Original Contributions
Ultrasound of radial, ulnar, median, and sciatic nerves in healthy subjects and patients with hereditary motor and sensory neuropathies

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Abstract

This study was conducted to evaluate the capability of ultrasonography to visualize extremity nerves. Fifty healthy women and men and 10 patients suffering with hereditary motor and sensory neuropathy (HMSN) were examined. The radial nerve lateral to the humerus, ulnar nerve distal to the cubital tunnel, median nerve in the middle of the forearm and proximal to the palmar crease, sciatic nerve in the middle of the thigh and tibial and common peroneal nerves just distal to their bifurcation, were investigated, employing a 7.5-MHz electronic linear-array transducer. In healthy subjects, the median, ulnar and radial nerves could be identified in all cases, the sciatic nerve in 37 cases, the tibial and peroneal nerves in 10 cases. The median values of thicknesses were about 3 mm for arm nerves and 6 to 7 mm for the sciatic nerve. Nerve sizes did not correlate with subjects′ height, weight or age. In the majority of the patients, arm and sciatic nerves were also visible. Thicknesses were normal in 34, increased in 11 and decreased in six of 51 nerves. In conclusion, ultrasonography allows reliable imaging of the major arm nerves and, occasionally, facilitates visualization of the sciatic, tibial and peroneal nerves in healthy subjects. Nerve size and structure did not differ significantly between patients with HMSN and healthy subjects.

Introduction

The neurophysiological investigation of peripheral nerves is a domain of electroneuro- and electromyography. However, these methods only reflect the function, but not the anatomy, of nerves. Several studies indicate that both ultrasonography Fornage 1988, Fornage 1993, Graif et al 1991, Silvestri et al 1995, Buchberger et al 1993 and magnetic resonance imaging (Buchberger et al. 1993) can depict extremity nerves. Ultrasonography is easily available and inexpensive and, therefore, might be a suitable method for depicting nerves.

The present study was conducted to investigate the capability of ultrasonography to visualize extremity nerves and to describe their ultrasonographic structure and size at defined locations in 50 healthy subjects and in a group of 10 patients with asymptomatic, mild or moderate hereditary motor and sensory neuropathy (HMSN) type 1.

Section snippets

Subjects

Fifty volunteers (25 women, 25 men), members of the staff in the Departments of Neurology and Clinical Neurophysiology, University of Goettingen, students and neurological patients without neuromuscular diseases, from 17 to 83 y old (median age, 30 y), with a median body weight of 70 kg (range, 47 to 105 kg) and height of 1.725 m (range, 1.56 to 2.00 m), and 8 adult and 2 juvenile neurological patients, 4 to 62 y old (median age, 34 y), with an HMSN were included in the study. The diagnoses

Healthy subjects

All nerves were more echogenic (hyperechoic) than surrounding muscles and subcutaneous fat. Parallel internal echoes (fascicular structure) in longitudinal scans were similar to those of tendons. Nerves could be distinguished from tendons, due to their localization and by means of dynamic examination as described by Fornage (Fornage, 1993): active contraction of the muscle as well as passive movement of the tendon results in considerable displacement of the tendon and echogenic aponeuroses, but

Discussion

Several recent studies indicate that ultrasonography can depict extremity nerves. Up to now, the median, ulnar and radial nerves (Fornage 1993), retroperitoneal femoral nerve (Sener et al. 1991), peroneal nerve in the popliteal space (Nebelung et al. 1993) and sciatic nerve (Graif et al. 1991) were investigated in small series of healthy subjects. Reference values of nerve thickness have been reported for the femoral nerve at the groin (Sener et al. 1991), the ulnar nerve (Pils et al. 1991),

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