Welcome to our Autumn Newsletter 2021! In Austria days are getting shorter again, leaves turn the most beautiful colors and temperatures are chilling during the night.
So for us, it is the perfect time to concentrate on our work again after a beautiful summer and read some good news on our favorite topic.
And we do have some good news for you: e-learning has been found to be effective for neuromuscular ultrasound even within the classical setting of online lectures. A new consensus based guideline for assessment of ulnar neuropathy at the elbow is out there, which stresses the combined use of nerve conduction studies AND neuromuscular ultrasound. Then there is a lot of movement in literature at the moment – meaning that there are several new papers dealing with dynamic examination 🙂 But have a look yourself:
E-LEARNING AND NMUS
Virtual neuromuscular ultrasound courses during COVID-19 pandemic: leveraging technology to enhance learning opportunities
Tawfik et al. Muscle Nerve 2021 Sept 10, online ahead of print
If you want to know whether e-learning works with NMUS – here you havet the answer: 98% of basic course attendees and 100% of the intermediate course attendees found the course useful or very useful.
Virtual courses are definitely an alternative to live training.
Of course we are sure about that. Therefore we have designed an online course for you that does not only present to you the knowledge, but also the active involvement for optimal learning transfer.
Plus: we are here for you any time, whenever questions arise and not only during the 48 hours of the course!
Expert consensus on the combined investigation of ulnar neuropathy at the elbow using electrodiagnostic tests and nerve ultrasound
Pelosi et al. Clin Neurophysiol 2021; 132(9): 2274-81
Sensitivity of electrodiagnostics (EDX) for diagnosing ulnar neuropathy at the elbow (UNE) is low, which is a problem, because UNE is a frequent entrapment neuropathy that can lead to impaired hand function.
This paper is based on the consensus of 15 experts in EDX and NMUS. The group consensus is:
- EDX and US together are more informative than either modality alone
- Both modalities should be performed in all investigations of UNE
- EDX testing should always include nerve conduction studies
- US of the ulnar nerve should include:
- CSA measurement
- an assessment of nerve mobility
- the entire length of the ulnar nerve
If you want to get started with the consent, but don´t know how – book our basic course to learn everything about diagnosing UNE with NMUS!
A LOOK INTO THE FUTURE
*Current and future applications of ultrasound imaging in peripheral nerve disorders.
Carroll A, Simon N. WJR 2020; 12(6):101
Emerging technologies in neuromuscular ultrasound
Hobson-Webb L. Muscle Nerve 2020; 61(6)
In this review we hear about elastography, photoacoustic imaging and artificial intelligence and how these techniques might help us with diagnosing peripheral nerve disorders in the future.
*Recent advances in ultrasound diagnosis of carpal tunnel syndrome
Yoshii Y, Zhao C, Amadio A. Diagnostics 2020
If you think everything has been said about CTS and US then you are wrong. Measuring the cross-sectional area for diagnosis might be old-fashioned in some years. This paper presents potential new techniques for diagnosing the most frequent compression syndrome. If you want to get an idea of techniques on the way, check this one out.
*Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature and theoretical mechanisms
Lam K, Hung C, Chiang Y, Onishi K, Su D, Clark T, Reeves K. J Pain Res 2020 Aug; 13:1957
Good if you are thinking about starting out with hydrodissection and would like to get an overview on current literature. Provides some nice videos on the procedure itself.
Ultrasound imaging and guidance in peripheral nerve entrapment: hydrodissection highlighted
Chang K, Wu W, Özcakar L
*Prognostic factors in carpal tunnel syndrome treated with 5% dextrose perineural injection: a retrospective study
Ho et al. Int J Med Sci 2021; 18(9):1960-5
A retrospective study of 52 patients looking for factors that help you to define which patients will profit most from hydrodissection in CTS. They dichotomized in good versus bad outcome with symptom relief >/<50% reduction in pain, measured with VAS 0-10. In stepwise regression analysis only sensory nerve conduction velocity remained significant, with those with lesser reduction (33.6+/- 0,8) had a better outcome. This may indicate that only the milder forms of CTS will profit more.
CORTICOSTEROID INJECTIONS IN CARPAL TUNNEL SYNDROME
Ultrasound-guided perineural vs. peritendinous corticosteroid injections in carpal tunnel syndrome: a randomized controlled trial
Mezian et al. Eur J Phys Rehabil Med 2021; epub ahead of print
The authors checked if the injection site – next to the median nerve (n=23) vs. among flexor tendons (n=23) – has a substantial impact on outcome. Again, the VAS was the primary outcome measure. After 2,6 and 12 weeks, no difference could be detected between the groups. The authors concluded that both injection sites are equally effective and safe.
*AANEM- IFCN Glossary of terms in neuromuscular electrodiagnostic medicine and ultrasound
Dengler R et al. Muscle Nerve 2020; 62 (1): 10
Providing us with a common language for describing our results.
*High-resolution ultrasound in the assessment of peripheral nerves in leprosy: a comparative cross-sectional study
Sreejith K. et al. Indian J Dermatol Venereol Leprol 2021; 87(29), 199-206
Nerve thickening in leprosy is important for classification and treatment of the disease. The authors compared detection rate of nerve swelling in clinical vs. ultrasound. Overall, HRUS detected 41% of 300 nerves enlarged compared to 20% diagnosed by clinical examination. There was a big difference especially in nerves without impairment of function. The authors concluded that HRUS may improve the sensitivity of the diagnostic criterion of peripheral nerve enlargement.
Akita J et al. Comparison between nerve conduction study and high-resolution ultrasonography with color doppler in type 1 and type 2 leprosy patients.
Clin Neurophysiol Pract 2021; 6, 97-102
The authors evaluated 257 nerves in 35 leprosy patients with signs or symptoms suggestive of inflammatory activity by means of NCS and ultrasound. Subacute segmental demyelination and presence of blood flow were considered to signify IA.
Inflammatory activity was detected in 68% of patients with NCS vs. 74% with US. Combining the methods resulted in diagnostic rate of 91%.
CHRONIC INFLAMMATORY DEMYELINATING POLYNEUROPATHY and DIFFERENTIALS
Nerve ultrasound comparison between transthyretin familial amyloid polyneuropathy and chronic inflammatory demyelinating polyneuropathy
Du et al. Front Neurol 2021; 12; 632096
TTR-FAP and CIDP are important differential diagnoses, because they can be treated effectively, but need different treatments. Both can manifest as rapid onsetting polyneuropathy and might show demyelinating features in NCS, therefore leading to misdiagnosis.
Patients with TTR-FAP (n=18), CIDP (n=13) and healthy controls (n=14) were scanned along upper and lower extremity nerves – measuring CSA at multiple sites. Generally, there was a milder enlargement in TTR-FAP than in CIDP. However, the difference was not enough to create a credible index to differentiate between the two disorders. Variability of the median nerve along its course was significantly higher in CIDP, but also only with a sensitivity of 69% and a specificity of 83%. The authors conclude that the variability may a useful tool for differentiating these neuropathies.
Conclusion: not ready for use in your ultrasound-lab. Further studies needed.
Changes of clinical, neurophysiological and nerve ultrasound characteristics in CIDP over time: a 3-year follow up.
Fioda et al. J Neurol 2021, epub ahead of print
23 patients with CIDP were followed for 3 years. The interesting part: during FU, the CSA increased in half of the nerve segments and correlated with INCAT increase and NCV and cMAP reduction.
High-resolution nerve ultrasound abnormalities in POEMS syndrome – a comparative study
Dörner et al. Diagnostics 2021; 11 (2): 264
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is rare, but might be mixed up with CIPD. A case series of three patients with POEMS syndrome is compared to CIDP patients and controls. Both groups of patients showed enlargement of various nerves, which did not turn out as being a distinguishing feature between the two disorders. However, the POEMS patients were found to have a specific pattern of alteration – hypoechoic fascicles with increased hyperechoic intraneural connective tissue. Future studies will be needed.
Ultrasound of the lateral femoral cutaneous nerve – a review of literature and pictorial essay
Becciolini et al. J Ultrasound Med Aug 13, online ahead of print
If you deal regularly dealing with patients with Meralgia paraesthetica, this one is surely a good investment of your time. Get an overview on the changes of that nasty little nerve that come with the frequent entrapment syndrome.
PS: we consider HRUS one of the most valuable tools to rule IN meralgia, as of course you do the diagnosis clinically, but might want to have a confirmative test!
Two different groups published on the posterior antebrachial cutaneous nerve – one used cadavers, the other one healthy subjects:
*The course of posterior antebrachial cutaneous nerve: anatomical and sonographic study with a clinical implication
García-Martínez et al. Int J Environ Res Public Health 2021; 18(15): 7733
19 cadaver upper extremities were examined with ultrasound to identify possible points of compression for the posterior antebrachial cutaneous nerve (PACN). They identified different courses of the small nerve: in 84% of cases the PACN ran parallel to the radial nerve until the latter crossed the lateral intermuscular septum (LIMS), in 16% it ran more posteriorly and in 21% it crossed the LIMS with the radial nerve. The authors conclude that compression of the PACN is a possible cause for pain around the lateral elbow.
Ultrasonographic anatomy of posterior antebrachial cutaneous nerve in healthy subjects
Woo et al. Muscle Nerve 2021 Aug 8, epub ahead of print
In this study, both arms of 30 healthy volunteers were examined and the exact course of the PACN and its major branches identified.
THE INTERESTING CASE
Ok, here we get to reports, but both deal with schwannomas in the head/neck region. We found this an interesting differential diagnosis to lymph node pathology, where ultrasound can surely contribute. But be careful: small schwannomas won´t all show the typical features that you can find in the bigger ones!
Great auricular nerve schwannoma: a rare presentation and literature review
Oh et al. BMJ Case Rep 2021; 14(7): e242972
Multiple schwannomas of the facial nerve mimicking cervical lymphoma: a case report
Kühn et al. J Med Case Rep 2021; 15(1):436
We hope the chosen articles are informative for you. Feedback is welcome as always.
We wish you the best during these strange times. Stay safe.
Your Sonocampus Team
*This is a free article
We wish you the best during these hard times. Stay safe.
Your Sonocampus Team
*This is a free article