Diagnosis Of Peripheral Nerve Injuries Research Articles

High-resolution ultrasound of the supra- and infraclavicular levels of the brachial plexus including the axillary nerve: imaging anatomy based on multiplanar reconstructions and technical guide.

The diagnosis of peripheral nerve injuries remains challenging. Electromyography and nerve conduction studies do not allow precise localization of the lesion and differentiation between lesions in continuity and non-continuity in cases with complete axonotmesis. Improved ultrasound technology allows the examination of almost the entire peripheral nervous system. The complex sono-anatomy of the brachial plexus outside of the standard scanning planes makes it difficult to access this region. On the basis of the Visible Human Project of the National Institutes of Health (NIH), multiplanar reconstructions were created with the 3D Slicer open-source software in the various planes of the ultrasound cross-sections. The ultrasound examination itself and the guidance of the ultrasound probe in relation to the patient were recorded as video files and were synchronized through the audio channel. Subsequently, image matching was performed. Multiplanar reconstructions facilitate visualization of anatomical regions which are challenging to access thereby enabling physicians to evaluate the course of the peripheral nerve of interest in dynamic conditions. Sonographically visible structures could be reproducibly identified in single-frame analysis. With precise knowledge of the ultrasound anatomy, the nerve structures of the brachial plexus can also be dynamically assessed almost in their entire course. An instructional video on ultrasound of the brachial plexus supplements this manuscript and has been published on Vimeo.com.

Imaging diagnosis in peripheral nerve injury.

Peripheral nerve injuries (PNIs) can be caused by various factors, ranging from penetrating injury to compression, stretch and ischemia, and can result in a range of clinical manifestations. Therapeutic interventions can vary depending on the severity, site, and cause of the injury. Imaging plays a crucial role in the precise orientation and planning of surgical interventions, as well as in monitoring the progression of the injury and evaluating treatment outcomes. PNIs can be categorized based on severity into neurapraxia, axonotmesis, and neurotmesis. While PNIs are more common in upper limbs, the localization of the injured site can be challenging. Currently, a variety of imaging modalities including ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) and positron emission tomography (PET) have been applied in detection and diagnosis of PNIs, and the imaging efficiency and accuracy many vary based on the nature of injuries and severity. This article provides an overview of the causes, severity, and clinical manifestations of PNIs and highlights the role of imaging in their management.

Ultrasound as the main method for diagnosing peripheral nerve injuries in mine blast trauma

BACKGROUND: The amount of published data related to peripheral nerve blast injuries is limited.
 AIM: The study was aimed at determining the accuracy and sensitivity and assessing the specificity of ultrasound in the diagnosis of peripheral nerve injuries in mine blast trauma.
 METHODS: A total of 159 patients (274 peripheral nerves) were examined. Ultrasound was performed according to the standard technique using a HI VISION Avius HITACHI scanner with an EUP-L74M linear transducer (a frequency range of 513 MHz) and a preset musculoskeletal system ultrasound program. The duration of nerve injuries ranged from 2 to 273 days. All patients were men aged 20 to 48 years. Peripheral nerves were damaged as a result of mine blast trauma. Statistical analysis was used to assess sensitivity, specificity, and diagnostic accuracy. These characteristics were calculated according to the qualitative assessment of surgical intervention, the results of conservative treatment, and the method under study (ultrasound).
 RESULTS: A total of 274 damaged peripheral nerves were examined. The Group 1 included 93 (34%) nerves that required surgical intervention. In Group 2, consisting of 181 (66%) nerves, conservative treatment was used. Most of the nerves (47 [51%]) in Group 1 were damaged due to the compression effects of scarring in the surrounding tissues. Seventeen (18%) partial violations of the anatomical integrity of nerves with the formation of intramural and marginal neuromas were detected. Multiple and single nerve injuries were observed in 95 (59.7%) and 64 people (40.3%), respectively. Peripheral nerves of the upper extremities were damaged more frequently (185 [67.5%]), whereas nerves of the lower extremities were damaged in 89 (32.5%) cases. Ultrasound showed an increase in the cross-sectional area of nerves, blurred contours, decreased echogenicity, and changes in the bundle structure up to the complete absence of differentiation of individual fascioculi. The formation of neuromas was observed in complete and partial nerve ruptures. All 93 nerves in Group 1 underwent surgical intervention, particularly, external neurolysis (32 [34%]), internal neurolysis (15 [16%]), nerve suture (15 [16%]), excision of neuroma followed by microsurgical epineural suture (18 [19%]), and autoneural plasty (11 [12%]). In 2 (3%) cases, a decision was made to abstain from plasty and perform a tendon transposition due to a pronounced diastasis. All patients of Group 2 were shown to have a wait-and-see approach, and conservative therapy was prescribed. In 179 (99%) cases, complete recovery of sensory and motor activity was observed within 21 days. In 2 (1%) patients, a repeated ultrasound was performed due to no effect of treatment. Compression by scar tissues was revealed, and surgical intervention was made.
 CONCLUSIONS: In mine-explosive impact, ultrasound is the leading method for diagnosing peripheral nerve injuries. Ultrasound with sensitivity of 97.8% and specificity of 98.8% reveals lesions for which surgical treatment is indicated. The diagnostic accuracy is 98.5%.

A review of upper extremity peripheral nerve injuries in throwing athletes.

Peripheral nerve injuries in the upper extremities may be common in throwing athletes as the throwing motion places extreme stress on the dominant arm. The combination of extreme stress along with repetitive microtrauma from throwing uniquely places the throwing athlete at elevated risk of upper extremity peripheral nerve injury. However, because symptoms can be nonspecific and frequently coexist with pathology in the upper extremity, the diagnosis of peripheral nerve injury is often delayed. Diagnosis of peripheral nerve injuries may require a combination of history and physical examination, diagnostic imaging, electrodiagnostic testing, and diagnostic ultrasound-guided injections. The primary management should include physical therapy focusing on throwing mechanics and kinetic chain evaluation. However, some athletes require surgical intervention if symptoms do not improve with conservative management. The purpose of this focused narrative review is to highlight upper extremity peripheral neuropathies reported in throwing athletes and to provide an overview of the appropriate clinical diagnosis and management of the throwing athlete with a peripheral nerve injury.

Травматические и ятрогенные повреждения лучевого нерва при переломах диафиза плечевой кости

Damages to the radial nerve in diaphyseal fractures of the humerus, both primary and iatrogenic, are frequent and severe complications, accompanied by a long-term persistence of neurological deficit. The lecture discusses the issues of diagnosis, tactics of surgical treatment, pathogenetic treatment of the radial nerve traumatic neuropathy, and indications for revision. The main method of instrumental diagnosis of peripheral nerve injuries is ultrasound, which has a high diagnostic value in relation to the pathology under study. When choosing the method of osteosynthesis of a complicated fracture of the humerus, preference should be given to a closed pin osteosynthesis as a safer and less traumatic method. Revision of the radial nerve is indicated when a rupture is detected, with an unfavorable interposition with bone fragments and an implant.

Analysis of Clinical Effect of High-frequency Color Doppler Ultrasound in Diagnosis of Peripheral Nerve Injury

Analysis of Clinical Effect of High-frequency Color Doppler Ultrasound in Diagnosis of Peripheral Nerve Injury

Paraparesis due to ischemic lumbosacral Radiculoplexopathy

Background: Lumbosacral radiculoplexopathy (LSRP) is a rare entity, with several etiologies described in the literature. Vascular lesions to the lower part of the aorta and the common iliac artery can cause LSRP of ischemic etiology. Clinical Presentation: A 66-year-old man with a previous history of peripheral obstructive arterial disease (POAD) requiring aortobifemoral and femoropopliteal procedures had a prolonged hospital stay due to various complications: stent infection and occlusion, aortoenteric fistula causing hemorrhagic shock, transmetatarsal amputation of the right foot. In this context, he underwent multiple endovascular procedures. At discharge, the patient presented flaccid paraparesis, distal bilateral hypoesthesia, saddle anesthesia and urinary and anal incontinence. Spinal cord infarction was excluded. An electromyographic study confirmed the diagnosis of bilateral LSRP of ischemic etiology. Conclusion: This case highlights the importance of including ischemic etiology as a differential diagnosis of peripheral nerve injuries, namely in patients with POAD.

Three-Dimensional In vivo Magnetic Resonance Imaging (MRI) of Mouse Facial Nerve Regeneration.

MRI (magnetic resonance imaging) is an indispensable tool in the diagnosis of centrals nervous system (CNS) disorders such as spinal cord injury and multiple sclerosis (MS). In contrast, diagnosis of peripheral nerve injuries largely depends on clinical and electrophysiological parameters. Thus, currently MRI is not regularly used which in part is due to small nerve calibers and isointensity with surrounding tissue such as muscles. In this study we performed translational MRI research in mice to establish a novel MRI protocol visualizing intact and injured peripheral nerves in a non-invasive manner without contrast agents. With this protocol we were able to image even very small nerves and nerve branches such as the mouse facial nerve (diameter 100–300 μm) at highest spatial resolution. Analysis was performed in the same animal in a longitudinal study spanning 3 weeks after injury. Nerve injury caused hyperintense signal in T2-weighted images and an increase in nerve size of the proximal and distal nerve stumps were observed. Further hyperintense signal was observed in a bulb-like structure in the lesion site, which correlated histologically with the production of fibrotic tissue and immune cell infiltration. The longitudinal MR representation of the facial nerve lesions correlated well with physiological recovery of nerve function by quantifying whisker movement. In summary, we provide a novel protocol in rodents allowing for non-invasive, non-contrast agent enhanced, high-resolution MR imaging of small peripheral nerves longitudinally over several weeks. This protocol might further help to establish MRI as an important diagnostic and post-surgery follow-up tool to monitor peripheral nerve injuries in humans.

Bilaterally prolonged latencies of pain-related evoked potentials in peripheral nerve injuries

ObjectiveCross-sectional study to test the applicability of pain-related evoked potentials (PREP) for the diagnosis of peripheral nerve injuries (PNI). IntroductionPatients with generalized polyneuropathies show prolonged latencies and decreased amplitudes of PREP indicating an impairment of A-delta fibers. Although these fibers are frequently affected in PNI, it is unclear, if PREP-testing detects PNI comparable to Nerve Conduction Studies (NCS). Methods23 patients with PNI of one upper limb underwent bilateral PREP-testing (using concentric surface electrodes) and NCS. 41 healthy controls underwent PREP-testing only. We determined pain thresholds, N1-latencies and N1P1-amplitudes of PREP and analyzed them for group and side-to-side differences. Small-fiber function was evaluated using thermal detection thresholds of Quantitative Sensory Testing (QST). N1-latencies above a cut-off calculated by ROC-analysis were defined as abnormal in order to compare detection rates of PREP and NCS. ResultsPatients with PNI showed bilaterally prolonged N1-latencies (ipsilateral: 167.0 ± 40.7 ms vs. 141.2 ± 20.5 ms / contralateral: 160.0 ± 41.0 ms vs. 140.2 ± 23.9 ms) without a significant side-to-side difference. Pain thresholds were increased on the affected side only (4.6 ± 5.2 mA vs. 2.4 ± 1.4 mA (controls)). N1P1-amplitudes did not differ between patients and controls. 7 (32%) patients showed prolonged N1-latencies (>176 ms) of PREP. NCS were abnormal in 16 (73%) cases. 13 (59%) patients showed thermal hypoesthesia in QST. ConclusionContrary to our expectations, we found bilaterally prolonged N1-latencies and normal N1P1-amplitudes in patients with PNI. Our findings support the hypothesis of a bilateral generation of PREP and indicate that PREP are not suitable for the diagnosis of PNI.

Improved diagnostics and therapeutic decision making in traumatic peripheral nerve lesions using MR-neurography

The correct diagnosis of peripheral nerve injuries is essential for choosing the correct treatment in nerve surgery. Especially, nerve defects require early diagnosis to provide quick surgical reconstruction and prevent long-term disabilities. Recent developments in MR-neurography provide surgeons with a diagnostic tool delivering precise information on the structure and possibly function of nerves. Here we describe a series of cases, that benefited from preoperative MR-neurography to identify the correct type of injury. We demonstrate five traumatic nerve injuries which were evaluated using high-resolution MR-neurography imaging for therapeutic planning, combined with standard clinical, electrophysiological and sonography diagnostics. We show the clinical feasibility, benefit of this new technique for nerve surgery and the correlation of preoperative MR-neurography images to the intraoperative situation (in surgically managed cases). Two cases were successfully treated without surgery based on the intact nerve-integrity found in the MR-neurography, despite pathological electrophysiology and inconclusive sonography. In three cases, the MR-Neurography enabled a precise diagnosis and localization of the nerve lesion. Thereby, a precise surgical reconstruction of the nerve lesion was achieved, confirming the matching of MR-neurography findings and intraoperative situs. Although, systematic clinical analyses are not available yet, our data suggest that MR-neurography can help surgeons to correctly define the type of nerve injury and thus identify the appropriate treatment preoperatively. In the presented cases, MR-neurography correctly diagnosed the type of injury and therefore allowed adequate planning and decision making between non-surgical treatment, neurolysis or nerve reconstruction. We believe that MR-neurography is an emerging tool for nerve surgeons to improve the treatment of nerve injuries. MR-neurography delivers decisive information on the nerve lesion and helps to identify the necessity to operate and the correct surgical treatment.

周围神经损伤的外科处理

目的：探讨周围神经损伤的外科处理技术及手术疗效。方法：临床各种神经损伤病例共36例，其中采用神经松解术治疗25例，神经吻合术8例，取腓肠神经桥接手术3例。所有病例术后均行神经营养药物及康复治疗。结果：经2~3年随访，其中优21例，良5例，中5例，差5例，观察其中疗效评价为中、差者均为神经移植患者及部分神经吻合患者。结论：周围神经损伤诊断一经成立，原则上手术越早越好。处理臀盖下结构以及胸廓出口周围对医师技术要求较高。主张早期、足量使用神经营养药物并进行早期功能锻炼。Objective: To explore the surgical technique and curative effect of peripheral nerve injury. Methods: Altogether 36 cases with every kinds of peripheral nerve injury were treated by operation. 25 cases were treated by lytic operation, 8 cases were treated by anastomosis, and 3 cases were treated by nerve transplantation with sural nerve. All cases were treated by nerve nutrition drugs and recovery therapy. Results: The follow-up ranged from 2 to 3 years. Excellent results were obtained in 21 cases, good in 5 cases, fair in 5 cases and poor in 5 cases. The cases with poor or fair results were mainly because of nerve transplantation or nerve anastomosis. Conclusions: As soon as the diagnosis of peripheral nerve injury was confirmed, operation should be begun immediately. The technique of control the structure under greatest gluteal muscle and surrending thorax exit is difficult to surgeon. To emphasize using nerve nutrition drugs earlier and full dose, earlier functional exercise also be emphasized.

Pulsed Ultrasound Differentially Stimulates Somatosensory Circuits in Humans as Indicated by EEG and fMRI

Peripheral somatosensory circuits are known to respond to diverse stimulus modalities. The energy modalities capable of eliciting somatosensory responses traditionally belong to mechanical, thermal, electromagnetic, and photonic domains. Ultrasound (US) applied to the periphery has also been reported to evoke diverse somatosensations. These observations however have been based primarily on subjective reports and lack neurophysiological descriptions. To investigate the effects of peripherally applied US on human somatosensory brain circuit activity we recorded evoked potentials using electroencephalography and conducted functional magnetic resonance imaging of blood oxygen level-dependent (BOLD) responses to fingertip stimulation with pulsed US. We found a pulsed US waveform designed to elicit a mild vibration sensation reliably triggered evoked potentials having distinct waveform morphologies including a large double-peaked vertex potential. Fingertip stimulation with this pulsed US waveform also led to the appearance of BOLD signals in brain regions responsible for somatosensory discrimination including the primary somatosensory cortex and parietal operculum, as well as brain regions involved in hierarchical somatosensory processing, such as the insula, anterior middle cingulate cortex, and supramarginal gyrus. By changing the energy profile of the pulsed US stimulus waveform we observed pulsed US can differentially activate somatosensory circuits and alter subjective reports that are concomitant with changes in evoked potential morphology and BOLD response patterns. Based on these observations we conclude pulsed US can functionally stimulate different somatosensory fibers and receptors, which may permit new approaches to the study and diagnosis of peripheral nerve injury, dysfunction, and disease.

Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients

The objectives of this study were (1) epidemiological analysis of traumatic peripheral nerve injuries; (2) assessment of neuropathic pain and quality of life in patients affected by traumatic neuropathies. All consecutive patients with a diagnosis of traumatic neuropathies from four Italian centres were enrolled. Electromyography confirmed clinical level and site diagnosis of peripheral nerve injury. All patients were evaluated by disability scales, pain screening tools, and quality of life tests. 158 consecutive patients for a total of 211 traumatic neuropathies were analysed. The brachial plexus was a frequent site of traumatic injury (36%) and the radial, ulnar, and peroneal were the most commonly involved nerves with 15% of iatrogenic injuries. Seventy-two percent of the traumatic neuropathies were painful. Pain was present in 66% and neuropathic pain in 50% of all patients. Patients had worse quality of life scores than did the healthy Italian population. Moreover, there was a strong correlation between the quality of life and the severity of the pain, particularly neuropathic pain (Short Form-36 [SF-36] p < 0.005; Beck Depression Inventory [BDI] p < 0.0001). Traumatic neuropathies were more frequent in young males after road accidents, mainly in the upper limbs. Severe neuropathic pain and not only disability contributed to worsening the quality of life in patients with traumatic neuropathies.

Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity

The aim of our study is to assess the efficiency of the ultrasonography (US) in the diagnosis of peripheral nerve injury. This study includes nine patients (six radial, one median and two posterior interosseous (PIO) nerves) with peripheral nerve injury diagnosed by clinical and electrophysiological methods in the last 3 years. Preoperatively, an ultrasonographic examination was performed and correlated with physical exam and surgical findings. Five patients, who were diagnosed as peripheral nerve transection by US, underwent surgery. The ultrasonographic findings were concordant with the intraoperative findings. Axonal swelling alone was found in the remaining three patients, who were treated conservatively because of preserved nerve continuity without display of nerve compression. In one patient, we were unable to visualize the nerve due to obesity and soft tissue edema. High-resolution US provide morphological information about the exact location, intensity and extent of the nerve injuries, facilitating the preoperative diagnosis. Thus, US may be a useful method for planning optimal treatment strategy in especially iatrogenic nerve injuries.

Thermometric diagnosis of peripheral nerve injuries

The diagnosis of nerve injury using thermotropic liquid crystal temperature strips was compared blindly and prospectively against operative findings in 36 patients requiring surgical exploration for unilateral upper limb lacerations with suspected nerve injury. Thermotropic liquid crystal strips were applied to affected and non-affected segments in both hands in all subjects. A pilot study showed that a simple unilateral laceration without nerve injury results in a cutaneous temperature difference between limbs, but not within each limb. Thus, for detection of a nerve injury, comparison was made against the unaffected nerve distribution in the same hand. Receiver operating characteristic curve analysis showed that an absolute temperature difference > or = 1.0 degrees C was diagnostic of a nerve injury (area under the curve = 0.985, sensitivity = 100%, specificity = 93.8%). Thermotropic liquid crystal strip assessment is a new, reliable and objective method for the diagnosis of traumatic peripheral nerve injuries. If implemented in the acute setting, it could improve the reliability of clinical assessment and reduce the number of negative surgical explorations.

Electrophysiologic testing for the diagnosis of peripheral nerve injuries.

ANESTHESIOLOGISTS have an important role in preventing perioperative nerve injury, monitoring nerve function to minimize damage, and diagnosing peripheral nerve lesions at an early stage to optimize their management. The purpose of the current article is therefore to clarify the use and limitations of electrophysiologic testing in the diagnosis and management of anesthesiarelated nerve injuries. The occurrence of perioperative nerve injuries is well described. In the American Society of Anesthesiologists Closed Claims Database (a standardized collection of case summaries from the closed malpractice claims of a number of insurance companies), 16% of the 4,183 claims have been for anesthesia-related nerve injury. 1 Regional nerve block may lead to a focal nerve deficit. During surgery itself, direct injury or tourniquet compression to insure a bloodless field may be responsible. In rare instances, the compression is seemingly innocuous, as from a blood pressure cuff that inflates automatically at periodic intervals. 2 Malpositioning of patients during surgery may lead to com

Physical Diagnosis of Peripheral Nerve Injuries

Physical Diagnosis of Peripheral Nerve Injuries

Peripheral Nerve Injuries; Principles of Diagnosis.

This is one of the briefest and best illustrated books on peripheral nerves. The anatomical drawings are quite extensive and are very clear. There are numerous drawings and photographs, which aid in neurological diagnosis of peripheral nerve injuries. Associated injuries are also discussed. There is little discussion about disputed subjects relative to peripheral nerve injuries, such as treatment. The bibliography is very extensive and includes many foreign authors. This is an excellent book. It is particularly instructive in peripheral nerve anatomy and diagnosis.

Early Diagnosis of Peripheral Nerve Injuries in Battle Casualties

Early Diagnosis of Peripheral Nerve Injuries in Battle Casualties

THE ELECTRICAL DIAGNOSIS OF PERIPHERAL NERVE INJURY

Journal Article THE ELECTRICAL DIAGNOSIS OF PERIPHERAL NERVE INJURY Get access ANTHONY E. RITCHIE ANTHONY E. RITCHIE Department of Physiology, University of Edinburgh, and Gogarburn Peripheral Nerve Unit, Scottish E.M.S. Hospitals Search for other works by this author on: Oxford Academic PubMed Google Scholar Brain, Volume 67, Issue 4, December 1944, Pages 314–330, https://doi.org/10.1093/brain/67.4.314 Published: 01 December 1944