Contribution of ultrasound in a neurophysiological lab in diagnosing nerve impairment: A one-year systematic assessment

Padua, Luca; Aprile, Irene; Pazzaglia, Costanza; Frasca, Giampiero; Caliandro, Pietro; Tonali, P.; Martinoli, Carlo

doi:10.1016/j.clinph.2007.03.011

Cited by 78 publications

(61 citation statements)

References 20 publications

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“…Ultrasound was particularly useful in cases with atypical clinical or neurophysiological characteristics, as already reported by Padua et al, 24 and in all cases in which no neural response could be evoked. Also, it was useful in identifying multifocal damage or uncommon sites of injury, which cannot be achieved by electrodiagnostic testing alone.…”

Section: Posttraumatic and Postsurgical Neuropathiesmentioning

confidence: 67%

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: 67%

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

Toia

Gagliardo

D’Arpa

et al. 2016

JNS

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“…[1][2][3][4] Its advantages include the ability to screen extensive lengths of nerves quickly and with good resolution. It is painless, noninvasive, and inexpensive.…”

mentioning

confidence: 99%

Peripheral nerve size in normals and patients with polyneuropathy: An ultrasound study

Zaidman¹,

Al-Lozi²,

Pestronk³

2009

Muscle and Nerve

306

338

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Ultrasound has been used for visualizing peripheral nerve pathology. Our goal was to use ultrasound to quantitate the sizes of upper extremity nerves along their length in control subjects and patients with neuropathy. We measured median and ulnar nerve cross-sectional areas (NCSA) in the arms of 190 subjects, including 100 with neuropathies and 90 controls. We found that NCSAs in healthy child and adult controls were greater with increasing height, at proximal sites, and at sites of entrapment. Nerves were enlarged in all Charcot-Marie-Tooth 1A (CMT-1A) (11 of 11; 100%), most chronic inflammatory demyelinating polyneuropathy (CIDP) (31 of 36; 86%), half of Guillain-Barré syndrome (GBS) (8 of 17; 47%), but few axonal neuropathy (7 of 36, 19%) subjects. In GBS, nerve enlargement occurred early and with minimal electrodiagnostic abnormalities in some patients. We conclude that NCSA measured by ultrasound is a quantifiable marker of nerve features that should be corrected for patient characteristics and nerve site. NCSA is generally larger in demyelinating than it is in axonal polyneuropathies.

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“…Certain groups have advocated using MRI (Britz et al, 1995), and others, including this one (Padua et al, 2007;Di Pasquale et al, 2010), US, either as part of research protocols or routine clinical practice. A recent clinical practice guideline approved by the American Academy of Orthopaedic Surgeons (Keith et al, 2009) did not find cogent data that MRI or computerized tomography (CT) improved sensitivity or specificity in diagnosing CTS.…”

mentioning

confidence: 98%

“…Largely based on the works of these authors (Martinoli and Bianchi, 2007;Padua et al, 2007) and that of others (Iverson, 2005;Visser, 2006), we have tested the waters by adding routine screening US to a relatively common neuropathy-that is, neuropathy of the common fibular nerve-in cases where electrophysiological testing localizes a lesion to the level of the fibular neck. These tests are conducted concurrently by experienced neurologists and physiatrists in our EMG laboratory.…”

mentioning

confidence: 99%

Dynamic imaging in patients with carpal tunnel syndrome

Spinner¹,

Blouin²,

Amrami³

2010

Clinical Anatomy

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Contribution of ultrasound in a neurophysiological lab in diagnosing nerve impairment: A one-year systematic assessment

Cited by 78 publications

References 20 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?

Peripheral nerve size in normals and patients with polyneuropathy: An ultrasound study

Dynamic imaging in patients with carpal tunnel syndrome

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