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Journal Review: A standardized ultrasound approach in neuralgic amyotrophy
Journal Review: A standardized ultrasound approach in neuralgic amyotrophy

Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive upper limb weakness and muscle atrophy. While NA is incompletely understood and often difficult to diagnose, early recognition may prevent unnecessary tests and interventions and, in some situations, allow for prompt treatment, which can potentially minimize adverse long-term sequalae. High-resolution ultrasound (HRUS) has become a valuable tool in the diagnosis and evaluation of NA. Pathologic HRUS findings can be grouped into four categories: nerve swelling, swelling with incomplete constric-tion, swelling with complete constriction, and fascicular entwinement, which may represent a continuum of pathologic processes. Certain ultrasound findings may help predict the likelihood of spontaneous recovery with conservative manage-ment versus the need for surgical intervention. We recommend relying heavily on history and physical examination to determine which nerves are clinically affected and should therefore be assessed by HRUS. The nerves most frequently affected by NA are the suprascapular, long thoracic, median and anterior interosseous nerve (AIN) branch, radial and posterior interosseous nerve (PIN) branch, axillary, spinal accessory, and musculocutaneous. When distal upper limb nerves are affected (AIN, PIN, superficial radial nerve), the lesion is almost always located in their respective fascicles within the parent nerve, proximal to its branching point. The purpose of this review is to describe a reproducible, standardized, ultrasono-graphic approach for evaluating suspected NA, and to share reliable techniques and clinical considerations when imaging commonly affected nerves.

1)Be able to plan an appropriate ultrasonographic approach to studying the patient with suspected neuralgic amyotrophy;
2) Be able to perform technically satisfactory scans of the musculocutaneous, median, and radial nerves in patients with suspected neuralgic amyotrophy;
3) Be able to perform technically satisfactory scans of less commonly studied upper extremity nerves in these patients:  suprascapular, axillary, long thoracic, spinal accessory, and phrenic. 

The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The AANEM designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit expires 11/29/2025.

Dr. Cignetti, Ms. Cox, and Drs. Baute, McGhee, Strakowski, Boon, Norbury, and Cartwright have no conflicts of interest. Dr. van Alfen works as an ultrasound consultant for Dynacure and performs edito-rial services for Wiley Publishing; all payments go to their employer.

Natalie E. Cignetti, MD; Rebecca S. Cox, BS; Vanessa Baute, MD; Marissa B. McGhee, MD; Nens van Alfen, MD, PhD; Jeffrey A. Strakowski, MD; Andrea J. Boon. MD; John W. Norbury, MD; Michael S. Cartwright, MD, MS.
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Expires on Nov 29, 2025
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Credit Offered:
1 CME Credit
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