Systematic Review of the Use of Power Doppler Ultrasound in the Imaging of Peripheral Nerve Compression Neuropathy

Landau, Andrew J; Parameswaran, Priyanka; Fresco, Rabiah; Simón, L; Dy, Christopher J.; Brogan, David M.

doi:10.1097/prs.0000000000008627

Cited by 5 publications

(3 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14,29 Advances in electrodiagnosis and imaging have supported preoperative surgical planning, but significant intraoperative decisionmaking remains necessary. 14,30,31 Therefore, decision to perform a simple in situ decompression vs more extensive decompression remains elusive. Mechanomyography may help validate neurological deficits and predict outcomes, aiding in such decisions.…”

Section: Discussionmentioning

confidence: 99%

Mechanomyography as a Surgical Adjunct for Treatment of Chronic Entrapment Neuropathy: A Case Series

Javeed

Birenbaum

et al. 2023

Operative Neurosurgery

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Chronic entrapment neuropathy results in a clinical syndrome ranging from mild pain to debilitating atrophy. There remains a lack of objective metrics that quantify nerve dysfunction and guide surgical decision-making. Mechanomyography (MMG) reflects mechanical motor activity after stimulation of neuromuscular tissue and may indicate underlying nerve dysfunction. OBJECTIVE: To evaluate the role of MMG as a surgical adjunct in treating chronic entrapment neuropathies. METHODS: Patients 18 years or older with cubital tunnel syndrome (n = 8) and common peroneal neuropathy (n = 15) were enrolled. Surgical decompression of entrapped nerves was performed with intraoperative MMG of the hypothenar and tibialis anterior muscles. MMG stimulus thresholds (MMG-st) were correlated with compound muscle action potential (CMAP), motor nerve conduction velocity, baseline functional status, and clinical outcomes. RESULTS: After nerve decompression, MMG-st significantly reduced, the mean reduction of 0.5 mA (95% CI: 0.3-0.7, P < .001). On bivariate analysis, MMG-st exhibited significant negative correlation with common peroneal nerve CMAP (P < .05), but no association with ulnar nerve CMAP and motor nerve conduction velocity. On preoperative electrodiagnosis, 60% of nerves had axonal loss and 40% had conduction block. The MMG-st was higher in the nerves with axonal loss as compared with the nerves with conduction block. MMG-st was negatively correlated with preoperative hand strength (grip/pinch) and foot-dorsiflexion/toe-extension strength (P < .05). At the final visit, MMG-st significantly correlated with pain, PROMIS-10 physical function, and Oswestry Disability Index (P < .05). CONCLUSION: MMG-st may serve as a surgical adjunct indicating axonal integrity in chronic entrapment neuropathies which may aid in clinical decision-making and prognostication of functional outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Mechanomyography as a Surgical Adjunct for Treatment of Chronic Entrapment Neuropathy: A Case Series

Javeed

Birenbaum

et al. 2023

Operative Neurosurgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Fowler et al, in their meta-analysis, showed that the Sn for diagnostic ultrasound ranged between 0.57 and 0.98 and the Sp ranged from 0.63 to 1.00 [ 58 ]. Landau et al reviewed the use of power Doppler ultrasound and found that Sn/Sp for diagnosing CTS showed high levels of variability, reporting a range of 0.02-0.93 for Sn and an Sp of 0.89-1.00 [ 59 ]. The lack of an accepted diagnostic gold standard or reference standard for CTS likely contributes to this diagnostic uncertainty and serves as a caution against using individual tests in isolation to make the diagnosis.…”

Section: Reviewmentioning

confidence: 99%

Sensitivity and Specificity of Examination Maneuvers for Carpal Tunnel Syndrome: A Meta-Analysis

Ozdag¹,

Hu²,

Hayes³

et al. 2023

Cureus

View full text Add to dashboard Cite

Our purpose was to assess the diagnostic validity (sensitivity (Sn) and specificity (Sp)) of physical examination maneuvers for carpal tunnel syndrome (CTS). This meta-analysis utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Studies assessing exam maneuvers (including components of the CTS-6) for CTS were identified in MEDLINE (Medical Literature Analysis and Retrieval System Online) and Embase (Excerpta Medica Database) databases. Assessed maneuvers assessed included: Phalen's test, Tinel's sign, Durkan test, scratch-collapse test, Semmes-Weinstein monofilament (SWM), and static 2-point discrimination (2PD) test. Data extracted included: article name, total number of subjects/hands, type of exam, and exam Sn/Sp. Forest plots were presented to display the estimated Sn/Sp and boxplots were used to demonstrate the locality, spread, and skewness of the Sn/Sp through the quartiles. After screening 570 articles, 67 articles involving 8924 hands were included. Forty-eight articles assessed Phalen's test, 45 assessed Tinel's sign, 21 assessed the Durkan test, seven assessed the scratch-collapse test, 11 assessed SWM, and six assessed the static 2PD test. Phalen's test demonstrated the greatest median Sn (0.70, (Q1, Q3): (0.51, 0.85)), followed by the Durkan test (0.67, (Q1, Q3): (0.46, 0.82)). 2PD demonstrated the highest median Sp (0.90, (Q1, Q3): (0.88, 0.90)), followed by SWM (0.85, (Q1, Q3): (0.51, 0.89)). There is considerable variability with respect to the validity of physical exam tests used in the diagnosis of CTS. Upper-extremity surgeons should be aware of inherent limitations for individual exam maneuvers. In the absence of a uniformly accepted diagnostic gold standard, a combination of exams, along with pertinent patient history, should guide the diagnosis of CTS.

show abstract

“…4 ). 8 , 24 , 25 A systematic review by Landau et al 26 found that PDUS is unreliable as a screening test but increases the diagnostic accuracy of ultrasound in compressive neuropathies. The analysis of PDUS waveforms provides a surrogate for intraneural blood flow by assessing the velocity of flow.…”

Section: Diagnosis Of Compressive Neuropathiesmentioning

confidence: 99%

Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity

Graesser,

Dy,

Brogan

2023

Journal of Hand Surgery Global Online

Self Cite

View full text Add to dashboard Cite

Systematic Review of the Use of Power Doppler Ultrasound in the Imaging of Peripheral Nerve Compression Neuropathy

Cited by 5 publications

References 38 publications

Mechanomyography as a Surgical Adjunct for Treatment of Chronic Entrapment Neuropathy: A Case Series

Mechanomyography as a Surgical Adjunct for Treatment of Chronic Entrapment Neuropathy: A Case Series

Sensitivity and Specificity of Examination Maneuvers for Carpal Tunnel Syndrome: A Meta-Analysis

Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity

Contact Info

Product

Resources

About