{"id":2183,"date":"2019-10-01T13:22:57","date_gmt":"2019-10-01T18:22:57","guid":{"rendered":"http:\/\/test.pegasuslectures.com\/blog\/?p=2183"},"modified":"2019-10-01T13:22:57","modified_gmt":"2019-10-01T18:22:57","slug":"part-ii-new-paradigms-for-ultrasound-assessing-peripheral-nerves","status":"publish","type":"post","link":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/2019\/10\/01\/part-ii-new-paradigms-for-ultrasound-assessing-peripheral-nerves\/","title":{"rendered":"PART II – New Paradigms for Ultrasound: Assessing Peripheral Nerves"},"content":{"rendered":"

NEW PARADIGMS FOR ULTRASOUND: ASSESSING PERIPHERAL NERVES<\/strong><\/p>\n

CONTINUED FROM PART I<\/a><\/p>\n

\"jamie-blog2_b\"<\/a>Our last blog<\/a> discussed the gradual ascendancy of ultrasound \/sonographic evaluation(s) within the field of musculoskeletal anatomy<\/a>, and more specifically in assessing pathologies for peripheral nerves.\u00a0 This material was presented earlier this year at the 2019 American Institute of Ultrasound in Medicine (AIUM)<\/a> Annual Convention<\/a>.<\/p>\n

We covered the rapid technological improvements over the past 4-5 years, and briefly outlined how this offers many advantages to both the patient and the examining medical professional.\u00a0 Aside from the inherent cost-advantages previously discussed<\/a>, creating a less imposing or obtrusive examination environment fulfills the fundamental goal of improving patient care<\/strong> by facilitating communication and feedback in addition to reducing stress\/anxiety.<\/p>\n

BEST PRACTICES PRE-EXAM –<\/strong><\/p>\n

It is important to ascertain if the patient has undergone any surgical procedures that may have altered the normal anatomy.\u00a0 The examiner should be familiar with the normal post-surgical sonographic characteristics of affected tissue so that it is not mistaken for pathology.<\/p>\n

While obtaining a detailed patient history<\/strong>, try to determine the mechanism of injury in order to concentrate on the most likely structure(s) creating pain.\u00a0 Additionally, encourage the patient to discuss any accident, sports-related or overuse injury, acute trauma, or chronic microtrauma which may point you toward a specific muscle\/nerve group.<\/p>\n

If none of the above conditions is identified, it is critical to understand the types of symptoms the patient is experiencing.\u00a0 For example, exercise-related pain<\/strong> can be caused by a degenerative joint disease or tendinopathy.\u00a0 Night pain<\/strong> could be related to an inflammatory condition.\u00a0 Burning, tingling or numbness<\/strong> could be suggestive of nerve entrapment.<\/p>\n

\"jamie-blog2_e\"<\/a><\/p>\n

Having identified the likely-affected muscle or nerve group, inspect and palpate the proximate skin and subcutaneous tissue for bruising or ecchymosis, tenderness, inflammation or dysfunction.\u00a0 Ascertain what kind of movement produces pain and evaluate a full range of movements, attempting to reproduce the conditions associating with the patient\u2019s discomfort.<\/p>\n

In summary, a detailed history and physical exam<\/strong> are critical to determining what areas and structures to scan.<\/p>\n

TRANSDUCER SELECTION \u2013<\/strong><\/p>\n

Depending on the area of interest, you should select either a linear or curved linear transducer. As referenced previously<\/a>, higher frequency transducers are appropriate to provide the precise detail resolution specific to nerve studies.\u00a0 This superior spatial resolution comes at the expense of penetration, unfortunately.\u00a0 Therefore, in evaluating deeper structures (e.g. abdomen or hip) a lower-frequency transducer may be required.<\/p>\n

\"jamie-blog2_a\"<\/a>In addition to the \u201cstandard\u201d linear transducer with a larger footprint, a smaller-faced version exists, often referred to as a \u201chockey stick\u201d because of its shape.\u00a0 This type of probe is optimal for imaging the hand, ankle, and foot because it provides better contact around the curves of the bones in these areas.\u00a0 Recalling that air is the proverbial gremlin of ultrasound studies, a generous amount of transmission gel should be used to improve the imaging of these extremities.<\/p>\n

EXAMINATION \u2013<\/strong><\/p>\n

In evaluations of nerve\/muscle structures with bilateral counterparts<\/strong>, ultrasound images should be captured from each \u201cside\u201d for comparative purposes, especially when subtle pathology is suspected.\u00a0 This is another inherent advantage of MSK ultrasound<\/a> exams insomuch as it doesn\u2019t require a complicated, separate imaging procedure.<\/p>\n

\"jamie-blog2_c\"<\/a>Dynamic evaluation is another superior feature of MSK ultrasound<\/a> studies, comparing favorably against older technologies.\u00a0 This dynamic\/real-time imaging of the nerves and muscles in motion helps differentiate<\/span> them from the surrounding structures for better visualization.\u00a0 A familiarity with localized anatomy is fundamental.<\/strong>\u00a0 For example, when scanning a nerve in the short axis from proximal to distal in motion, a muscle will eventually become a tendon which attaches to bone, whereas a nerve will continue until it divides.\u00a0 Observing the nerves in motion also allows the sonographer to recognize a normal \u201choneycomb\u201d appearance of a nerve, distinguishing it from surrounding soft tissue.<\/p>\n

\"jamie-blog2_d\"<\/a>As we discussed earlier, all this can be performed bedside or in an office environment, which benefits both patient and examiner.<\/p>\n

In the next blog, I will have some final thoughts and insights on evaluating the ultrasound image and optimizing settings<\/strong>.<\/p>\n

\"jamie-bie_photo\"Jamie Bie is the Senior Musculoskeletal<\/a> Ultrasound Specialist at Columbia University\/New York Presbyterian Imaging<\/a>. She was awarded the ARDMS<\/a> Pioneer Musculoskeletal Ultrasound credential in 2012. In addition to holding the RMSKS<\/a> credential, she is also registered in Vascular Technology<\/a>, Abdomen<\/a>, OB\/GYN<\/a>, and Breast<\/a>. Jamie has written departmental protocols and has trained several physicians and sonographers in Musculoskeletal Ultrasound<\/a>.<\/em><\/p>\n

Jamie Bie is also the author of newly-released Musculoskeletal Ultrasound: A Comprehensive Guide to MSK Imaging and Interventional Techniques<\/strong><\/a>,\u00a0a comprehensive, step-by-step guide to MSK Ultrasound. This textbook includes an overview of\u00a0MSK Ultrasound physics, illustrated protocols, anatomy review by section, transducer and ultrasound overlays to clarify positioning and structure recognition, and CheckPoints noted throughout the text, providing critical technical tips.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

NEW PARADIGMS FOR ULTRASOUND: ASSESSING PERIPHERAL NERVES CONTINUED FROM PART I Our last blog discussed the gradual ascendancy of ultrasound \/sonographic evaluation(s) within the field of musculoskeletal anatomy, and more specifically in assessing pathologies for peripheral nerves.\u00a0 This material was … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[16],"tags":[15,11,39,40],"_links":{"self":[{"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/posts\/2183"}],"collection":[{"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/comments?post=2183"}],"version-history":[{"count":19,"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/posts\/2183\/revisions"}],"predecessor-version":[{"id":2207,"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/posts\/2183\/revisions\/2207"}],"wp:attachment":[{"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/media?parent=2183"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/categories?post=2183"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pegasuslectures.com\/blog\/index.php\/wp-json\/wp\/v2\/tags?post=2183"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}