 and 0.1 mL kg-1 of levobupivacaine 0.5%, respectively). If nociceptive response occurred, isoflurane was increased by 0.1%, and TPC was increased by 0.5 ng mL-1 in group fTCI; a fentanyl bolus (1 μg kg-1) was administered in group PNB. During the first 24 postoperative hours, methadone (0.2 mg kg-1) was administered intramuscularly according to the Short Form Glasgow Composite Pain Scale, or if pain was equal to 5/24 or 4/20 for two consecutive assessments, or if the dog was non-weight bearing. The area under the curve (AUC) of pain scores, cumulative postoperative methadone requirement, food intake and pharmacoeconomic implications were calculated. RESULTS Incidence of bradycardia (p = 0.025), nociceptive response to surgery (p = 0.041) and AUC of pain scores (p < 0.0001) were greater in group fTCI. Postoperatively, 16/19 (84.2%) and eight/20 (40%) dogs in groups fTCI and PNB, respectively, were given at least one dose of methadone (p = 0.0079). Food intake was greater in group PNB (p = 0.049). Although total cost was not different (p = 0.083), PNB was more cost-effective in dogs weighing >15 kg. CONCLUSIONS AND CLINICAL RELEVANCE Compared with group fTCI, incidence of bradycardia, nociceptive response to surgery, postoperative pain scores, cumulative methadone requirement were lower, and food intake was greater in group PNB, with an economic advantage in dogs weighing >15 kg.
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Affiliation(s)
- Nunzia Palomba
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
| | - Enzo Vettorato
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK.
| | - Chiara De Gennaro
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
| | - Federico Corletto
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
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Ródenas S, Summers BA, Saveraid T, Denning A, Marioni-Henry K. Chronic Hypertrophic Ganglioneuritis Mimicking Spinal Nerve Neoplasia: Clinical, Imaging, Pathologic Findings, and Outcome after Surgical Treatment. Vet Surg 2012; 42:91-8. [DOI: 10.1111/j.1532-950x.2012.01045.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The aim of this study was to determine the course of the median nerve and its adjacent structures in the carpal canals of 8 healthy dogs by using high-frequency transducers. Before performing ultrasonography, the transverse and posteroanterior diameters as well as the perimeter of the carpus were measured at just proximal to the side of the carpal pad. The anatomical structures were then determined at two levels of the carpal canal, which were named the proximal and distal levels, on the transverse sonograms. The cross-sectional areas, perimeters and the transverse and posteroanterior diameters of the median nerve were measured at these levels. Although all the measurements were larger at the proximal level, significant differences between the proximal and distal levels were determined for the cross-sectional area, the perimeter and the transverse diameter of the median nerve. On the transverse sonogram, the deep digital flexor tendon was seen in almost the center of the carpal canal like a comma shape and also it had a small concavity on the caudal side. The superficial digital flexor tendon was seen as an ovoid shape on the transverse sonograms and it was located nearly at the posterior side of the carpal canal. Both tendons were seen as intermediate-grade echogenic structures. The median artery was located inside of the concavity of the deep digital flexor tendon. Also, the median nerve was seen at the posteromedial side of the median artery. As a result of this study, the cross-sectional areas of the median nerve ranged between 1.01-2.68 mm2 at the proximal level and between 0.93-1.91 mm2 at the distal level.
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Affiliation(s)
- Erkut Turan
- Department of Anatomy, Faculty of Veterinary Medicine, University of Adnan Menderes, PK: 17, 09016, Isikli-Aydin, Turkey.
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Abstract
To describe the ultrasonographic technique for investigation of the canine sciatic nerve, four canine cadaver pelvic limbs, two live healthy dogs, and five canine patients with suspected peripheral sciatic nerve lesions were examined with a high-resolution linear ultrasound transducer. The caudal part of the lumbosacral trunk and the origin of the sciatic nerve were visualized through the greater ischiatic foramen. The two components of the sciatic nerve, common peroneal and tibial nerves, were distinguished along the entire length of the nerve, until they branched at the level of the distal femur. In healthy live dogs they appeared as two adjacent hypoechoic tubular structures with internal echotexture of discontinuous hyperechoic bands, surrounded by a thin rim of highly echogenic tissue. The common peroneal component had a smaller diameter and was on the cranial aspect of the tibial component. An ultrasonographic lesion compatible with a peripheral nerve sheath tumor was found in one dog. Improved understanding of the ultrasonographic anatomy of the sciatic nerve supports clinical use of this modality.
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Affiliation(s)
- Livia Benigni
- Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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Abstract
A study of the ultrasonographic appearance and size of the sciatic, tibial, peroneal, suprascapular, radial, median, and ulnar nerves and a comparison with the anatomic size and location of these nerves in the normal adult horse is reported. Cadavers and live horses were studied. Landmarks for localization and techniques for nerve identification are described. The depth and diameter of each nerve at various locations and the success rate in imaging each nerve are reported. Statistically significant correlations were found between anatomically and ultrasonographically measured nerve depths and diameters. The success rate in identifying nerves was 70% in the live horses and 49% in cadavers, with the deep peroneal nerve being the easiest to identify. Some applications of this technique in horses are discussed.
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Affiliation(s)
- Kate Alexander
- Veterinary Teaching Hospital, The Ohio State University, 601 Vernon L. Tharp St., Columbus, OH 43210, USA
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McDonnell JJ, Platt SR, Clayton LA. Neurologic conditions causing lameness in companion animals. Vet Clin North Am Small Anim Pract 2001; 31:17-38. [PMID: 11787260 DOI: 10.1016/s0195-5616(01)50036-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Animals presented with non-weight-bearing lameness are a diagnostic challenge for the veterinarian. It is extremely important to distinguish between orthopedic and neurologic causes of lameness, because the diagnostic and therapeutic plans can be quite different. Myopathies can be confused with orthopedic disease because of gait abnormalities and associated muscle pain. Common myopathies seen in companion animal medicine include polymyositis, muscular dystrophy, endocrine and infectious myopathies, and myasthenia gravis. Lameness caused by disease of the nerve root or nerve is confused with orthopedic disease because of the disturbances of a nerve's sensory distribution (nerve-root signature) or disruption of the motor innervation. The diseases of the nerve root or nerve discussed are lateralized intervertebral disk disease, spinal cord neoplasia, malignant peripheral nerve sheath tumors, and traumatic neuropathies. The diagnosis of these diseases requires careful attention to the signalment, a complete history, and a thorough physical examination focusing on the neurologic and orthopedic components. Ancillary testing should be selected based on these results and a minimum database. Electrodiagnostic testing, radiography, and advanced imaging may help to localize the lesion more precisely and sometimes to confirm the diagnosis. Surgical exploration and histopathology often provide the definitive diagnosis. These cases of non-weight-bearing lameness are a diagnostic challenge, but when successful resolution can be reached, it is gratifying to the clinician, client, and patient.
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Affiliation(s)
- J J McDonnell
- Department of Clinical Sciences, School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts, USA
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Platt SR, Graham J, Chrisman CL, Collins K, Chandra S, Sirninger J, Newell SM. Magnetic resonance imaging and ultrasonography in the diagnosis of a malignant peripheral nerve sheath tumor in a dog. Vet Radiol Ultrasound 1999; 40:367-71. [PMID: 10463831 DOI: 10.1111/j.1740-8261.1999.tb02128.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 9-year-old male neutered mixed breed dog had a two-month history of progressive left thoracic limb lameness. There was electromyographic evidence of denervation potentials in all muscles of this limb. In magnetic resonance images a multilobulated, hyperintense mass was visible caudal to the middiaphysis of the left humerus on T-2 weighted images. The mass, which was isointense with surrounding tissue on T1 weighted images, extended proximally towards the brachial plexus. The mass was also visible as a fusiform structure of mixed echogenicity sonographically, although fine-needle aspiration performed at this time was nondiagnostic. A malignant peripheral nerve sheath tumor was diagnosed histopathologically.
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Affiliation(s)
- S R Platt
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville 32610, USA
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Abstract
This article discusses the current state of neurosonography in veterinary medicine. After a brief introduction, indications, normal appearance, and appearance in pathology are discussed in separate sections for brain, spinal cord, and peripheral nerves. Each section is illustrated by selected images showing normal anatomy and pathology.
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Affiliation(s)
- J A Hudson
- Department of Radiology, Auburn University, Alabama, USA
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