Assessment of the utility of ultrasonography with high-frequency transducers in the diagnosis of postoperative neuropathies.

Abstract

The primary aim of this paper was to assess the relevance of high-frequency ultrasound examination in qualifying patients for either surgical or conservative treatment of postoperative peripheral neuropathies. The study was conducted in a group of 71 patients who in 2009–2011 were referred to ultrasound examinations due to a clinical suspicion of peripheral neuropathies. For the purposes of this analysis, the suspected postoperative neuropathies were divided into three groups: after surgical treatment of the median nerve (1), after surgical treatment of the ulnar nerve (2) and other postoperative neuropathies (3). All patients underwent the interview, physical examination and ultrasound examination. The ultrasound examinations were performed with Esaote MyLab 50 and MyLab 60 systems. Based on the clinical and US examinations, the patients were qualified for either surgical (51 cases) or conservative treatment (20 cases). An EMG examination was also performed in certain patients (60 cases). Mean values of cross-sectional areas and diameters of the nerve trunks were calculated in individual pathology groups. The ultrasound features of the peripheral nerves analyzed in the study, such as echostructure, notch sign, hyperemia and continuity of the transverse ligament, were divided into subgroups. Moreover, the frequency of adhesions between the nerve trunks and adjacent tissues, occurrence of pain on compression with a transducer and instability of the ulnar nerve as well as angulation of the posterior interosseous nerve in a dynamic examination was calculated. The analyses of the collected material were performed by means of descriptive statistics. The results of clinical and surgical verification were consistent with ultrasound findings in 100% of cases. The results indicate that high-frequency ultrasonography is a valuable method in qualifying patients for various types of treatment of peripheral postoperative neuropathies.