HRUS of finger's traumatic neuromas

Congress:

ESSR 2017

Poster Number:

P-0232

Type:

Educational Poster

Keywords:

Trauma, Education, Ultrasound, Neuroradiology peripheral nerve, Musculoskeletal system

Authors:

N. Romano, A. Fischetti, I. Mussetto, A. Muda; Genoa/IT

DOI:

10.1594/essr2017/P-0232

DOI-Link:

https://dx.doi.org/10.1594/essr2017/P-0232

Fig. 1: Fig.1 a)HRUS (22MHz) axial scan of a normal digital nerve (yellow arrow);...

Fig. 3: Fig.3 Drawing of a traumatic neuroma of the IV finger.

Fig. 4: Fig.4 HRUS 22MHz linear ultrasound probe

Fig. 7: Fig. 7 Man 45 y.o.Two months ago he injured with a knife at the base of the V...

Fig. 5: Fig.5 Man 55 y.o, amputation of the distal phalanx of the III...

Learning objectives

The purposes of our educational exhibit are to: 1. describe thepathophysiologicand clinical features of traumaticneuromasof the finger 2. illustrate thesonographicfeatures of finger's traumaticneuromas with HRUS

Background

Traumatic neuroma results from abnormal nerve regeneration in a reaction to surgery or injury. After a peripheral nerve lesion, the mechanical trauma leads nerve’s regeneration, that will be initiated by axonal outgrowth from the proximal nerve end. Common histopathologic features of a neuroma, are nerve fibers and fascicles in various stages of maturation and varying orientation, and the presence of scar tissue. A neuroma can be either asymptomatic or symptomatic. When a neuroma is symptomatic, pain is the most important feature together with altered sensation...

Imaging findings OR Procedure Details

Normal nerves are linear, fascicular,hyperechoicstructures, and imaging of peripheral nerves is dependent on theechogenicityof surrounding tissues; theechogenicityof the peripheral nerves is between the relatively lowechogenicityof muscle and the higherechogenicityof tendon. The typical appearance ofneuromaswith HRUS is that of an ovoid, well defined, incompressible,hypoechoicregion of focal swelling in continuity distally and proximally with a normal nerve. Pressure from the transducer applied on this region can reproduce the patient’s pain and can lead to the neuroma. We present our experience with neuromas of the fingers, in which...

Conclusion

This poster shows ultrasound as a very important tool in the diagnosis and valuation of peripheral nerve injuryof the fingers of the hand,dueto its excellent spatial resolution. Today, thanks to technological evolution we havehigh frequency ultrasound probes that allow us to study very wellmillimetricnerve disorders. Moreover, see very well so small alterations could be useful in the future for interventional procedures HRUS-guided.

References

-J.Watson et al. Neuromas of the Hand and Upper Extremity. The Journal of hand surgery. March 2010 -Van der Avoort et al. The incidence of symptomatic neuroma in amputation and neurorrhaphy patients. J Plast reconstr. Oct 2013. -Chen KH, Lee KF, Hsu HC, Huang WC, Hsiao KY, Fang KM. The role of high-resolution ultrasound in the diagnosis of a traumatic neuroma in an injured median nerve. Am J PhysMedRehabil. Sep 2009 -Hong-Jen Chiou, Yi-Hong Chou, See-Ying Chiou, Ji-Bin Liu,Cheng-Yen Chang;Peripheral Nerve Lesions: Role of High-Resolution...

Personal Information

Nicola Romano: Department of Radiology, University of Genoa, Genoa (Italy) Aldo Fischetti: Department of Radiology, University of Genoa, Genoa (Italy) Ilaria Mussetto: Department of Radiology, University of Genoa, Genoa (Italy) Alessandro Muda: Department odf Radiology, IRCCS San Martino IST, Genoa (Italy)