High-resolution ultrasonography of the cutaneous nerve branches in the hand and wrist

Ultrasonography can be used in the diagnosis of various neuropathies, including nerve injury. Nerves often involved in traumatic and iatrogenic injury are small cutaneous branches in the hand and wrist, which cannot be seen in detail using current ultrasound probes. This study explored the potential of high-resolution ultrasonography in seeing these nerve branches in the human. The VisualSonics Vevo 770 system with a 15–82.5 MHz probe was compared to a commonly used 5–12 MHz probe and ultrasound machine. The accuracy was validated by ultrasound guided dye injection into cadaver nerves, with subsequent anatomical dissection and verification. Results were confirmed in two healthy volunteers. The Vevo 770 system was able to accurately identify the small cutaneous nerves. It could also depict the median nerve and its fascicles in greater detail. This may be useful for clinical diagnosis, localisation and follow-up of neuropathies and nerve injuries.

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Role of High-Resolution Ultrasonography in Evaluation of Median Nerve and Thickness of Flexor Retinaculum in Patients with Hypothyroidism

Indian Journal of Musculoskeletal Radiology ◽

10.25259/ijmsr_45_2019 ◽

2020 ◽

Vol 2 ◽

pp. 36-43

Author(s):

Kunwar Pal Singh ◽

Kamlesh Gupta ◽

Iqbaljit Kaur ◽

Vijinder Arora

Keyword(s):

High Resolution ◽

Healthy Volunteers ◽

Median Nerve ◽

Cross Sectional Area ◽

Width Ratio ◽

Sectional Area ◽

Cross Sectional ◽

Flexor Retinaculum ◽

Nerve Fascicle ◽

High Resolution Ultrasonography

Objectives: To determine the role of high resolution ultrasonography in evaluation of cross sectional area, maximum nerve fascicle thickness and thickness/width ratio of the median nerve and flexor retinaculum thickness in patients with hypothyroidism and to correlate it with the healthy volunteers. Material and Methods: A prospective study was conducted from February 2018 to October 2019 on 62 patients which included 32 clinically proven cases of hypothyroidism and 30 healthy volunteers. High resolution ultrasonography was performed using high frequency linear probes. Results: The most affected parameter was cross sectional area of median nerve at three levels, inlet/outlet ratio of CSA of the median nerve and thickness of flexor retinaculum in hypothyroidism patients in correlation with healthy volunteers. These parameters showed statistically significant p values. Maximum nerve fascicle thickness and thickness/width ratio of the median nerve showed no statistical significance in hypothyroid patients in correlation with healthy volunteers. Conclusion: High-resolution ultrasonography plays an important role in evaluating the changes occuring in cross sectional area of the median nerve, its inlet/outlet CSA ratio and flexor retinaculum thickness in hypothyroidism patients as correlated with the healthy volunteers.

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End-to-side neurorrhaphy as a salvage procedure for irreparable nerve injuries

Journal of Neurosurgery ◽

10.3171/jns.2003.99.1.0180 ◽

2003 ◽

Vol 99 (1) ◽

pp. 180-185 ◽

Cited By ~ 21

Author(s):

Tunç C. Öğün ◽

Mustafa Özdemir ◽

Hakan Şenaran ◽

Mehmet E. Üstün

Keyword(s):

Median Nerve ◽

Nerve Repair ◽

Salvage Procedure ◽

Nerve Grafting ◽

Nerve Injuries ◽

Abductor Pollicis Brevis ◽

Content Type ◽

Sensory Recovery ◽

Abductor Pollicis Brevis Muscle

✓ After a few reports on end-to-side nerve repair at the beginning of the last century, the technique was put aside until its recent reintroduction. The authors present their results in three patients with median nerve defects that were between 15 and 22 cm long and treated using end-to-side median-to-ulnar neurorrhaphy through an epineurial window. The follow-up times were between 32 and 38 months. Sensory evaluation involved superficial touch, pinprick, and two-point discrimination tests. Motor evaluation was completed by assessing the presence of opposition and by palpating the abductor pollicis brevis muscle. Sensory recovery was observed in all patients in the median nerve dermatome, and motor recovery was absent, except in Case 1. End-to-side nerve repair can be a viable alternative to nerve grafting in patients with long gaps between the ends of the injured nerve.

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Gliding Distance of the Extensor Pollicis Longus Tendon with Respect to Wrist Positioning: Observation in the Hands of Healthy Volunteers Using High-Resolution Ultrasonography

Journal of Hand Therapy ◽

10.1016/j.jht.2008.08.002 ◽

2009 ◽

Vol 22 (1) ◽

pp. 44-48 ◽

Cited By ~ 5

Author(s):

Min Chen ◽

Sadako Tsubota ◽

Mitsuhiro Aoki ◽

Ayumu Echigo ◽

Meng Han

Keyword(s):

High Resolution ◽

Healthy Volunteers ◽

Extensor Pollicis Longus ◽

Longus Tendon ◽

High Resolution Ultrasonography ◽

Extensor Pollicis Longus Tendon

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Volume Matters in Ultrasound-Guided Perineural Dextrose Injection for Carpal Tunnel Syndrome: A Randomized, Double-Blinded, Three-Arm Trial

Frontiers in Pharmacology ◽

10.3389/fphar.2020.625830 ◽

2020 ◽

Vol 11 ◽

Author(s):

Meng-Ting Lin ◽

Chun-Li Liao ◽

Ming-Yen Hsiao ◽

Hsueh-Wen Hsueh ◽

Chi-Chao Chao ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Group Analysis ◽

Post Injection ◽

Ultrasound Guided ◽

Electrophysiological Studies ◽

Tunnel Syndrome ◽

Double Blinded

Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects for CTS participants. In this randomized, double-blinded, three-arm trial, 63 wrists diagnosed with CTS were randomized into three groups that received ultrasound-guided PDI with either 1, 2 or 4 ml of 5% dextrose water. All participants finished this study. Primary outcome as visual analog scale (VAS) and secondary outcomes including Boston Carpal Tunnel Questionnaire (BCTQ), Disability of the Arm, Shoulder and Hand score (QuickDASH), electrophysiological studies and cross-sectional area (CSA) of the median nerve at carpal tunnel inlet were assessed before and after PDI at the 1st, 4th, 12th and 24th weeks. For within-group analysis, all three groups (21 participants, each) revealed significant improvement from baseline in VAS, BCTQ and QuickDASH at the 1st, 4th, 12th and 24th weeks. For between-group analysis, 4 ml-group yielded better VAS reduction at the 4th and 12th weeks as well as improvement of BCTQ and QuickDASH at the 1st, 4th, and 12th weeks, compared to other groups. No significant between-group differences were observed in electrophysiological studies or median nerve CSA at any follow-up time points. There were no severe complications in this trial, and transient minor adverse effects occurred equally in the three groups. In conclusion, ultrasound-guided PDI with 4 ml of 5% dextrose provided better efficacy than with 1 and 2 ml based on symptom relief and functional improvement for CTS at the 1st, 4th, and 12th week post-injection, with no reports of severe adverse effects. There was no significant difference between the three groups at the 24th-week post-injection follow-up.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03598322.

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