Diagnostic ultrasound of the residual limb: A narrative review

Powell, Jordan; Sparling, Tawnee L.; Yuan, Xiaoning

doi:10.1002/pmrj.12896

Cited by 3 publications

(2 citation statements)

References 44 publications

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“…Transtibial prosthetic users commonly encounter difficulties in achieving an optimal fit between their residual limb and socket, with a reported prevalence of 59% experiencing moderate to severe residual limb pain 1 , 2 . Simultaneously, prosthetists encounter difficulties in objectively evaluating the effects of their prosthetic adjustments on the loading of the residual limb 3 , 4 . Currently, prosthetic fitting relies on iterative processes, employing a trial-and-error approach to improve residual bone control.…”

Section: Introductionmentioning

confidence: 99%

“…Ultrasound (US) has been employed for decades to monitor various musculoskeletal dysfunctions 20 . This relatively cheap and simple method could potentially be utilized as a diagnostic or investigational tool for understanding the residual bone-socket interactions and deformation of soft tissues by prosthesis users 3 , 7 , 8 . However, the application on prosthetic devices is limited.…”

Section: Introductionmentioning

confidence: 99%

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Application of ultrasound to monitor in vivo residual bone movement within transtibial prosthetic sockets

Jonkergouw,

Prins,

Donse

et al. 2024

Sci Rep

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Transtibial prosthetic users do often struggle to achieve an optimal prosthetic fit, leading to residual limb pain and stump-socket instability. Prosthetists face challenges in objectively assessing the impact of prosthetic adjustments on residual limb loading. Understanding the mechanical behaviour of the pseudo-joint formed by the residual bone and prosthesis may facilitate prosthetic adjustments and achieving optimal fit. This study aimed to assess the feasibility of using B-mode ultrasound to monitor in vivo residual bone movement within a transtibial prosthetic socket during different stepping tasks. Five transtibial prosthesis users participated, and ultrasound images were captured using a Samsung HM70A system during five dynamic conditions. Bone movement relative to the socket was quantified by tracking the bone contour using Adobe After-Effect. During the study a methodological adjustment was made to improve data quality, and the first two participants were excluded from analysis. The remaining three participants exhibited consistent range of motion, with a signal to noise ratio ranging from 1.12 to 2.59. Medial–lateral and anterior–posterior absolute range of motion varied between 0.03 to 0.88 cm and 0.14 to 0.87 cm, respectively. This study demonstrated that it is feasible to use B-mode ultrasound to monitor in vivo residual bone movement inside an intact prosthetic socket during stepping tasks.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of ultrasound to monitor in vivo residual bone movement within transtibial prosthetic sockets

Jonkergouw,

Prins,

Donse

et al. 2024

Sci Rep

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Neuroma-to-Nerve Ratio: Does Size Matter?

Weigel,

Raasveld,

Liu

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Anatomic features of neuromas have been explored in imaging studies. However, there has been limited research into these features using resected, ex vivo human neuroma specimens. The aim of this study was to investigate the influence that time may have on neuroma growth and size, and the clinical significance of these parameters. METHODS: Patients who underwent neuroma excision between 2022 through 2023 were prospectively included in this study. Neuroma specimens were obtained after operative resection. Standardized neuroma size measurements, expressed as a neuroma-to-nerve ratio (NNR), were conducted with ImageJ software. Pain data (numeric rating scale, 0-10) were prospectively recorded during preoperative evaluation, and patient factors were collected from chart reviews. RESULTS: Fifty terminal neuroma specimens from 31 patients were included, with 94.0% of the neuromas obtained from individuals with amputations. Most neuromas were excised from the lower extremities (n = 44, 88.0%). The neuromas had a median NNR of 2.45, and the median injury to neuroma excision interval was 6.3 years. Larger NNRs were associated with a longer injury to neuroma excision interval and with a smaller native nerve diameter. In addition, sensory nerves were associated with a larger NNR compared with mixed nerves. NNR was not associated with preoperative pain or with anatomical nerve distribution. CONCLUSION: This study suggests that neuromas seem to continue to grow over time and that smaller nerves may form relatively larger neuromas. In addition, sensory nerves develop relatively larger neuromas compared with mixed nerves. Neuroma size does not appear to correlate with pain severity. These findings may stimulate future research efforts and contribute to a better understanding of symptomatic neuroma development.

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Cortical Reorganization after Limb Loss: Bridging the Gap between Basic Science and Clinical Recovery

Sparling,

Iyer,

Pasquina

et al. 2024

J. Neurosci.

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Despite the increasing incidence and prevalence of amputation across the globe, individuals with acquired limb loss continue to struggle with functional recovery and chronic pain. A more complete understanding of the motor and sensory remodeling of the peripheral and central nervous system that occurs postamputation may help advance clinical interventions to improve the quality of life for individuals with acquired limb loss. The purpose of this article is to first provide background clinical context on individuals with acquired limb loss and then to provide a comprehensive review of the known motor and sensory neural adaptations from both animal models and human clinical trials. Finally, the article bridges the gap between basic science researchers and clinicians that treat individuals with limb loss by explaining how current clinical treatments may restore function and modulate phantom limb pain using the underlying neural adaptations described above. This review should encourage the further development of novel treatments with known neurological targets to improve the recovery of individuals postamputation.Significance StatementIn the United States, 1.6 million people live with limb loss; this number is expected to more than double by 2050. Improved surgical procedures enhance recovery, and new prosthetics and neural interfaces can replace missing limbs with those that communicate bidirectionally with the brain. These advances have been fairly successful, but still most patients experience persistent problems like phantom limb pain, and others discontinue prostheses instead of learning to use them daily. These problematic patient outcomes may be due in part to the lack of consensus among basic and clinical researchers regarding the plasticity mechanisms that occur in the brain after amputation injuries. Here we review results from clinical and animal model studies to bridge this clinical–basic science gap.

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Diagnostic ultrasound of the residual limb: A narrative review

Cited by 3 publications

References 44 publications

Application of ultrasound to monitor in vivo residual bone movement within transtibial prosthetic sockets

Application of ultrasound to monitor in vivo residual bone movement within transtibial prosthetic sockets

Neuroma-to-Nerve Ratio: Does Size Matter?

Cortical Reorganization after Limb Loss: Bridging the Gap between Basic Science and Clinical Recovery

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