Ultrasound-Guided Treatment of Peripheral Nerve Pathology

Dettori, Nathan J.; Choudur, Hema; Chhabra, Avneesh

doi:10.1055/s-0038-1641571

Cited by 14 publications

(31 citation statements)

References 58 publications

(80 reference statements)

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“…Ultrasound is the first choice level technique to image the nerve according to the last Guidelines of the European Society of Musculoskeletal Radiology (ESSR) [ 26 ] and widely applicated in ultrasound-guided injections around the nerve [ 27 , 28 ], we attempted to use ultrasound to identify the 3D distribution, which would help to avoid damaging LFCN from cutting to the suture. This is different from traditional skin marking protocol using ultrasound guidance.…”

Section: Discussionmentioning

confidence: 99%

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Yao

Wang

et al. 2021

J Orthop Surg Res

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Background The postoperative complaints of hypoesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients are not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods A total of 59 patients (28 males and 31 females, age 69.0 ± 4.6 years, BMI 24.7 ± 3.0 kg/m2) were randomly allocated to the ultrasound group and 58 patients (28 males and 30 females, age 68.5 ± 4.5 years, BMI 24.8 ± 2.8 kg/m2) were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months of post surgery, the rate of LFCN injury and abnormal sensitive area was evaluated in both groups. Results There was a significant consistency in gender, age and BMI of these two groups (P > 0.05). Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8 ± 2.6 (3.0–12.0) mm to 11.1 ± 3.4 (4.0–17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3 ± 4.6 (− 5.0–10.0) mm at proximal part and − 2.7 ± 4.7 (− 10.0–8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group was significantly lower than those in the control group (3.4% vs. 25.9%, P = 0.001, at 1 month; 3.4% vs. 22.4%, P = 0.005, at 3 months). Conclusions LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN using preoperative ultrasound mapping could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

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Section: Discussionmentioning

confidence: 99%

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Yao

Wang

et al. 2021

J Orthop Surg Res

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“…Compared with no 3D location, the identi cation of LFCN was a great option to signi cantly decrease the rate of DAA-induced LFCN injury. Similar studies, which focused on the treatment of meralgia paresthetica of LFCN or nerve block conduction using ultrasound guiding technique, also demonstrated that ultrasonographic images provided precious and visible position that would be helpful to a safe and effective treatment, especially for nerves with anatomical variation and some branches [29][30][31].…”

Section: Discussionmentioning

confidence: 81%

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Yao

Wang

Zhuang

et al. 2021

Preprint

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Background：The postoperative complaints of hypoaesthesia or a burning sensation due to lateral femoral cutaneous nerve (LFCN) injury in patients is not yet solved. The present study aimed to identify the three-dimensional (3D) distribution of LFCN using preoperative ultrasound and evaluate the rate of injury in direct anterior approach for total hip arthroplasty. Methods： A total of 59 patients were allocated to the ultrasound group and 58 patients were in the control group. Surgeons received the data of 3D distribution of LFCN only in the ultrasound group before surgery with respect to the direction, the depth on the skin, and the length to tensor fasciae latae (TFL). The anatomical characteristics of LFCN in the surgical region were summarized. At 1 and 3 months post-surgery, the rate of LFCN injury and abnormal sensitive area were evaluated in both groups. Results： Based on the data from the ultrasound group, over 90% of patients had one or two branches of LFCN. LFCN always courses in the fascia layer, the depth ranged from 6.8±2.6 (3.0 ~12.0) mm to 11.1±3.4 (4.0 ~17.0) mm and depended on the thickness of the subcutaneous fat, and length was 3.3±4.6 (-5.0 ~10.0) mm at proximal part and -2.7±4.7 (-10.0 ~8.0) at distal end to the medial edge of TFL. Both the rate of LFCN injury and abnormal sensory area in the ultrasound group were significantly lower than those in the control group (3.4% VS 25.9%, P=0.001, χ21=11.893, at 1 month; 3.4% VS 22.4%, P=0.005, χ21=9.471, at 3 months).Conclusions： LFCN mostly courses along the medial border of TFL in the fascia layer. The 3D distribution of LFCN could help the surgeons to evaluate the risk of injury preoperatively and decrease the rate of injury during the operation. However, some branch injuries, especially for the fan type LFCN, could not be avoided.

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“…With the typical in-plane approach, 15 16 the puncture site is placed somewhat away from the transducer footprint to allow for a shallower approach relative to the probe. A shallower approach increases the angle between the US beam and needle ( Fig.…”

Section: Needle Selection and Positioningmentioning

confidence: 99%

“…2a, b ). The visibility of the needle is significantly increased with angles > 40 degrees 1 16 17 and is maximal if perpendicularly oriented, with the needle acting as a specular reflector. 2 A variety of techniques have been introduced in US machines and needle technologies to improve visualization, especially when optimal approach angles cannot be achieved.…”

Section: Needle Selection and Positioningmentioning

confidence: 99%

“…Cover the nonsterile probe and gel with a sterile probe cover. 1 7 16 20 21 Some probe covers have tacky material that is applied directly to the probe and eliminates the need for gel underneath the cover. Alternatively, a sterilized uncovered probe with sterile gel may be preferable when the target is difficult to delineate because the lack of intervening material often improves visualization.…”

Section: Preparing the Injection Site And Basic Injection Principlesmentioning

confidence: 99%

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Ultrasound-Guided Musculoskeletal Injections

Lin

Gimarc

Adler

et al. 2021

Semin Musculoskelet Radiol

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Musculoskeletal injections serve a variety of diagnostic and therapeutic purposes, with ultrasonography (US) guidance having many advantages: no ionizing radiation, real-time guidance, high spatial resolution, excellent soft tissue contrast, and the ability to identify and avoid critical structures. Sonography can be cost effective and afford flexibility in resource-constrained settings. This article describes US-guided musculoskeletal injections relevant to many radiology practices and provides experience-based suggestions. Structures covered include multiple joints (shoulder, hip), bursae (iliopsoas, subacromial-subdeltoid, greater trochanteric), peripheral nerves (sciatic, radial), and tendon sheaths (posterior tibial, peroneal, flexor hallucis longus, Achilles, long head of the biceps). Trigger point and similar targeted steroid injections, as well as calcific tendinopathy barbotage, are also described.

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Ultrasound-Guided Treatment of Peripheral Nerve Pathology

Cited by 14 publications

References 58 publications

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Preoperative ultrasound to map the three-dimensional anatomical distribution of the lateral femoral cutaneous nerve in direct anterior approach for total hip arthroplasty

Preoperative Ultrasound to Map the Three-Dimensional Anatomical Distribution of the Lateral Femoral Cutaneous Nerve in Direct Anterior Approach for Total Hip Arthroplasty

Ultrasound-Guided Musculoskeletal Injections

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