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Snoj Ž, Pušnik L, Cvetko E, Burica Matičič U, Jengojan SA, Omejec G. Sciatic nerve fascicle differentiation on high-resolution ultrasound with histological verification: An ex vivo study. Muscle Nerve 2024; 70:265-272. [PMID: 38877775 DOI: 10.1002/mus.28181] [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: 11/11/2023] [Revised: 05/28/2024] [Accepted: 06/01/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION/AIMS The development of high-resolution ultrasound (HRUS) has enabled the depiction of peripheral nerve microanatomy in vivo. This study compared HRUS fascicle differentiation to the structural depiction in histological cross-sections (HCS). METHODS A human cadaveric sciatic nerve was marked with 10 surgical sutures, and HRUS image acquisition was performed with a 22-MHz probe. The nerve was excised and cut into five segments for HCS preparation. Selected HCS were cross-referenced to HRUS, with sutures to improve orientation. Sciatic nerve and fascicle contouring were performed to assess nerve and fascicular cross-sectional area (CSA), fascicle count, and interfascicular distances. Three groups were defined based on HRUS fascicle differentiation in comparison to HCS, namely single fascicle (SF), fascicular cluster (FC), and no depiction (ND) group. RESULTS On cross-referenced HRUS to HCS images, 58% of fascicles were differentiated. On HRUS, significantly larger fascicle CSA and smaller fascicle count were observed compared with HCS. Group analysis showed that 41% of fascicles were defined as SF, 47% as FC, and 12% as ND. The mean fascicle CSA in the ND group was 0.05 mm2. Compared with the SF, the FC had significantly larger fascicle CSA (1.2 ± 0.7 vs. 0.6 ± 0.4 mm2; p < .001) and shorter interfascicular distances (0.1 ± 0.04 vs. 0.5 ± 0.3 μm; p < .001). DISCUSSION While HRUS can depict fascicular anatomy, only half of the fascicles visualized on HRUS directly correspond to single fascicles observed on HCS. The amount of interfascicular epineurium appears to influence the ability of HRUS to differentiate individual fascicles.
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Affiliation(s)
- Žiga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Pušnik
- Faculty of Medicine, Institute of Anatomy, University of Ljubljana, Ljubljana, Slovenia
| | - Erika Cvetko
- Faculty of Medicine, Institute of Anatomy, University of Ljubljana, Ljubljana, Slovenia
| | - Urša Burica Matičič
- Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Suren Armeni Jengojan
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gregor Omejec
- Division of Neurology, Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia
- The Higher Education Institution Fizioterapevtika, Ljubljana, Slovenia
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Manske RC, Wolfe C, Page P, Voight M, Bardowski B. Use of Diagnostic Musculoskeletal Ultrasound in the Evaluation of Piriformis Syndrome: A Review for Rehabilitation Providers. Int J Sports Phys Ther 2024; 19:768-772. [PMID: 38835987 PMCID: PMC11144665 DOI: 10.26603/001c.118145] [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] [Indexed: 06/06/2024] Open
Abstract
Piriformis Syndrome (PS) is a neuromuscular condition caused by the entrapment of the sciatic nerve at the level of the piriformis muscle (PM) and can cause significant discomfort and disability. PS is often misdiagnosed due to its overlapping symptoms with other lumbar and sciatic issues and as such, diagnosing PS remains challenging despite recent invasive and non-invasive diagnostic methods. Diagnostic musculoskeletal ultrasound (MSK US) offers a non-invasive, cost-effective alternative for the identification and evaluation of PS, providing dynamic, real-time imaging of the PM and adjacent structures. This article reviews the applications, advantages, and procedural insights of MSK US in the diagnosis of PS, emphasizing its relevance in rehabilitation settings. We discuss the technical aspects of ultrasound use, interpretation of findings, and integration into clinical practice, aiming to enhance the diagnostic accuracy and therapeutic outcomes for patients with suspected PS.
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Cuendet D, Valsecchi D, Najberg H, Maestretti G, Medlin F. Neuromuscular ultrasound changes in unilateral symptomatic subacute lumbosacral radiculopathy: A prospective simple blinded cohort study. Muscle Nerve 2024; 69:566-571. [PMID: 38390643 DOI: 10.1002/mus.28061] [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: 03/10/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION/AIMS Lumbosacral radiculopathy (LR) is a common disorder. Neuromuscular ultrasound (NMU) is a rapidly evolving technique for the investigation of peripheral nerve and muscle disorders, but studies using NMU in LR are lacking. The aim of the present study was to investigate ultrasonographic neuromuscular changes distant from root compression in patients with subacute to chronic compressive LR with motor impairment. METHODS Patients with unilateral subacute to chronic L4, L5, or S1 radiculopathy with motor impairment and confirmed by magnetic resonance imaging were included. The sciatic and femoral nerve cross-sectional areas (CSA), the CSA of lower limb muscles, and muscle fasciculation detection rate were assessed using a pre-specified neuromuscular ultrasound evaluation with blinded side-to-side comparison. RESULTS Of the 18 included patients, 66% were male and the mean age was 51 years. Overall, 16.7% had L4, 55.5% L5, and 27.8% S1 radiculopathy, mostly due to disc herniation (83%). Sciatic nerve CSA of the symptomatic side was increased (61.4 mm2 vs. 51.3 mm2; p = .001), and the fasciculation detection rate was higher in the affected muscles (delta = 13%, p = .007) compared to unaffected ones. Muscle CSA in affected and nonaffected muscles was decreased on the symptomatic side. DISCUSSION NMU evaluation in patients with symptomatic subacute to chronic LR revealed sciatic nerve enlargement distant from nerve root compression and higher fasciculation rates. These structural findings on NMU might be due to an axonal repair mechanism and an inflammatory response with endoneurial edema induced by ongoing nerve damage and potentially reflect progressive axonal loss.
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Affiliation(s)
- David Cuendet
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Daniele Valsecchi
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Hugo Najberg
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Gianluca Maestretti
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Friedrich Medlin
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
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Alvites R, Lopes B, Sousa P, Sousa AC, Coelho A, Moreira A, Rêma A, Atayde L, Mendonça C, Luís AL, Maurício AC. Ultrasound Landmarks in the Approach to the Common Peroneal Nerve in a Sheep Model-Application in Peripheral Nerve Regeneration. Life (Basel) 2023; 13:1919. [PMID: 37763322 PMCID: PMC10533066 DOI: 10.3390/life13091919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Peripheral nerve injury (PNI) remains a medical challenge with no easy resolution. Over the last few decades, significant advances have been achieved in promoting peripheral nerve regeneration, and new assessment tools have been developed, both functional and imaging, to quantify the proportion and quality of nerve recovery. The exploration of new animal models, larger, more complex, and with more similarities to humans, has made it possible to reduce the gap between the results obtained in classic animal models, such as rodents, and the application of new therapies in humans and animals of clinical interest. Ultrasonography is an imaging technique recurrently used in clinical practice to assess the peripheral nerves, allowing for its anatomical and topographic characterization, aiding in the administration of anesthesia, and in the performance of nerve blocks. The use of this technique in animal models is scarce, but it could be a useful tool in monitoring the progression of nerve regeneration after the induction of controlled experimental lesions. In this work, sheep, a promising animal model in the area of peripheral nerve regeneration, were subjected to an ultrasonographic study of three peripheral nerves of the hind limb, the common peroneal, and tibial and sciatic nerves. The main aim was to establish values of dimensions and ultrasound appearance in healthy nerves and landmarks for their identification, as well as to perform an ultrasound evaluation of the cranial tibial muscle, an effector muscle of the common peroneal nerve, and to establish normal values for its ultrasound appearance and dimensions. The results obtained will allow the use of these data as control values in future work exploring new therapeutic options for nerve regeneration after induction of common peroneal nerve injuries in sheep.
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Affiliation(s)
- Rui Alvites
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
- Instituto Universitário de Ciências da Saúde (IUCS), Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Avenida Central de Gandra 1317, 4585-116 Gandra, Portugal
| | - Bruna Lopes
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Patrícia Sousa
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Ana Catarina Sousa
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - André Coelho
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Alícia Moreira
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Alexandra Rêma
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Luís Atayde
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Carla Mendonça
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Ana Lúcia Luís
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Ana Colette Maurício
- Departamento de Clínicas Veterinárias, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto (UP), Rua de Jorge Viterbo Ferreira, No. 228, 4050-313 Porto, Portugal; (R.A.); (B.L.); (P.S.); (A.C.S.); (A.C.); (A.M.); (A.R.); (L.A.); (C.M.); (A.L.L.)
- Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente da Universidade do Porto (ICETA), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Associate Laboratory for Animal and Veterinary Science (AL4AnimalS), 1300-477 Lisboa, Portugal
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Eby SF, Teramoto M, Lider J, Lash M, Caragea M, Cushman DM. Sonographic peripheral nerve cross-sectional area in adults, excluding median and ulnar nerves: A systematic review and meta-analysis. Muscle Nerve 2023; 68:20-28. [PMID: 36583383 DOI: 10.1002/mus.27783] [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: 04/12/2021] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/AIMS Although electromyography remains the "gold standard" for assessing and diagnosing peripheral nerve disorders, ultrasound has emerged as a useful adjunct, providing valuable anatomic information. The objective of this study was to conduct a systematic review and meta-analysis evaluating the normative sonographic values for adult peripheral nerve cross-sectional area (CSA). METHODS Medline and Cochrane Library databases were systematically searched for healthy adult peripheral nerve CSA, excluding the median and ulnar nerves. Data were meta-analyzed, using a random-effects model, to calculate the mean nerve CSA and its 95% confidence interval (CI) for each nerve at a specific anatomical location (= group). RESULTS Thirty groups were identified and meta-analyzed, which comprised 16 from the upper extremity and 15 from the lower extremity. The tibial nerve (n = 2916 nerves) was reported most commonly, followed by the common fibular nerve (n = 2580 nerves) and the radial nerve (n = 2326 nerves). Means and 95% confidence interval (CIs) of nerve CSA for the largest number of combined nerves were: radial nerve assessed at the spiral groove (n = 1810; mean, 5.14 mm2 ; 95% CI, 4.33 to 5.96); common fibular nerve assessed at the fibular head (n = 1460; mean, 10.18 mm2 ; 95% CI, 8.91 to 11.45); and common fibular nerve assessed at the popliteal fossa (n = 1120; mean, 12.90 mm2 ; 95% CI, 9.12 to 16.68). Publication bias was suspected, but its influence on the results was minimal. DISCUSSION Two hundred thirty mean CSAs from 15 857 adult nerves are included in the meta-analysis. These are further categorized into 30 groups, based on anatomical location, providing a comprehensive reference for the clinician and researcher investigating adult peripheral nerve anatomy.
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Affiliation(s)
- Sarah F Eby
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Masaru Teramoto
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Lider
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Madison Lash
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marc Caragea
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel M Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Rhoul A, Gartit M, Noumairi M, Elmir S, Allam AES, Lachkar A, Abdeljaouad N, Yacoubi H, EL Oumri AA. Screw Impingement Causing Massive Swelling of the Sciatic Nerve: A Case Report. Cureus 2022; 14:e31059. [DOI: 10.7759/cureus.31059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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Singh KP, Kaur S, Arora V. Reference Values for the Cross Sectional Area of Normal Tibial Nerve on High-resolution Ultrasonography. J Ultrason 2022; 22:e144-e152. [PMID: 36482929 PMCID: PMC9714288 DOI: 10.15557/jou.2022.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/02/2022] [Indexed: 07/30/2023] Open
Abstract
AIM The aim of the study was to establish reference values for the cross-sectional area of the tibial nerve on high-resolution ultrasonography and to investigate the relationship between the cross-sectional area of the tibial nerve and subject's age, gender, height (in cm), weight (in kg) and body mass index. METHODS Two hundred subjects of either gender and over 18 years of age with no history of peripheral neuropathy or trauma to the lower limb were evaluated with high-resolution ultrasonography. Mean cross-sectional areas of tibial nerves were measured at two different levels in both lower limbs, first at 1 cm below the bifurcation of the sciatic nerve into tibial and common peroneal nerves (level I) and the second at 1 cm superior and posterior to the medial malleolus (level II). RESULTS The mean cross-sectional area measured at level I (0.196 + 0.014 cm2) was larger than the one measured at level II (0.111 ± 0.011 cm2). A positive correlation was found between the mean cross-sectional area and height, weight, and body mass index (p <0.05). Women had smaller cross-sectional areas of the tibial nerves than men at both sites. In addition, no significant relationship was found with the age of the subjects (p >0.05). CONCLUSION The established reference values of the cross-sectional area of the tibial nerve will aid in early diagnosis of peripheral neuropathy.
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Affiliation(s)
| | - Sumanjeet Kaur
- Radiodiagnosis, Sgrd University of Health Sciences, India
| | - Vijinder Arora
- Radiodiagnosis, Sgrd University of Health Sciences, India
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Bae DW, An JY. Cross-sectional area reference values for high-resolution ultrasonography of the lower extremity nerves in healthy Korean adults. Medicine (Baltimore) 2022; 101:e29842. [PMID: 35777005 PMCID: PMC9239665 DOI: 10.1097/md.0000000000029842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The cross-sectional area (CSA) reference values of the lower extremity nerves in Asians have been rarely reported. For this study, 107 sex- and age-matched, healthy subjects with a mean age of 46 years (range, 24-75 years) were recruited. All subjects underwent standardized nerve conduction studies of the upper and lower extremities. The CSA was measured unilaterally at 12 sites in the lower extremity nerves, including the femoral, lateral femoral cutaneous, sciatic, common peroneal, superficial peroneal, deep peroneal, tibial, and sural nerves. The CSA significantly correlated with height, weight, and body mass index. The CSA was significantly larger in males than females at most nerves except for the lateral femoral cutaneous, common peroneal (fibular head), and superficial peroneal nerves (distal calf). There was no statistically significant difference between the age groups except for the tibial nerve (ankle). The results of this study provide CSA reference values for the lower extremity nerves including small branches and the values can be useful in the ultrasonographic investigation of various peripheral neuropathies in East Asian populations.
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Affiliation(s)
- Dae Woong Bae
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Young An
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Jae Young An, Department of Neurology, St. Vincent’s Hospital, The Catholic University of Korea, 93-6, Ji-dong, Paldal-gu, Suwon, Gyeonggi-do 442-723, Korea (e-mail: )
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Greenfield AL, Parrikh M, Kanesa-Thasan R. Ultrasonographic Evaluation of Peripheral Nerves: Technical Considerations. Semin Musculoskelet Radiol 2022; 26:105-113. [PMID: 35609572 DOI: 10.1055/s-0042-1742606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advances in ultrasonographic (US) technology featuring high-resolution transducers have revolutionized US over recent years as a modality increasingly used in the evaluation of musculoskeletal structures and peripheral nerves. A wide variety of nerve pathologies can be detected, such as neoplastic and tumorlike lesions, entrapment syndromes, posttraumatic injuries, and inflammatory conditions. US can serve as an imaging tool for guiding percutaneous treatments, such as injection therapies or hydrodissection, and assist with perioperative nerve marking and visualization of peripheral nerves in the operating room. This article describes the normal US appearance of peripheral nerves, US imaging techniques, common peripheral nerve pathologies, and interventional applications.
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Affiliation(s)
- Antje L Greenfield
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mannan Parrikh
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Riti Kanesa-Thasan
- Section of Musculoskeletal Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Voltan G, Bernardes Filho F, Lugão HB, Nogueira-Barbosa MH, Frade MAC. Ultrasound reference values for peripheral nerve cross-sectional areas and indices in a sample of healthy individuals in Brazil. Radiol Bras 2022; 55:337-345. [PMID: 36514679 PMCID: PMC9743255 DOI: 10.1590/0100-3984.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To establish peripheral nerve cross-sectional area (CSA) reference values (absolute values, measures of asymmetry, and measures of focality) for healthy individuals in Brazil. Materials and Methods Sixty-six healthy volunteers underwent high-resolution ultrasound of the peripheral nerves. We obtained CSA measurements for three peripheral nerves, at specific locations: the median nerve, in the carpal tunnel (MT); the ulnar nerve, at the cubital tunnel site (UT) and at the pre-tunnel site (UPT); and the common fibular nerve, near the fibular head (FH). We calculated the CSA indices between the same sites on different sides (ΔCSAs) and between the ulnar nerve tunnel and pre-tunnel sites on the same side (ΔTPT). Results A total of 132 neural sites were analyzed, and the following CSA values (mean ± SD, median) were obtained: MT (6.3 ± 1.9 mm2, 6.0 mm2); UT (6.2 ± 1.6 mm2, 6.1 mm2); UPT (5.6 ± 1.7 mm2, 5.4 mm2); and FH (10.0 ± 3.7 mm2, 9.9 mm2). The ΔCSA values (mean ± SD, median) were as follows: MT (0.85 ± 0.7 mm2, 0.95); UT (0.81 ± 0.62 mm2, 0.95); UPT (0.61 ± 0.51 mm2, 0.5); and FH (1.0 ± 0.77 mm2, 1.0). The ΔTPT (mean ± SD, median) was (1.0 ± 0.8 mm2, 1.0). Conclusion Among individuals in Brazil, peripheral nerve CSA values tend to be higher among males and to increase with aging. However, the same does not appear to hold true for the ΔCSA or the ΔTPT, the exception being the difference between the right and left UT. Differences in CSA values greater than 2.5 mm2 between sides or between sites along the same nerve can indicate asymmetry or focal thickening in neuropathy, respectively.
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Affiliation(s)
- Glauber Voltan
- Dermatology Division, Department of Internal Medicine, Faculdade de
Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil.
| | - Fred Bernardes Filho
- Dermatology Division, Department of Internal Medicine, Faculdade de
Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil.
| | - Helena Barbosa Lugão
- Dermatology Division, Department of Internal Medicine, Faculdade de
Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil.
| | - Marcello Henrique Nogueira-Barbosa
- Radiology Division, Department of Internal Medicine, Faculdade de Medicina
de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão
Preto, SP, Brazil.
| | - Marco Andrey Cipriani Frade
- Dermatology Division, Department of Internal Medicine, Faculdade de
Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP),
Ribeirão Preto, SP, Brazil. ,Correspondence: Correspondence: Dr. Marco Andrey Cipriani Frade.
Serviço de Dermatologia, Departamento de Clínica Médica – FMRP-USP.
Avenida Bandeirantes, 3900, Monte Alegre. Ribeirão Preto, SP, Brazil, 14049-900.
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11
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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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12
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Felisaz PF, Belatti E, Deligianni X, Bergsland N, Santini F, Paoletti M, Solazzo F, Germani G, Cortese A, Vegezzi E, Bieri O, Bastianello S, Pichiecchio A. Variable echo time imaging for detecting the short T2* components of the sciatic nerve: a validation study. MAGMA (NEW YORK, N.Y.) 2021; 34:411-419. [PMID: 32964300 PMCID: PMC8154754 DOI: 10.1007/s10334-020-00886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this study was to develop and validate an MRI protocol based on a variable echo time (vTE) sensitive to the short T2* components of the sciatic nerve. MATERIALS AND METHODS 15 healthy subjects (M/F: 9/6; age: 21-62) were scanned at 3T targeting the sciatic nerve at the thigh bilaterally, using a dual echo variable echo time (vTE) sequence (based on a spoiled gradient echo acquisition) with echo times of 0.98/5.37 ms. Apparent T2* (aT2*) values of the sciatic nerves were calculated with a mono-exponential fit and used for data comparison. RESULTS There were no significant differences in aT2* related to side, sex, age, and BMI, even though small differences for side were reported. Good-to-excellent repeatability and reproducibility were found for geometry of ROIs (Dice indices: intra-rater 0.68-0.7; inter-rater 0.70-0.72) and the related aT2* measures (intra-inter reader ICC 0.95-0.97; 0.66-0.85) from two different operators. Side-related signal-to-noise-ratio non-significant differences were reported, while contrast-to-noise-ratio measures were excellent both for side and echo. DISCUSSION Our study introduces a novel MR sequence sensitive to the short T2* components of the sciatic nerve and may be used for the study of peripheral nerve disorders.
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Affiliation(s)
- Paolo Florent Felisaz
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Radiology, Desio Hospital, ASST Monza, Desio, Italy
| | - Eugenio Belatti
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Xeni Deligianni
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.
| | - Niels Bergsland
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Francesco Santini
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Matteo Paoletti
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Francesca Solazzo
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Giancarlo Germani
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Andrea Cortese
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
- Department for Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology, London, UK
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
| | - Oliver Bieri
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Stefano Bastianello
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, PV, Italy
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13
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Cornelson SM, Ruff AN, Wells C, Sclocco R, Kettner NW. Sonographic measures and sensory threshold of the normal sciatic nerve and hamstring muscles. J Ultrasound 2021; 25:47-57. [PMID: 33515412 PMCID: PMC8964850 DOI: 10.1007/s40477-020-00552-w] [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: 10/25/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The sciatic nerve innervates the hamstring muscles. Occasionally, the sciatic nerve is injured along with a hamstring muscle. Detailed biomechanical and sensory thresholds of these structures are not well-characterized. Therefore, we designed a prospective study that explored high-resolution ultrasound (US) at multiple sites to evaluate properties of the sciatic nerve, including cross-sectional area (CSA) and shear-wave elastography (SWE). We also assessed SWE of each hamstring muscle at multiple sites. Mechanical algometry was obtained from the sciatic nerve and hamstring muscles to assess multi-site pressure pain threshold (PPT). METHODS Seventy-nine asymptomatic sciatic nerves and 147 hamstring muscles (25 males, 24 females) aged 18-50 years were evaluated. One chiropractic radiologist with 4.5 years of US experience performed the evaluations. Sciatic nerves were sampled along the posterior thigh at four sites obtaining CSA, SWE, and algometry. All three hamstring muscles were sampled at two sites utilizing SWE and algometry. Descriptive statistics, two-way ANOVA, and rater reliability were assessed for data analysis with p ≤ 0.05. RESULTS A significant decrease in sciatic CSA from proximal to distal was correlated with increasing BMI (p < 0.001). Intra-rater and inter-rater reliability for CSA was moderate and poor, respectively. Elastographic values significantly increased from proximal to distal with significant differences in gender and BMI (p = 0.002). Sciatic PPT significantly decreased between sites 1 and 2, 1 and 3, and 1 and 4. Significant correlation between gender and PPT was noted as well as BMI (p < 0.001). Hamstring muscle elastographic values significantly differed between biceps femoris and semitendinosus (p < 0.001) and biceps femoris and semimembranosus (p < 0.001). All three hamstring muscles demonstrated increased PPT in males compared to females (p < 0.001). In addition, PPT of the biceps femoris correlated with BMI (p = 0.02). CONCLUSION High-resolution US provided useful metrics of sciatic nerve size and biomechanical properties. PPT for the normal sciatic nerve and hamstring muscles was obtained for future clinical application.
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Affiliation(s)
- Stacey M Cornelson
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA.
| | - Ashley N Ruff
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA
| | - Courtney Wells
- Human Performance Center, Logan University, Chesterfield, MO, USA
| | - Roberta Sclocco
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA
- Department of Radiology, Athinoula. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Norman W Kettner
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, 63017, USA
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14
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Rusu GM, Curcean AD, Dudea SM. Ultrasound and magnetic resonance imaging evaluation of the femoral and sciatic nerves. A study of healthy volunteers. Med Pharm Rep 2020; 93:357-364. [PMID: 33225261 PMCID: PMC7664720 DOI: 10.15386/mpr-1629] [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: 03/16/2020] [Revised: 05/05/2020] [Accepted: 05/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aims The study describes the femoral (FN) and sciatic nerves (SN), explored using ultrasound (US) and magnetic resonance imaging (MRI). The aims of the study are: to establish US/MRI correlations and define reference values: for the anteroposterior (AP) and mediolateral (ML) diameters and cross-sectional area (CSA) of the two nerves respectively, in well-defined anatomical measuring sites; to analyze the intraobserver variation; to define the value with least variability; to determine differences between the right-left and male-female reference values. Methods A prospective study was carried out on 24 healthy volunteers (11 men and 13 women). MRI scans were performed using a 1.5T system. To visualize both nerves (FN and SN), a single 3D T2 weighted acquisition was performed, in the coronal plane, with a wide FOV. For ultrasonographic examinations, a Hitachi EUB-8500 ultrasound machine, equipped with a 13 MHz linear transducer was used. The measurements were performed at well-defined anatomical locations. The mean reference values of the AP, ML diameters and CSA were calculated for femoral and sciatic nerves, both on MRI and US. The correlations between the values determined by the two techniques were analyzed. The intra-observer variation was calculated by measuring the nerves at the same anatomical location at two separate time points. Results Wilcoxon matched-pairs signed rank test indicated a non-significant difference (p> 0.05) for the femoral and sciatic nerves, on both sides, except the femoral nerve ML diameter on MRI (p=0.014). The mean MRI and US reference values for the femoral nerve were calculated between the psoas and iliac muscles: FNAPMRI 4.533 ± 0.486, FNAPUS 4.800 ± 1.237, FNMLMRI 6.172 ± 1.203, FNMLUS 7.685 ± 3.338, FNCSAMRI 24.811 ± 3.394, FNCSAUS 26.285 ± 17.608. The mean MRI and US measurements for the sciatic nerve were determined under the buttock, at the level of the ischial tuberosity: SNAPMRI 5.500 ± 1.201, SNAPUS 5.975 ± 1.312, SNMLMRI 10.375 ± 2.272, SNMLUS 13.500 ± 1.661, SNCSAMRI 50.625 ± 15.373, SNCSAUS 53.631 ± 15.847. The MRI and US differences between right and left sides, both for the femoral and sciatic nerves were insignificant. In selected cases, Wilcoxon paired test indicated differences between subjects, according to their gender, both on MRI and US. Conclusion Reference values for the femoral and sciatic nerves at specific anatomical sites were identified. Side to side variation and gender related differences add to current knowledge on nerve size in young Caucasian population.
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Affiliation(s)
| | - Andra Diana Curcean
- Radiology Department, Academic Emergency County Hospital, Cluj-Napoca, Romania
| | - Sorin Marian Dudea
- Radiology Department, Academic Emergency County Hospital, Cluj-Napoca, Romania.,Radiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Probst D, Stout A, Hunt D. Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment. PM R 2019; 11 Suppl 1:S54-S63. [PMID: 31102324 DOI: 10.1002/pmrj.12189] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Piriformis syndrome is a form of sciatica caused by compression of the sciatic nerve by the piriformis muscle. It is a relatively uncommon, but not insignificant, cause of sciatica. The diagnosis of piriformis syndrome is complicated by the large differential diagnosis of low back and buttock pain with many diagnoses having overlapping symptoms. This narrative review highlights the relevant anatomy, history, physical exam maneuvers, electrodiagnostic findings, and imaging findings that are used to diagnose piriformis syndrome. Also discussed are posterior gluteal myofascial pain syndromes that mimic piriformis syndrome. The review then outlines the different treatment options for piriformis syndrome including conservative treatment, injections, and surgical treatment. In addition, it provides the reader with a clinical framework to better understand and treat the complex, and often misunderstood, diagnosis of piriformis syndrome.
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Affiliation(s)
- Daniel Probst
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Alison Stout
- EvergreenHealth Sport & Spine Care, Kirkland, WA
| | - Devyani Hunt
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedics, Washington University School of Medicine, St. Louis, MO
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