E2179. Untangling the Nerves: Sonographic Findings of Upper Extremity Nerve Entrapments and Injuries with MRI Correlation
Authors
Preethi Kesavan;
University of Michigan
Steven Soliman;
University of Michigan
Mary Creedon;
University of Michigan
Eric Royston;
University of Michigan
Gunjan Malhotra;
University of Michigan
Matthew Rheinboldt;
Henry Ford Hospital
Andrew Petraszko;
Case Western Reserve University
Background
Peripheral neuropathy can lead to debilitating symptoms in patients including chronic pain, weakness, and alterations in sensation. Peripheral nerve injury is not uncommon, with approximately 2 - 3% of patients with major trauma having concomitant nerve injury. A similar prevalence has been seen with upper extremity nerve entrapment syndromes. Prompt recognition of the type of nerve injury is important in mediating timely treatment and decreasing associated morbidity. The use of high-resolution ultrasound, a low-cost, dynamic, and portable modality, can help reduce barriers to initial diagnosis and be used for therapeutic interventions.
Educational Goals / Teaching Points
The purpose of this exhibit is to discuss the benefits of ultrasound for evaluation of peripheral nerve injury, review details of ultrasound technique, and discuss ultrasound-guided treatment interventions. In addition, peripheral nerve injury classifications as well as an anatomic review of upper extremity nerve entrapment syndromes on ultrasound with MRI correlates will be provided.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will review the normal and abnormal sonographic appearance of peripheral nerves with respect to the Seddon classification of nerve injuries (neuropraxia, axonotmesis, and neurotmesis). The next section will discuss indications and technical considerations for ultrasound-guided peripheral nerve interventions including diagnostic/therapeutic injections for neurogenic pain, cyst decompression, and neuroma injections/ablations. Lastly, we will review nerve entrapment syndromes of the upper extremity including quadrilateral space syndrome, radial tunnel syndrome, carpal tunnel syndrome, and cubital tunnel syndrome.
Conclusion
Peripheral nerve injuries can have a significantly negative impact on patients’ quality of life. Using a cost-effective tool such as ultrasound for diagnostic and therapeutic purposes can help patients undergo timely intervention.
