Ultrasound diagnosis of bony nerve entrapment: Case series and literature review

Erra, Carmen; Granata, Giuseppe; Liotta, Giovanna; Podnar, Simon; Giannini, Mauro; Kushlaf, Hani; Hobson‐Webb, Lisa D.; Leversedge, Fraser J.; Martinoli, Carlo; Padua, Luca

doi:10.1002/mus.23845

Cited by 17 publications

(11 citation statements)

References 13 publications

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“…Also, it was useful in identifying multifocal damage or uncommon sites of injury, which cannot be achieved by electrodiagnostic testing alone. As reported by other authors, 8,14,21 ultrasound facilitated surgical planning in patients with neuromas, foreign bodies, and postfracture complications, allowing for targeted surgery and avoiding wide accesses for exploration because of accurate localization and estimation of nerve damage.…”

Section: Posttraumatic and Postsurgical Neuropathiesmentioning

confidence: 64%

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Toia

Gagliardo

D’Arpa

et al. 2016

JNS

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Since its first description for the assessment of recurrent laryngeal nerve palsy, 30 ultrasound nerve imaging has become an established technique for the study of peripheral neuropathies. Several clinical studies have recently demonstrated its high sensitivity and specificity and validated its usefulness in the diagnostic and therapeutic process for focal and generalized peripheral neuropathies. 1,4,7,15,19,29 High-resolution ultrasound is a reliable tool for examining both the extraneural and the intraneural morphology of peripheral nerves. It allows evaluation of nerve continuity and shape and detection of nerve enlargements, comabbreviatioNs CMAP = compound muscle action potential; CSA = cross-sectional area; EMG = electromyography; LSD = least significant difference; MUAP = motor unit action potential; SNAP = sensory nerve action potential. obJeCtive The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. methods The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examination, electrodiagnostic studies (nerve conduction study and electromyography), and ultrasound nerve study. Ultrasound was used to explore the nerve fascicular echo-texture, continuity, and surrounding tissues. The maximum cross-sectional area (CSA) and the presence of epineurial hyperechogenicity or intraneural hyper- or hypoechogenicity, of anatomical anomalies, dynamic nerve dislocations, or compressions were recorded. The concordance rate of neurophysiological and ultrasonographic data was analyzed, classifying ultrasound findings as confirming, contributive, or nonconfirming with respect to electrodiagnostic data. The correlation between maximum nerve CSA and neurophysiological severity degree in entrapment syndromes was statistically analyzed. results Ultrasonography confirmed electrodiagnostic findings in 36.1% of cases and showed a contributive role in the diagnosis and surgical planning in 53.8% of all cases; the findings were negative ("nonconfirming") in only 10.1% of the patients. In 16% of cases, ultrasound was not only contributive, but had a key diagnostic role in the presence of doubtful electrodiagnostic findings. The contributive role differed according to etiology, being higher for tumors (100%) and for posttraumatic or postsurgical neuropathies (72.2%) than for entrapment neuropathies (43.8%). CoNClusioNs Ultrasound is a powerful, noninvasive tool for the examination of peripheral nerve injuries, and can guide diagnosis of and surgical strategy for focal peripheral ne...

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Section: Posttraumatic and Postsurgical Neuropathiesmentioning

confidence: 64%

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Toia

Gagliardo

D’Arpa

et al. 2016

JNS

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“… 98 In addition, ultrasound can be used to assess whether surgical intervention is required in the setting of nerve discontinuity, 96 neuromas 99 or bony entrapment. 100 , 101 It is worth noting that ultrasound will not differentiate between severe axonal injury with and without intact epineurium.…”

Section: Traumatic Peripheral Nerve Injurymentioning

confidence: 99%

Review Article “Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date”

Hannaford¹,

Vucic²,

Kiernan³

et al. 2021

IJGM

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Neuromuscular ultrasound is rapidly becoming incorporated into clinical practice as a standard tool in the assessment of peripheral nerve diseases. Ultrasound complements clinical phenotyping and electrodiagnostic evaluation, providing critical structural anatomical information to enhance diagnosis and identify structural pathology. This review article examines the evidence supporting neuromuscular ultrasound in the diagnosis of compressive mononeuropathies, traumatic nerve injury, generalised peripheral neuropathy and motor neuron disease. Extending the sonographic evaluation of nerves beyond simple morphological measurements has the potential to improve diagnostics in peripheral neuropathy, as well as advancing the understanding of pathological mechanisms, which in turn will promote precise therapies and improve therapeutic outcomes.

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“…Rarely, callous formation in humeral or ulnar fractures can encase a nearby nerve, often, but not always, with deleterious effects. The appearance of a nerve entering and emerging from a calcific mass contiguous with bone is indicative of this condition 71 …”

Section: Bonementioning

confidence: 99%

Managing uncommon and unexpected findings during neuromuscular ultrasound

2020

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One barrier to widespread adoption of neuromuscular ultrasound by clinical neurophysiologists is concern over how to identify and manage non-neuromuscular findings. This review addresses this concern by describing the sonographic appearance of a variety of commonly observed pathologies and anatomic variants in dermal, subcutaneous, bony, glandular, lymphatic, vascular, and other superficial tissues. Additionally, it outlines techniques to ensure proper clinical and ultrasound evaluation of unexpected or uncommon findings. Finally, it highlights strategies to manage unexpected findings, including how to best communicate findings to patients and referring clinicians to avoid unnecessary testing and ensure appropriate follow-up. Ultrasound extends the ability of the neuromuscular sonographer-clinician to contribute to patient care.

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Ultrasound diagnosis of bony nerve entrapment: Case series and literature review

Abstract: US is becoming an invaluable tool for diagnosing peripheral nerve entrapments. The current cases suggest that nerve US should be strongly considered as an adjunctive diagnostic tool for nerve palsies developing after trauma.

Cited by 17 publications

References 13 publications

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

Review Article “Spotlight on Ultrasonography in the Diagnosis of Peripheral Nerve Disease: The Evidence to Date”

Managing uncommon and unexpected findings during neuromuscular ultrasound

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