Learning objectives
Electrophysiologic studies represent the diagnostic mainstay of peripheral neuropathy.
Ultrasound (US) and magnetic resonance (MRI) imaging provide additional diagnostic benefits due to their excellent spatial information regarding the affected nerve and its surroundings,
especially in cases when clinical and electrophysiologic findings are inconclusive2.
Background
Peripheral entrapment neuropathies apply to a broad spectrum of disorders or injuries that lead to dysfunction or damage of the peripheral nerves.
Commonly,
mass lesions such as an aberrant muscle,
scar,
tumor,
osteophyte,
or fracture fragment may lead to nerve compression or course deviation1.
In atypical presentation electrophysiologic studies are limited to determine mass causes of denervation2 and the complementary use of US and MRI may elucidate the location and etiology of nerve compression3,4.
US is a quick,
low-cost,
noninvasive method which enables dynamic evaluation...
Imaging findings OR Procedure Details
Different causes of peripheral entrapment neuropathy are shown in all the presented cases.
The first case presents a 14-years old girl after supracondylar fracture of distal humerus with discomfort while moving elbow.
MRI showed an atypical intraosseous course of diffusely edematous median nerve in the fractured distal humerus (blue arrows),
which most likely caused median nerve entrapment following trauma (Fig. 1).
The second case presents an 18-years old female with EMG confirmed denervation of common peroneal nerve,
however without neurologic deficit along tibial nerve.
Consequently...
Conclusion
Multimodal imaging by means of US and MRI can successfully assist in narrowing the differential diagnosis of peripheral entrapment neuropathies as well as can help in treatment procedure planning.
MRI with its high sensitivity has overall advantage to help identify specific muscle denervation patterns.
References
1.
Donovan,
A,
Rosenberg,
ZS,
Cavalcanti,
F.
MR imaging of entrapment neuropathies of the lower extremity part 2.
The Knee,
Leg,
Ankle,
and Foot.
RadioGraphics.
2010 July–August; 30(4): 1001–
19.
2.
Andreisek,
G,
Burg,
D,
Studer,
A,
Weishaupt,
D.
Upper extremity peripheral neuropathies: role and impact of MR imaging on patient management.
European Radiology.
2008 March 28; 18(9): 1953–
61.
3.
Linda,
DD,
Harish,
S,
Stewart,
BG,
Finlay,
K,
Parasu N,
Rebello RP.
Multimodality imaging of peripheral neuropathies of the upper limb and brachial plexus....
Personal Information
V.
Salapura1,
H.
Vogel1,
K.
Limpel Novak1,
J.Vidmar1,2
1University Medical Center Ljubljana,
Ljubljana,
Slovenia.
2Institute of Physiology,
Faculty of Medicine,
University of Ljubljana,
Slovenia.
correspondance:
[email protected]