Role of High-Resolution Ultrasonography of Ulnar Nerve in the Evaluation of Diabetic Peripheral Neuropathy

Abstract

BACKGROUND Diabetic peripheral neuropathy is a long term complication of diabetes. Traditionally, clinical history, physical examination and electro physiological studies were relied upon for diagnosis. Currently, High resolution ultrasonography has come into picture in the diagnosis of peripheral neuropathy due to the ease, time saving ability and noninvasiveness of the procedure. We wanted to correlate the cross-sectional area and maximum thickness of nerve fascicles of the ulnar nerve with the presence and severity of diabetic peripheral neuropathy. METHODS A retrospective study was conducted between October 2018 and January 2019. The study group consisted of 85 type 2 diabetic patients. 55 Diabetic patients with clinical signs and symptoms of peripheral neuropathy were assigned to Group I. Group II comprised of 30 diabetic patients with no clinical signs and symptoms of peripheral neuropathy. 70 healthy volunteers were also recruited for the study, and assigned to Group III. The cross sectional area and maximum thickness of nerve fascicles of the ulnar nerve were measured at every predetermined site. RESULTS The cross sectional area of the ulnar nerve was measured at three sites (inlet of the cubital tunnel, outlet of the cubital tunnel and Guyon tunnel). The mean cross sectional area and maximum thickness of nerve fascicles of the ulnar nerves in the above three sites in Group I compared with both Group II and III was significantly larger, and statistically significant correlation was found with the Toronto Clinical Neuropathy Score (p<0.001). The Group II patients also had a significantly larger mean cross sectional area and maximum thickness of nerve fascicles than Group III. CONCLUSIONS High resolution ultrasonography of ulnar nerve is an easy non-invasive tool for the early diagnosis of diabetic peripheral neuropathy by assessing the cross sectional area and maximum thickness of nerve fascicles.