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Wu Y, Barrere V, Han A, Andre MP, Orozco E, Cheng X, Chang EY, Shah SB. Quantitative evaluation of rat sciatic nerve degeneration using high-frequency ultrasound. Sci Rep 2023; 13:20228. [PMID: 37980432 PMCID: PMC10657462 DOI: 10.1038/s41598-023-47264-9] [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: 05/06/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023] Open
Abstract
In this study, we evaluated the utility of using high-frequency ultrasound to non-invasively track the degenerative process in a rat model of peripheral nerve injury. Primary analyses explored spatial and temporal changes in quantitative backscatter coefficient (BSC) spectrum-based outcomes and B-mode textural outcomes, using gray level co-occurrence matrices (GLCMs), during the progressive transition from acute to chronic injury. As secondary analyses, correlations among GLCM and BSC spectrum-based parameters were evaluated, and immunohistochemistry were used to suggest a structural basis for ultrasound outcomes. Both mean BSC spectrum-based and mean GLCM-based measures exhibited significant spatial differences across presurgical and 1-month/2-month time points, distal stumps enclosed proximity to the injury site being particularly affected. The two sets of parameters sensitively detected peripheral nerve degeneration at 1-month and 2-month post-injury, with area under the receiver operating charactersitic curve > 0.8 for most parameters. The results also indicated that the many BSC spectrum-based and GLCM-based parameters significantly correlate with each other, and suggested a common structural basis for a diverse set of quantitative ultrasound parameters. The findings of this study suggest that BSC spectrum-based and GLCM-based analysis are promising non-invasive techniques for diagnosing peripheral nerve degeneration.
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Affiliation(s)
- Yuanshan Wu
- Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, MC 0863, La Jolla, CA, 92093-0683, USA
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Victor Barrere
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Aiguo Han
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Michael P Andre
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Elisabeth Orozco
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Xin Cheng
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Eric Y Chang
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Sameer B Shah
- Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, MC 0863, La Jolla, CA, 92093-0683, USA.
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA.
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
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Tawfik EA, Cartwright MS, van Alfen N, Axer H, Boon AJ, Crump N, Grimm A, Hobson-Webb LD, Kerasnoudis A, Mandeville R, Preston DC, Sakamuri S, Shahrizaila N, Shin S, Shook SJ, Wilder-Smith E, Walker FO. Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations. Muscle Nerve 2023; 68:375-379. [PMID: 37074101 DOI: 10.1002/mus.27830] [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: 08/16/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta-analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus-based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non-agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus-based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high-quality uniform neuromuscular ultrasound practices.
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Affiliation(s)
- Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Crump
- Department of Neurology, Austin Health and University of Melbourne, Heidelberg, Australia
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan Shin
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
| | - Steven J Shook
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital, Lucerne, Switzerland
- Department of Neurology, University of Berne, Bern, Switzerland
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Xu XD, Lin L, Qiu YB, Zeng BW, Chen Y, Liu JL, Ye CH, Wang JL, Liu PC, Zhang LC. Ultrasonic visualization technique for anatomical and functional analyses of the sciatic nerve in rats. Front Neurosci 2023; 17:1187669. [PMID: 37456994 PMCID: PMC10339105 DOI: 10.3389/fnins.2023.1187669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background and objective Ultrasound has been widely used in the diagnosis and minimally invasive treatment of peripheral nerve diseases in the clinic, but there is still a lack of feasibility analysis in rodent models of neurological disease. The purpose of this study was to investigate the changes in the cross-sectional area of the sciatic nerve of different genders and body weights and to explore the effectiveness and reliability of an ultrasound-guided block around the sciatic nerve in living rats. Methods Using ultrasound imaging anatomy of the sciatic nerve of rats, the cross-sectional area of the sciatic nerve in rats of different genders from 6 to 10 weeks old was calculated, and then analyzed its correlation with body weight. Further analyses were conducted through behavioral and cadaveric studies to evaluate the feasibility of ultrasound-guided perineural injection of the sciatic nerve in rats. Results We first reported that the sciatic nerve cross-sectional area of rats was increased with age (F = 89.169, P < 0.001), males had a higher sciatic nerve cross-sectional area than females (F = 60.770, P < 0.001), and there was a positive correlation with body weight (rMale = 0.8976, P < 0.001; rFemale = 0.7733, P < 0.001). Behavioral observation of rats showed that the lower extremity complete block rate was 80% following the administration of drugs around the sciatic nerve under ultrasound guidance and staining with methylene blue occurred in all sciatic nerves and surrounding muscles and fascia using 20 ultrasound-guided injections. Conclusions Ultrasound visualization technology can be used as a new auxiliary evaluation and intervention therapy for animal models of peripheral nerve injury, and will provide overwhelming new references for the basic research of neurological diseases.
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Affiliation(s)
- Xiao-Dong Xu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Lei Lin
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu-Bei Qiu
- School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Bang-Wei Zeng
- Administration Department of Nosocomial Infection, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ye Chen
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Jun-Le Liu
- Department of Anesthesiology, Xiamen Third Hospital, Xiamen, China
| | - Cai-Hong Ye
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Jia-Li Wang
- The Graduate School of Fujian Medical University, Fuzhou, China
| | - Pei-Chang Liu
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liang-Cheng Zhang
- Department of Anesthesiology, Fujian Medical University Union Hospital, Fuzhou, China
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Fort NM, Victoria C, Ko L, Wolfe SW, Lee SK, Nwawka OK. High resolution ultrasound for the evaluation of radial nerve pathology adjacent to metallic hardware. J Orthop Res 2022; 40:2557-2564. [PMID: 35088459 DOI: 10.1002/jor.25278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 02/04/2023]
Abstract
Accurate localization and characterization of peripheral nerve injuries adjacent to metallic hardware is difficult with magnetic resonance imaging (MRI) due to susceptibility artifact. This study sought to present the use of high-resolution ultrasound (US) in accurate characterization of radial nerve injury adjacent to metallic hardware, using findings at the time of operative exploration as confirmation of the US assessment. A retrospective chart review of cases with clinically identified radial nerve injuries evaluated by the high-resolution US was performed from January 2015 through December 2019. Preoperative clinical data, US reports, MRI reports, electrodiagnostic (EDx) reports, and operative reports were reviewed for each case. Preoperative US correctly characterized the affected nerve component, type, and location of injury in all 13 cases (100%), when correlated with intraoperative findings. Nerve injury was directly adjacent to metallic hardware in 12 cases (92%). Out of the seven cases evaluated by both US and MRI, US correctly accurately diagnosed radial nerve injuries in all cases, whereas MRI accurately diagnosed in four cases (57%). In 3/7 cases (43%) MRI was nondiagnostic due to susceptibility artifact. MRI evaluation of the nerve was limited to some degree by metallic artifact in 6/7 cases (85%).
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Affiliation(s)
- Nicholas M Fort
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Christian Victoria
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - Steve K Lee
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York City, New York, USA
| | - O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
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5
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Jiaqi W, Hui L, Yanzhou W, Long L, Tianyou L. Radial nerve trapped posterior to the proximal fracture end after closed reduction of supracondylar humerus fracture in children: A case report. Int J Surg Case Rep 2022; 99:107628. [PMID: 36108377 PMCID: PMC9568743 DOI: 10.1016/j.ijscr.2022.107628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Radial nerve injury is very common in supracondylar humerus fractures, but radial nerve entrapment between the fracture ends after closed reduction is very rare, and we report a case of radial nerve entrapment after closed reduction. Case presentation A 7-year-old boy was admitted to the Department of Pediatric Orthopedics 24 days after closed reduction of a supracondylar fracture of the humerus with radial nerve injury. Preoperative ultrasound showed radial nerve entrapment between the fracture ends, which was confirmed by surgery. After nerve release surgery, the radial nerve recovered well. Clinical discussion How to treat supracondylar humerus fractures in case of nerve damage remains controversial. We presented a rare case with radial nerve injury after supracondylar humerus fracture caused complete motor palsy in which the main trunk of the radial nerve above the right elbow traveled posterior to the fracture site. Awareness of the status of the nerve before and after surgery can help in the clinical decision to perform a concomitant nerve exploration, and in the context of this, ultrasound may be more helpful. Conclusion We recommend identifying the radial nerve using ultrasound during the closed reduction. If the nerve is entrapped between the fracture ends, exploration is recommended. For cases without entrapment, closed reduction with Kirschner wire fixation can be performed first, and the nerve should be re-examined with ultrasound. Radial nerve entrapped posterior to the proximal fracture end after closed reduction of SCHF was very rare. The use of ultrasound to identify the nerve status can reduce unnecessary surgery in the presence of radial nerve in SCHF. We proposed the management of SCHF with radial nerve injury through a review of the literature.
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Affiliation(s)
- Wang Jiaqi
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, People's Republic of China
| | - Li Hui
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, People's Republic of China
| | - Wang Yanzhou
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, People's Republic of China
| | - Li Long
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, People's Republic of China
| | - Li Tianyou
- Department of Pediatric Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, People's Republic of China.
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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Strommen JA, Skinner S, Crum BA. Neurophysiology during peripheral nerve surgery. HANDBOOK OF CLINICAL NEUROLOGY 2022; 186:295-318. [PMID: 35772892 DOI: 10.1016/b978-0-12-819826-1.00022-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Electrophysiological monitoring of the peripheral nervous system during a variety of surgeries provides useful information that supplements and complements preoperative assessment. Monitoring improves localization and understanding of the underlying pathophysiology of peripheral nerve lesions leading to more rational treatment decisions and improved outcomes. Monitoring is accomplished by adaptation of routine electrodiagnostic techniques (i.e., nerve conduction studies, evoked potentials, and electromyography) with special attention to technical factors including electrical and movement artifact. These techniques have been successfully applied during surgery for entrapment neuropathies, traumatic nerve injury and repair, peripheral nerve tumors, and adjacent structure procedures that risk peripheral nerve injury. A clear understanding of the anatomy and neurophysiology is necessary, as is understanding and performing the difficult technical aspects of these studies to provide accurate information to enhance patient outcome and recovery. As in any intraoperative neurophysiologic monitoring (IONM) setting, constant and accurate communication between the IONM team, surgeon, and anesthesia team is critically important to meet these goals.
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Affiliation(s)
- Jeffrey A Strommen
- Department of Neurophysiology, Abbott Northwestern Hospital, Minneapolis, MN, United States.
| | - Stanley Skinner
- Department of Intraoperative Neurophysiology, Abbott Northwestern Hospital, Minneapolis, MN, United States.
| | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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8
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Endo Y, Sivakumaran T, Lee SC, Lin B, Fufa D. Ultrasound features of traumatic digital nerve injuries of the hand with surgical confirmation. Skeletal Radiol 2021; 50:1791-1800. [PMID: 33538864 DOI: 10.1007/s00256-021-03731-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Characterize the appearance of digital nerve injuries in different ultrasound planes and correlate the presence and size of neuromas with time from injury. MATERIALS AND METHODS Surgically confirmed nerve injuries were retrospectively evaluated. Appearances of the nerve injury in the available imaging planes were reviewed by two readers. Associations between presence and size of neuroma with time from injury were analyzed. RESULTS Injuries of 29 digital nerves (3 incomplete lacerations, 17 complete lacerations, 6 with 7 stump neuromas, 3 neuromas-in-continuity) noted on ultrasound were surgically confirmed. Among the 20 lacerations, long-axis images were obtained in 15, of which 10 depicted the injury and 4 did not. Among the 10 depicting the injury in long axis, 2 showed a discrete gap, and 7 showed the nerve obscured by laceration tissue without a gap. In short axis, the nerve injury was visible in all 20, and nerve laceration was seen as a discrete gap in 2, and obscuration by laceration tissue in 14. Neuromas were hypoechoic and well-defined. There was a positive association between time and presence of neuroma (OR = 1.3, p = 0.002). Correlations between time and cross-sectional area (rs = 0.45) and volume (rs = 0.57) of neuromas were moderately positive. CONCLUSION Ultrasound long axis may be less useful, and those short axis may be more reliable for assessing digital nerve injuries than previously reported. Neuromas are hypoechoic and well-defined, and their size can vary based on time from injury.
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Affiliation(s)
- Yoshimi Endo
- Department of Radiology and Imaging, Hospital for Special Surgery, 435 East 70th Street, New York, NY, 10021, USA.
| | - Thiru Sivakumaran
- Department of Radiology and Imaging, Hospital for Special Surgery, 435 East 70th Street, New York, NY, 10021, USA
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Susan C Lee
- Department of Radiology and Imaging, Hospital for Special Surgery, 435 East 70th Street, New York, NY, 10021, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, 435 East 70th Street, New York, NY, 10021, USA
| | - Duretti Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, 525 East 71st Street, 2nd Floor, New York, NY, 10021, USA
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9
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Goyal A, Wadgera N, Srivastava DN, Ansari MT, Dawar R. Imaging of traumatic peripheral nerve injuries. J Clin Orthop Trauma 2021; 21:101510. [PMID: 34386344 PMCID: PMC8333344 DOI: 10.1016/j.jcot.2021.101510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023] Open
Abstract
Nerves are commonly injured in case of blunt or penetrating trauma to the extremities. Patients with nerve injuries have profound consequences and thus a timely decision for operative management is a very important. Conventionally, management decisions have been based on clinical findings, patient course and electrophysiological studies. However, imaging modalities have an enormous role not only in localizing and grading of the nerve injuries but also in the follow-up of the nerve recovery. High-resolution ultrasound (HUS) is the modality of choice for evaluation of peripheral nerves. Magnetic resonance neurography (MRN) plays a complementary role, enabling better assessment of muscle changes and deeper nerves. Corresponding to the injured layer of the cross-section of the nerve, imaging manifestations differ in different grades of injury. Since imaging cannot detect ultrastructural changes at the microscopic level, thus there may be overlap in the imaging findings. Herewith, we discuss the imaging findings in different grades of nerve injury and propose a simple 3-tier grading for imaging (HUS and MRN) assessment of peripheral nerve injuries.
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Affiliation(s)
- Ankur Goyal
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India,Corresponding author. Department of Radio-diagnosis All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Nagesh Wadgera
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Deep Narayan Srivastava
- All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi, 110029, India
| | - Mohammed Tahir Ansari
- All India Institute of Medical Sciences, Department of Orthopaedics, New Delhi, 110029, India
| | - Rakesh Dawar
- All India Institute of Medical Sciences, Department of Plastic Surgery, New Delhi, 110029, India
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Singh KP, Singh P, Gupta K. Reference values for the cross-sectional area of the normal sciatic nerve using high-resolution ultrasonography. J Ultrason 2021; 21:e95-e104. [PMID: 34258034 PMCID: PMC8264619 DOI: 10.15557/jou.2021.0018] [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: 11/16/2020] [Accepted: 01/27/2021] [Indexed: 11/22/2022] Open
Abstract
Aim High-resolution ultrasonography is a new and promising technique to evaluate peripheral and spinal nerves. Its validity as a diagnostic tool in neurological diseases has been demonstrated in adults. The aims of study were to establish the reference values for the cross-sectional area of the normal sciatic nerve on high-resolution ultrasonography, and to determine the relationship between the cross-sectional area of the normal sciatic nerve and the subjects' age, gender, height (in cm), weight (in kg), and body mass index. Material and methods Two hundred subjects of both genders and above 18 years of age were studied with high-resolution ultrasonography. The subjects had no history of peripheral neuropathy or trauma to the lower limb. The cross-sectional areas of the normal sciatic nerves were obtained at two different levels in both lower limbs. The mean cross-sectional areas of the sciatic nerves were measured at two different levels, one located at 1 cm above the bifurcation of the sciatic nerve into the tibial and common peroneal nerves, and the other 4 cm above the bifurcation of the sciatic nerve into the tibial and common peroneal nerves. Results A positive correlation of the mean cross-sectional area was established with height, weight, and body mass index. Women had smaller cross-sectional areas of the normal sciatic nerves than men at both measuring sites. No significant relationship was established with the age of the subjects. Conclusions The established reference values of the cross-sectional area of the sciatic nerve can facilitate the analysis of pathological nerve conditions.
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Affiliation(s)
| | - Prabhjot Singh
- Radiodiagnosis, SGRD University of Health Sciences, India
| | - Kamlesh Gupta
- Radiodiagnosis, SGRD University of Health Sciences, India
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Shen J, Yang F, Chen W, Wang F, Liang C, Qiu Y, Xu W. The Efficacy of Ultrasound for Visualizing Radial Nerve Lesions with Coexistent Plate Fixation of Humeral Shaft Fractures. Injury 2021; 52:516-523. [PMID: 33257017 DOI: 10.1016/j.injury.2020.11.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ultrasound has been commonly employed for depicting the morphology of the lesions in patients with radial nerve neuropathy, including entrapment, tumor, trauma, and iatrogenic injury. However, few studies have evaluated the efficacy of ultrasound for visualizing radial nerve lesions with coexistent plate fixation of humeral shaft fractures. This study aimed to address this special clinical issue. METHODS We retrospectively examined the efficacy of ultrasound for visualizing radial nerve lesions with coexistent plate fixation of humeral shaft fractures based on intraoperative findings in patients who were treated in our hospital from January 2007 to June 2019. RESULTS Forty-six patients were included, and there was a 100% concordance between the ultrasound and intraoperative findings on radial nerve lesions. Ultrasonography revealed four types of lesions: radial nerve in continuity in thirty-one patients, neuroma in continuity in four patients, radial nerve stuck under the plate in three patients, and radial nerve transection in eight patients. The lesion radial nerve in continuity comprised two situations according to intraoperative electrodiagnostic test results, which could not be differentiated by ultrasonography, radial nerve in continuity treated with neurolysis in twenty-five patients and radial nerve in continuity treated with nerve graft in six patients. CONCLUSION Ultrasonography can accurately depict radial nerve lesions with coexistent plate fixation of humeral shaft fractures. It provides a basis for determining the extent of nerve damage in all patients except those with the lesion radial nerve in continuity, which is conducive to making treatment decisions as early as possible.
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Affiliation(s)
- Jun Shen
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangjing Yang
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weimin Chen
- Department of Ultrasound in Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fei Wang
- Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Shanghai, China
| | - Chunmin Liang
- Limb Function Reconstruction Center, Jing' an District Central Hospital, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Shanghai, China; Limb Function Reconstruction Center, Jing' an District Central Hospital, Shanghai, China; National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China; Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing' an District Central Hospital, Shanghai, China; Limb Function Reconstruction Center, Jing' an District Central Hospital, Shanghai, China; National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China; Research unit of synergistic reconstruction of upper and lower limbs after brain injury, Chinese Academy of Medical Sciences, Shanghai, China
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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]
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Li Z, Tian D, Chen L, Wang X, Jiang L, Yu Y. Electrical impedance myography for discriminating traumatic peripheral nerve injury in the upper extremity. Clin Neurophysiol 2017; 128:384-390. [DOI: 10.1016/j.clinph.2016.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/01/2016] [Accepted: 11/12/2016] [Indexed: 12/14/2022]
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14
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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]
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Abstract
This article provides an overview of the management of traumatic peripheral nerve injuries. It examines the basic pathophysiology of peripheral nerve injuries, along with the clinical presentation, diagnostic work-up, and treatment options and outcomes for the various classifications of traumatic peripheral nerve injuries.
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Affiliation(s)
- Matthew T Houdek
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Alexander Y Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Chen J, Wu S, Ren J. Ultrasonographic reference values for assessing normal radial nerve ultrasonography in the normal population. Neural Regen Res 2014; 9:1844-9. [PMID: 25422648 PMCID: PMC4239776 DOI: 10.4103/1673-5374.143433] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/06/2022] Open
Abstract
High-resolution ultrasound has been used recently to characterize median and ulnar nerves, but is seldom used to characterize radial nerves. The radial nerve is more frequently involved in entrapment syndromes than the ulnar and median nerves. However, the reference standard for normal radial nerves has not been established. Thus, this study measured the cross-sectional areas of radial nerves of 200 healthy male or female volunteers, aged 18 to 75, using high-resolution ultrasound. The results showed that mean cross-sectional areas of radial nerves at 4 cm upon the lateral epicondyle of the humerus and mid-humerus (midpoint between the elbow crease and axilla) were 5.14 ± 1.24 and 5.08 ± 1.23 mm2, respectively. The age and the dominant side did not affect the results, but the above-mentioned cross-sectional areas were larger in males (5.31 ± 1.25 and 5.19 ± 1.23 mm2) than in females (4.93 ± 1.21 and 4.93 ± 1.23 mm2, respectively). In addition, the cross-sectional areas of radial nerves were positively correlated with height and weight (r = 0.38, 0.36, respectively, both P < 0.05). These data provide basic clinical data for the use of high-resolution ultrasound for the future diagnosis, treatment, and prognostic evaluation of peripheral neuropathies.
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Affiliation(s)
- Jun Chen
- Department of Neurology, Affiliated Hospital of Guiyang Medical College, Guiyang, Guizhou Province, China ; Lianshui County Hospital of Jiangsu Proviuce, Huaian, Jiangsu Province, China
| | - Shan Wu
- Department of Neurology, Affiliated Hospital of Guiyang Medical College, Guiyang, Guizhou Province, China
| | - Jun Ren
- Pharmacology University of Wyoming College of Health Sciences, Wyoming INBRE Program, Laramie, WY, USA
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Hobson-Webb LD, Juel VC. The three dimensional assessment of peripheral nerve injury: An integrated clinical, neurophysiologic and sonographic approach. Clin Neurophysiol 2013; 124:1053-4. [DOI: 10.1016/j.clinph.2012.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 11/26/2012] [Accepted: 11/28/2012] [Indexed: 11/16/2022]
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Ultrasound assessment of sural nerve in Charcot-Marie-Tooth 1A neuropathy. Clin Neurophysiol 2013; 124:1695-9. [PMID: 23669651 DOI: 10.1016/j.clinph.2013.02.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/17/2013] [Accepted: 02/18/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Nerve ultrasound (US) has been used to study peripheral nerve disease, and increase of the cross-sectional area (CSA) has been described in demyelinating polyneuropathy. The objective of the current study is to characterise the US features of the sural nerve in a sample of Charcot-Marie-Tooth (CMT) 1A patients. METHODS A total of 20 CMT1A patients were enrolled. As control group we studied 37 age- and sex-matched subjects. All patients underwent clinical examination, neurophysiology and US evaluation of the bilateral sural nerve and right ulnar nerve. US results were correlated with neurophysiology and clinical data. RESULTS Sural nerve CSA was not increased in the majority of patients (70%), whereas an increased ulnar nerve CSA was present in the whole sample. Inverse relations were found between CSA of the ulnar nerve and body mass index (BMI) (p<0.0002, R=-0.8) and CSA of the sural nerve and age (right 0.006, R=-0.6, left 0.002, R=-0.6 and left and right p=0.00003, R=-0.4). CONCLUSIONS US showed ulnar CSA enlargement and normal sural nerve CSA. SIGNIFICANCE The significance of normal sural nerve CSA in CMT1A patients need to be further investigated, possibly through longitudinal studies.
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Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80:1634-40. [PMID: 23553474 DOI: 10.1212/wnl.0b013e3182904f3f] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To compare accuracy of ultrasound and MRI for detecting focal peripheral nerve pathology, excluding idiopathic carpal or cubital tunnel syndromes. METHODS We performed a retrospective review of patients referred for neuromuscular ultrasound to identify patients who had ultrasound and MRI of the same limb for suspected brachial plexopathy or mononeuropathies, excluding carpal/cubital tunnel syndromes. Ultrasound and MRI results were compared to diagnoses determined by surgical or, if not performed, clinical/electrodiagnostic evaluation. RESULTS We identified 53 patients who had both ultrasound and MRI of whom 46 (87%) had nerve pathology diagnosed by surgical (n = 39) or clinical/electrodiagnostic (n = 14) evaluation. Ultrasound detected the diagnosed nerve pathology (true positive) more often than MRI (43/46 vs 31/46, p < 0.001). Nerve pathology was correctly excluded (true negative) with equal frequency by MRI and ultrasound (both 6/7). In 25% (13/53), ultrasound was accurate (true positive or true negative) when MRI was not. These pathologies were typically (10/13) long (>2 cm) and only occasionally (2/13) outside the MRI field of view. MRI missed multifocal pathology identified with ultrasound in 6 of 7 patients, often (5/7) because pathology was outside the MRI field of view. CONCLUSIONS Imaging frequently detects peripheral nerve pathology and contributes to the differential diagnosis in patients with mononeuropathies and brachial plexopathies. Ultrasound is more sensitive than MRI (93% vs 67%), has equivalent specificity (86%), and better identifies multifocal lesions than MRI. In sonographically accessible regions ultrasound is the preferred initial imaging modality for anatomic evaluation of suspected peripheral nervous system lesions.
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Affiliation(s)
- Craig M Zaidman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
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