Contribution of ultrasound in a neurophysiological lab in diagnosing nerve impairment: A one-year systematic assessment

doi:10.1016/j.clinph.2007.03.011

Clinical Neurophysiology

Volume 118, Issue 6, June 2007, Pages 1410-1416

https://doi.org/10.1016/j.clinph.2007.03.011 Get rights and content

Abstract

Objective

To evaluate the usefulness of a combination of electromyography (EMG) and ultrasound (US) assessments in diagnosing nerve trunk involvement. We hypothesised that in some cases, when the clinical or neurophysiological picture is unclear, the simultaneous study of the peripheral nervous system through both US and EMG may provide pathologic information not obtainable through EMG alone, and this may influence therapeutic decisions.

Methods

In 2005, we performed a prospective study in 77 consecutive patients with involvement of a single nerve trunk, using a combination of EMG and US in the same session. We divided the diagnostic contribution of US into four categories: diagnostic, confirming, inconclusive and misdiagnostic.

Results

In about a quarter of the patients, US provided results confirming the clinical neurophysiological diagnosis. In another quarter of the cases, US was very helpful in modifying diagnosis and therapy. In most of these cases, the contribution of US was important for the detection of tumors or cysts, thus showing the cause of nerve involvement. In half of the cases the US results were inconclusive, and in one case US was misdiagnostic.

Conclusions

The combination of EMG and US performed in the same session (or in collaboration with an ultrasound examiner) may be useful for diagnosis and determination of appropriate therapy.

Significance

Diagnosis of mononeuropathies is improved through a combined functional and morphological evaluation of the nerve by using EMG and US.

Introduction

Neurophysiological assessment (EMG) is an objective method that is useful in the diagnosis and classification of nerve involvement.

EMG evaluation is commonly used to diagnose the nerve lesion and assess its severity, but it does not provide spatial information about the nerve anatomy or its surroundings.

Advances in ultrasound technology have allowed to obtain greater spatial resolution and to depict nerves with excellent visual quality (Chiou et al., 2003, Martinoli et al., 2005). Ultrasound may be helpful to detect compression and entrapment neuropathies thanks to the high detail of resolution provided (Bianchi et al., 2004, Martinoli et al., 2004). The contribution of ultrasound technique in focal nerve involvement allows to study the nerve along its course from an anatomical point of view. Ultrasound is a non-invasive, inexpensive and easily available method providing a dynamic examination (Bianchi et al., 2003).

Because of the complementary perspectives provided by ultrasound, we decided to add ultrasound assessment to EMG evaluation performed in the same session.

Several studies on the complementarities of EMG and ultrasound in the diagnosis of nerve involvement, and on the validation of ultrasound, are reported in the literature (Martinoli et al., 2000, Beekman et al., 2004a, Beekman et al., 2004b, Beekman et al., 2005, Bianchi et al., 2004, Iannicelli et al., 2005, Padua et al., 2006, Wiesler et al., 2006). However, as far as we are aware, there has until now been no systematic evaluation of the usefulness of a combination of these tools in a consecutive sample of patients (in various clinical conditions) referred to an EMG lab for nerve impairment. We performed a prospective study in order to evaluate this issue. In other words, our study dealt with the following question: To what degree, and in what way, does ultrasound, in a neurophysiological lab, provide further information for diagnosis and therapy in atypical clinical neurophysiological cases? We hypothesised that in some cases, where the clinical or neurophysiological picture was unclear, a parallel study of the peripheral nervous system through both ultrasound and EMG may provide pathologic information that may influence therapy.

Section snippets

Materials and methods

Our department is a referral Centre for nerve entrapments, and more generally nerve lesions, usually assessed by means of clinical evaluation and neurophysiological tools (Padua et al., 1999, Padua et al., 2004). The sample of patients referred to our department includes about 70% urban tertiary and 30% rural subjects. In 2005, we performed 1257 EMG examinations. Three hundred and forty-five examinations were specifically focused on the evaluation of mononeuropathies. We studied 77 patients (38

Diagnostic

Ultrasound allowed to identify the cause of the nerve lesion in 20 cases (26%). Table 1 summarises the clinical features of the cases included in this group, and also shows how ultrasound examination influenced diagnosis and treatment. Fig. 1, Fig. 2, Fig. 3 summarise the clinical/neurophysiological features and show ultrasound picture. For this group of patients, ultrasound allowed to investigate the cause of the nerve lesion: in six cases, it revealed the presence of a nerve tumor (2 in the

Discussion

The association of EMG and ultrasound, in the same session, aims to combine data concerning the type of functional nerve involvement and site of lesion (supplied by neurophysiology) together with visualisation of the nerve (by ultrasound). To our knowledge, no study has systematically evaluated the utility of combined ultrasound and EMG evaluation in a consecutive sample of patients referred to an EMG lab for nerve impairment.

The results of our study indicate that ultrasound modified diagnosis

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Contribution of ultrasound in a neurophysiological lab in diagnosing nerve impairment: A one-year systematic assessment

Abstract

Objective

Methods

Results

Conclusions

Significance

Introduction

Section snippets

Materials and methods

Diagnostic

Discussion

Multicenter study of peroneal mononeuropathy: clinical, neurophysiologic, and quality of life assessment

J Peripher Nerv Syst

Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow

Neurology

Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow

Muscle Nerve

Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy

Neurology

Sonography of the hand and wrist

Radiologe

High-resolution sonography of compressive neuropathies of the wrist

J Clin Ultrasound

Peripheral nerve lesions: role of high-resolution US

Radiographics

High resolution ultrasonography in the diagnosis of the carpal tunnel syndrome

Radiol Med (Torino)

Ultrasonography of peripheral nerves

Semin Ultrasound CT MR