6533b85afe1ef96bd12b91fe

RESEARCH PRODUCT

EMERGING ROLE OF ULTRASOUND IMAGING ASSOCIATED TO CLINICAL NEUROPHYSIOLOGY AS A SUPPLEMENTARY DIAGNOSTICS TECHNIQUE OF PERIPHERAL NERVES PATHOLOGIES: A SICILIAN EXPERIENCE

subject

description

PURPOSE: to show the relevance of peripheral nerve ultrasound imaging as a supplementary technique in a clinical neurophysiological evaluation. METHODS: peripheral nerves ultrasound (US) examination was performed in patients with a medical history of nerve entrapment and/or post-traumatic neuropathy but with clinical or neurophysiological unusual findings. A 10-18 MHz transducer was used. RESULTS: we recruited 50 patients with clinical evidence of peripheral neuropathies (25M, 25F): 24 median nerves, 1 anterior interosseous, 14 ulnar, 3 brachial plexus, 2 posterior interosseus, 1 superficial radial, 1 superficial peroneal and 4 common peroneal nerves. Overall 20/50 patients had a history of trauma: 4/24 patients with median pathology, 6/14 ulnar, 3/4 common peroneal, 1/2 posterior interosseous and all cases of involvement of the brachial plexus, superficial peroneal and superficial radial nerves. CONCLUSIONS: our data show that peripheral nerve US is advisable: in all patients with post-traumatic etiology (40%) as it could reveal neuromas and neurotmesis; in all post-surgical iatrogenic onset neuropathies for the uncommon sites of injury; in severe diseases with not evocable nerve at the neurophysiological examination; in patients with diffuse pre-existing (and confounding) neurophysiological alterations (but with clinical suspect of new neuropathy); in entrapment neuropathies for screening purpose (we found concomitant tenosynovitis in 21.7% of carpal tunnel syndromes; dynamic ulnar nerve luxation at the elbow in 28.5% of case); in all brachial plexus pathologies as multiple sites of injury – i.e. radial, ulnar and posterior interosseous have been documented; for early selection of surgical candidates and post-surgical patients monitoring.