2021 Workshop Handout Bundle-Advanced US of Lower Limb Nerves

Advanced US of Lower Limb Nerves - Shook

Pdf Summary

Neuromuscular ultrasound is a valuable tool for evaluating peripheral nerve pathologies and guiding patient management. It offers excellent resolution and a flexible field-of-view, making it ideal for assessing peripheral nerves throughout their course. However, there are technical and practical limitations to consider, such as the inability to image through bone and the need for operator experience.<br /><br />Neuromuscular ultrasound complements traditional diagnostic modalities like nerve conduction studies (NCS) and electromyography (EMG). When combined with these techniques, ultrasound can impact the clinical approach in up to 43% of patients, primarily by identifying potentially surgically-amenable pathologies and important anatomic variations. Ultrasound is more sensitive than MRI for visualizing peripheral nerves and is typically the initial imaging modality for peripheral nerve assessment. However, MRI may be used for studying nerves deep within the body or beneath bone.<br /><br />Ultrasound can accurately diagnose and assess various peripheral nerve pathologies. For example, in carpal tunnel syndrome, the increased cross-sectional area of the median nerve at the level of the pisiform bone is a reliable parameter for diagnosis. Ultrasound can also identify structural causes of carpal tunnel syndrome and anatomical variations, impacting surgical approach. In ulnar nerve entrapment, ultrasound can localize the site of entrapment when electromyography is equivocal and identify relevant pathology and anatomical variants. It can also guide surgical intervention and assess postoperative prognosis.<br /><br />Ultrasound is useful in assessing peroneal mononeuropathy, intraneural ganglion cysts, nerve sheath tumors, and nerve trauma. It can aid in localizing lesions, identifying adjacent pathology, and guiding surgical planning. Ultrasound is sensitive and specific for early identification of nerve transection and can be utilized in acute presurgical planning as well as for managing remote nerve trauma.<br /><br />Overall, neuromuscular ultrasound, when combined with clinical examination and electromyography, significantly impacts the management and improves outcomes for patients with peripheral nerve disease. It provides valuable diagnostic information, aids in surgical planning, and allows for precise localization of nerve pathologies.

Keywords

Neuromuscular ultrasound

Peripheral nerve pathologies

Patient management

Resolution

Field-of-view

Technical limitations

Nerve conduction studies

Electromyography

Anatomic variations

Surgical planning

ncs

EMG