1
|
Bourke G, Wade RG, van Alfen N. Updates in diagnostic tools for diagnosing nerve injury and compressions. J Hand Surg Eur Vol 2024; 49:668-680. [PMID: 38534079 DOI: 10.1177/17531934241238736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Predicting prognosis after nerve injury and compression can be challenging, even for the experienced clinician. Although thorough clinical assessment can aid diagnosis, we cannot always be precise about long-term functional recovery of either motor or sensory nerves. To evaluate the severity of nerve injury, surgical exploration remains the gold standard, particularly after iatrogenic injury and major nerve injury from trauma, such as brachial plexus injury. Recently, advances in imaging techniques (ultrasound, magnetic resonance imaging [MRI] and MR neurography) along with multimodality assessment, including electrodiagnostic testing, have allowed us to have a better preoperative understanding of nerve continuity and prediction of nerve health and possible recovery. This article outlines the current and potential roles for clinical assessment, exploratory surgery, electrodiagnostic testing ultrasound and MRI in entrapment neuropathies, inflammatory neuritis and trauma. Emphasis is placed on those modalities that are improving in diagnostic accuracy of nerve assessment before any surgical intervention.
Collapse
Affiliation(s)
- Gráinne Bourke
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds, UK
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Nens van Alfen
- Department of Neurology, Clinical Neuromuscular Imaging Group, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Tawfik EA, Cartwright MS, van Alfen N, Axer H, Boon AJ, Crump N, Grimm A, Hobson-Webb LD, Kerasnoudis A, Mandeville R, Preston DC, Sakamuri S, Shahrizaila N, Shin S, Shook SJ, Wilder-Smith E, Walker FO. Neuromuscular ultrasound standardized scanning techniques and protocols: Expert panel recommendations. Muscle Nerve 2023; 68:375-379. [PMID: 37074101 DOI: 10.1002/mus.27830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
Neuromuscular ultrasound has become an integral part of the diagnostic workup of neuromuscular disorders at many centers. Despite its growing utility, uniform standard scanning techniques do not currently exist. Scanning approaches for similar diseases vary in the literature creating heterogeneity in the studies as reported in several meta-analysis. Moreover, neuromuscular ultrasound experts including the group in this study have different views with regards to technical aspects, scanning protocols, and the parameters that should be assessed. Establishing standardized neuromuscular scanning protocols is essential for the development of the subspeciality to ensure uniform clinical and research practices. Therefore, we aimed to recommend consensus-based standardized scanning techniques and protocols for common neuromuscular disorders using the Delphi approach. A panel of 17 experts participated in the study, which consisted of three consecutive electronic surveys. The first survey included voting on six scanning protocols addressing the general scanning technique and five common categories of suspected neuromuscular disorders. The subsequent surveys focused on refining the protocols and voting on new steps, rephrased statements, or areas of non-agreement. A high degree of consensus was achieved on the general neuromuscular ultrasound scanning technique and the scanning protocols for focal mononeuropathies, brachial plexopathies, polyneuropathies, amyotophic lateral sclerosis, and muscle diseases. In this study, a group of neuromuscular ultrasound experts developed six consensus-based neuromuscular ultrasound scanning protocols that may serve as references for clinicians and researchers. The standardized protocols could also aid in achieving high-quality uniform neuromuscular ultrasound practices.
Collapse
Affiliation(s)
- Eman A Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Michael S Cartwright
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Crump
- Department of Neurology, Austin Health and University of Melbourne, Heidelberg, Australia
| | - Alexander Grimm
- Department of Neurology, University Hospital Tuebingen, Tuebingen, Germany
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Ross Mandeville
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David C Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan Shin
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
| | - Steven J Shook
- Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Einar Wilder-Smith
- Department of Neurology, Kantonsspital, Lucerne, Switzerland
- Department of Neurology, University of Berne, Bern, Switzerland
| | - Francis O Walker
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
3
|
Soni NJ, Nathanson R, Andreae M, Khosla R, Vadamalai K, Kode K, Boyd JS, LoPresti CM, Resop D, Basrai Z, Williams J, Bales B, Sauthoff H, Wetherbee E, Haro EK, Smith N, Mader MJ, Pugh J, Finley EP, Schott CK. Development of a multisystem point of care ultrasound skills assessment checklist. Ultrasound J 2022; 14:17. [PMID: 35551527 PMCID: PMC9096739 DOI: 10.1186/s13089-022-00268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Many institutions are training clinicians in point-of-care ultrasound (POCUS), but few POCUS skills checklists have been developed and validated. We developed a consensus-based multispecialty POCUS skills checklist with anchoring references for basic cardiac, lung, abdominal, and vascular ultrasound, and peripheral intravenous line (PIV) insertion. Methods A POCUS expert panel of 14 physicians specializing in emergency, critical care, and internal/hospital medicine participated in a modified-Delphi approach to develop a basic POCUS skills checklist by group consensus. Three rounds of voting were conducted, and consensus was defined by ≥ 80% agreement. Items achieving < 80% consensus were discussed and considered for up to two additional rounds of voting. Results Thirteen POCUS experts (93%) completed all three rounds of voting. Cardiac, lung, abdominal, and vascular ultrasound checklists included probe location and control, basic machine setup, image quality and optimization, and identification of anatomical structures. PIV insertion included additional items for needle tip tracking. During the first round of voting, 136 (82%) items achieved consensus, and after revision and revoting, an additional 21 items achieved consensus. A total of 153 (92%) items were included in the final checklist. Conclusions We have developed a consensus-based, multispecialty POCUS checklist to evaluate skills in image acquisition and anatomy identification for basic cardiac, lung, abdominal, and vascular ultrasound, and PIV insertion. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00268-4.
Collapse
Affiliation(s)
- Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA. .,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Mark Andreae
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rahul Khosla
- Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University, Washington, DC, USA
| | | | - Karthik Kode
- Department of Medicine, University of Hawai'i at Manoa John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jeremy S Boyd
- Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles M LoPresti
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA.,Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jason Williams
- Section of Hospital Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.,Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Brian Bales
- Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harald Sauthoff
- Medicine Service, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Erin Wetherbee
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.,Pulmonary, Critical Care, and Sleep Apnea, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Natalie Smith
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Michael J Mader
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jacqueline Pugh
- Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Erin P Finley
- Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.,Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Christopher K Schott
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care Systems, Pittsburgh, PA, USA
| |
Collapse
|