2024 Workshop Handout Bundle-W88C EDX and US Evaluation of Proximal Upper and Lower Limb Mononeuropathies Boon Litchy

W88C EDX and US Evaluation of Proximal Upper and Lower Limb Mononeuropathies Boon Litchy

Pdf Summary

The document is a comprehensive overview of techniques for electrodiagnostic and ultrasound evaluation of proximal upper and lower limb mononeuropathies, presented by Dr. William J. Litchy and Dr. Andrea Boon from the Mayo Clinic. Aimed at a workshop setting, the document focuses on the practicalities of nerve conduction studies, crucial for assessing nerve damage in conditions affecting the proximal nerves of the upper and lower limbs.<br /><br />Key highlights include:<br />1. **General Guidelines**:<br />   - Emphasis is placed on accurate setup, from ensuring proper equipment function to preparing the patient (e.g., skin cleaning) to minimize artifacts and enhance measurement reliability.<br /><br />2. **Specific Procedures for Various Nerves**:<br />   - **Accessory Nerve**: Instructions cover placement of recording and stimulation electrodes, troubleshooting, and using ultrasound for localization.<br />   - **Axillary Nerve**: Detailed steps on electrode placement and measurements, along with common issues such as excessive artifact or incorrect measurements.<br />   - **Musculocutaneous Nerve**: Particular focus on electrode positioning on the biceps and the use of calipers for precise measurements.<br />   - **Phrenic Nerve**: Dual-technique approach for recording diaphragm responses to eliminate errors and ensure internal consistency.<br />   - **Suprascapular Nerve**: Includes electrode positioning over the infraspinatus muscle and ultrasound guidance.<br />   - **Lateral Antebrachial Cutaneous Nerve**: Instructions for sensory nerve action potential evaluations, often used in the context of brachial plexopathies.<br />   - **Medial Antebrachial Cutaneous Nerve**: Procedural details similar to LACN, reflecting its use in plexopathy assessments.<br />   - **Femoral Nerve**: Suitable for repetitive nerve stimulation, particularly in Lambert Eaton Myasthenic Syndrome cases.<br />   - **Lateral Femoral Cutaneous Nerve**: Includes common causes of neuropathy and detailed nerve conduction study procedures.<br /><br />3. **Troubleshooting Common Issues**:<br />    Addressing excessive shock artifacts, movement artifacts, and incorrect measurements across all procedures, emphasizing the precision required in each step to ensure accurate data.<br /><br />4. **Use of Ultrasound**:<br />    Suggested for several nerves, providing step-by-step instructions to enhance localization during studies.<br /><br />5. **Safety Measures**:<br />    Guidelines for safe practices, particularly around pacemaker-implanted patients.<br /><br />The document concludes with a bibliography of key texts for further reading and reference values for various nerve conduction studies, underscoring the importance of comparative analysis in diagnosing mononeuropathies.

Keywords

electrodiagnostic

ultrasound evaluation

proximal mononeuropathies

nerve conduction studies

ncs

upper limb nerves

lower limb nerves

troubleshooting artifacts

nerve localization

safety measures

Mayo Clinic

nerve conduction studies

nerve conduction study

ncs