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Mainenti Pagnez MA, de Vilhena Moreira R, Martins do Rio JP, Corrêa LA, Mathieson S, Bittencourt JV, Nogueira LC. Structural and dynamic characteristics in sonographic evaluation of the sciatic nerve in patients with probable neuropathic pain - A cross-sectional study. Musculoskelet Sci Pract 2025; 76:103272. [PMID: 39908891 DOI: 10.1016/j.msksp.2025.103272] [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] [Received: 08/26/2024] [Revised: 01/17/2025] [Accepted: 01/29/2025] [Indexed: 02/07/2025]
Abstract
INTRODUCTION Structural and dynamic alterations of peripheral nerves are commonly observed in patients with radiculopathy. The current study aimed to compare the cross-sectional area (CSA), echogenicity index (ECHO), and skin-to-nerve distance (SKN) of the sciatic nerve between the symptomatic and asymptomatic sides of patients with probable neuropathic pain under different levels of nerve tension. METHODS A cross-sectional study was conducted with 31 participants classified as having probable chronic neuropathic pain. The CSA, ECHO, and SKN of the sciatic nerve of both lower limbs were measured in the following positions: A) flexed knee and neutral ankle, B) extended knee and ankle plantarflexion, and C) extended knee and ankle dorsiflexion. Sonographic measurements of both lower limbs were compared using repeated measures analysis of variance. RESULTS The mean age of the sample was 44 years (SD 10; 77.4% females), and the mean pain intensity was 5.3 (SD 1.9) out of 10 on the Numeric Pain Rating Scale. No significant differences were found for CSA, ECHO, or SKN measurements between the symptomatic and asymptomatic sides for the three tested positions. Position C had a smaller CSA of the sciatic nerve on both sides compared to position A. Both sides exhibited the nerve being more superficial in position C compared to the other positions. CONCLUSION Participants with probable chronic neuropathic pain had similar CSA, ECHO, and SKN of the sciatic nerve between the symptomatic and asymptomatic lower limbs. Increasing sciatic nerve tension (position C) reduced CSA and caused superficial nerve displacement on both sides.
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Affiliation(s)
- Maria Alice Mainenti Pagnez
- Rehabilitation Science Postgraduation Department, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; Madrid School of Osteopathy (EOM), Rio de Janeiro, Brazil.
| | | | - Jessica Pinto Martins do Rio
- Rehabilitation Science Postgraduation Department, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; Physiotherapy Department at Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Leticia Amaral Corrêa
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Wallumattagal Campus, Macquarie University, Sydney, Australia
| | - Stephanie Mathieson
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Juliana Valentim Bittencourt
- Rehabilitation Science Postgraduation Department, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; Physiotherapy Department at Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
| | - Leandro Calazans Nogueira
- Rehabilitation Science Postgraduation Department, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; Physiotherapy Department at Federal Institute of Rio de Janeiro (IFRJ), Rio de Janeiro, Brazil
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Weigel DT, Raasveld FV, Liu WC, Mayrhofer-Schmid M, Hwang CD, Tereshenko V, Renthal W, Woolf CJ, Valerio IL, Eberlin KR. Neuroma-to-Nerve Ratio: Does Size Matter? Neurosurgery 2025; 96:545-554. [PMID: 39248535 DOI: 10.1227/neu.0000000000003166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/07/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Anatomic features of neuromas have been explored in imaging studies. However, there has been limited research into these features using resected, ex vivo human neuroma specimens. The aim of this study was to investigate the influence that time may have on neuroma growth and size, and the clinical significance of these parameters. METHODS Patients who underwent neuroma excision between 2022 through 2023 were prospectively included in this study. Neuroma specimens were obtained after operative resection. Standardized neuroma size measurements, expressed as a neuroma-to-nerve ratio (NNR), were conducted with ImageJ software. Pain data (numeric rating scale, 0-10) were prospectively recorded during preoperative evaluation, and patient factors were collected from chart reviews. RESULTS Fifty terminal neuroma specimens from 31 patients were included, with 94.0% of the neuromas obtained from individuals with amputations. Most neuromas were excised from the lower extremities (n = 44, 88.0%). The neuromas had a median NNR of 2.45, and the median injury to neuroma excision interval was 6.3 years. Larger NNRs were associated with a longer injury to neuroma excision interval and with a smaller native nerve diameter. In addition, sensory nerves were associated with a larger NNR compared with mixed nerves. NNR was not associated with preoperative pain or with anatomical nerve distribution. CONCLUSION This study suggests that neuromas seem to continue to grow over time and that smaller nerves may form relatively larger neuromas. In addition, sensory nerves develop relatively larger neuromas compared with mixed nerves. Neuroma size does not appear to correlate with pain severity. These findings may stimulate future research efforts and contribute to a better understanding of symptomatic neuroma development.
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Affiliation(s)
- Daniel T Weigel
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
- Maastricht University, Maastricht , The Netherlands
| | - Floris V Raasveld
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, Rotterdam , The Netherlands
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Wen-Chih Liu
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung , Taiwan
| | - Maximilian Mayrhofer-Schmid
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg , Germany
| | - Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Vlad Tereshenko
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - William Renthal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Clifford J Woolf
- Department for Neurobiology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston , Massachusetts , USA
- Department of Neurobiology, Harvard Medical School, Boston , Massachusetts , USA
| | - Ian L Valerio
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA
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Cuendet D, Valsecchi D, Najberg H, Maestretti G, Medlin F. Neuromuscular ultrasound changes in unilateral symptomatic subacute lumbosacral radiculopathy: A prospective simple blinded cohort study. Muscle Nerve 2024; 69:566-571. [PMID: 38390643 DOI: 10.1002/mus.28061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION/AIMS Lumbosacral radiculopathy (LR) is a common disorder. Neuromuscular ultrasound (NMU) is a rapidly evolving technique for the investigation of peripheral nerve and muscle disorders, but studies using NMU in LR are lacking. The aim of the present study was to investigate ultrasonographic neuromuscular changes distant from root compression in patients with subacute to chronic compressive LR with motor impairment. METHODS Patients with unilateral subacute to chronic L4, L5, or S1 radiculopathy with motor impairment and confirmed by magnetic resonance imaging were included. The sciatic and femoral nerve cross-sectional areas (CSA), the CSA of lower limb muscles, and muscle fasciculation detection rate were assessed using a pre-specified neuromuscular ultrasound evaluation with blinded side-to-side comparison. RESULTS Of the 18 included patients, 66% were male and the mean age was 51 years. Overall, 16.7% had L4, 55.5% L5, and 27.8% S1 radiculopathy, mostly due to disc herniation (83%). Sciatic nerve CSA of the symptomatic side was increased (61.4 mm2 vs. 51.3 mm2; p = .001), and the fasciculation detection rate was higher in the affected muscles (delta = 13%, p = .007) compared to unaffected ones. Muscle CSA in affected and nonaffected muscles was decreased on the symptomatic side. DISCUSSION NMU evaluation in patients with symptomatic subacute to chronic LR revealed sciatic nerve enlargement distant from nerve root compression and higher fasciculation rates. These structural findings on NMU might be due to an axonal repair mechanism and an inflammatory response with endoneurial edema induced by ongoing nerve damage and potentially reflect progressive axonal loss.
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Affiliation(s)
- David Cuendet
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Daniele Valsecchi
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Hugo Najberg
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
| | - Gianluca Maestretti
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
- Neuro-spinal Unit, Department of Orthopedics surgery and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Friedrich Medlin
- Neurology Unit, Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
- Faculty of Science and Medicine, University Fribourg, Fribourg, Switzerland
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Lo JK, Robinson LR. Piriformis syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:203-226. [PMID: 38697742 DOI: 10.1016/b978-0-323-90108-6.00002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.
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Affiliation(s)
- Julian K Lo
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Lawrence R Robinson
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Castro JCD, Wang D, Chien GCC. Regenerative medicine for neuropathic pain: physiology, ultrasound and therapies with a focus on alpha-2-macroglobulin. Pain Manag 2022; 12:779-793. [PMID: 35762220 DOI: 10.2217/pmt-2022-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The currently available drugs to treat neuropathic pain do not provide adequate pain management. As such, other treatments including stem cells, platelet-rich plasma and plasma-derived molecules such as alpha-2 macroglobulin (A2M) are being explored because they show promising potential for neuropathic pain. The various mechanisms and immunomodulatory effects could be a desirable approach in targeting neuropathic pain. This review indicates that A2M can be highly efficacious due to its conformational change during activation and specificity of action on various cytokines. Its ability to reduce neuropathic pain can further the future of neuropathic intervention. However, there is a lack of robust clinical studies and thus further research is needed to verify and expand the understanding of its therapeutic effects.
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Affiliation(s)
- Jeimylo C de Castro
- Department of Physical Medicine & Rehabilitation, The Medical City-South Luzon, Santa Rosa, Laguna, 4026, Philippines.,SMARTMD Center for Non-Surgical Pain Interventions, Makati, 1224, Philippines
| | - Daniel Wang
- Kansas City University, Kansas City, MO 64106, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA 93003, USA.,GCC Institute for Regenerative Medicine, Irvine, CA 92606, USA
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Assessment of lower limb peripheral nerves with ultrasound in patients with traumatic amputation. Turk J Phys Med Rehabil 2021; 67:357-364. [PMID: 34870124 PMCID: PMC8606988 DOI: 10.5606/tftrd.2021.7926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to assess the sciatic nerve (SN), common peroneal nerve (CPN), and tibial nerve (TN) by ultrasound in patients with traumatic lower limb amputation (LLA) and to examine the possible relationship between ultrasonographic and clinical findings.
Patients and methods
This cross-sectional study included a total of 33 male patients (mean age: 36.6±8.7 years; range, 21 to 48 years) who had LLA due to traumatic injury between May 2019 and April 2020. Amputation and prosthesis use and functional K level of activity were recorded. Ultrasound examinations were performed to measure the cross-sectional areas (CSAs) of the SN, CPN, and TN bilaterally at the same levels. The values from the normal sides were accepted as controls.
Results
The CSA values were greater on the amputated sides than the non-amputated sides for SN (p=0.001), TN (p=0.001), and CPN (p=0.015), regardless of the activity level. The amputated side SN (p=0.001), TN (p=0.001), and CPN (p=0.016) were thicker in patients with level of K4 activity than the non-amputated side. For the patients with K3 activity level, larger TN CSA values were determined on the amputated side, compared to those at the K4 level (p=0.035). The SN was found to be greater in patients using microprocessor-controlled knee prosthesis (p=0.032) and TN was larger in hypobaric sealing membrane users on the amputated sides (p=0.041).
Conclusion
The SN, CPN, and TN were found to be larger in all patients on the amputated sides and in patients with K4 activity level. Based on these findings, the K3 activity level and the use of hypobaric sealing membrane seems to affect the CSA values of TN. Additionally, the use of microprocessor knee prosthesis affects the CSA values of SN. We believe that these results may be essential for the analysis or prediction of lower extremity nerve involvement according to the K activity level and the use of prosthesis in patients with traumatic LLA.
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Coraci D, Capobianco SV, Romano M, Calvaruso S, Vecchio M, Giovannini S, Loreti C, Fusco A, Masiero S, Santilli V, Padua L. Neuropathic Pain and Ultrasonography: A Multiperspective Literature Evaluation. Diagnostics (Basel) 2021; 11:1705. [PMID: 34574046 PMCID: PMC8470278 DOI: 10.3390/diagnostics11091705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 12/13/2022] Open
Abstract
Among the tools useful for the management of neuropathic pain, ultrasound presents several advantages, shown by the literature. We assessed the scientific production about neuropathic pain and ultrasound from different points of view: general topics, journal categories, geographical origin and lexical analysis. We searched papers on PubMed using the Medical Subject Headings "neuropathic pain" AND "ultrasound". We collected data about the journals where the papers were published, the country of the affiliation of the first author. For the lexical analysis, we evaluated the presence of selected words in the papers, and we built a graph representing the connections among words and papers. The papers were focused on the use of ultrasound as a diagnostic tool and guide for the therapy, assessing its application in different diseases such as Morton's neuroma and piriformis syndrome. The most represented journal category was anesthesia while the most common country the United States of America. The lexical analysis confirmed the importance of ultrasound for diagnosis of specific disease and treatment of pain. The described approaches provide a multiperspective evaluation of the literature and may support the interpretation of the information contained by the papers.
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Affiliation(s)
- Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, 35121 Padua, Italy;
| | | | - Marcello Romano
- Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, 90146 Palermo, Italy;
| | | | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy;
| | - Silvia Giovannini
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (C.L.); (A.F.); (L.P.)
| | - Claudia Loreti
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (C.L.); (A.F.); (L.P.)
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (C.L.); (A.F.); (L.P.)
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, 35121 Padua, Italy;
| | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.G.); (C.L.); (A.F.); (L.P.)
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Toijala TM, Canapp DA, Canapp SO. Ultrasonography Findings in the Proximal Sciatic Nerve and Deep Gluteal Muscles in 29 Dogs With Suspected Sciatic Neuritis. Front Vet Sci 2021; 8:704904. [PMID: 34513972 PMCID: PMC8429782 DOI: 10.3389/fvets.2021.704904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to describe the ultrasonography technique and analyze the ultrasonographic findings of the proximal sciatic nerve and deep gluteal muscles in dogs with suspected sciatic neuritis. The records of 29 dogs that underwent musculoskeletal ultrasound of the sciatic nerve and deep gluteal muscles were retrospectively evaluated. Both right and left sides were evaluated. Abnormal findings were unilateral in 28/29 (97%) of the dogs. The muscles examined included the piriformis muscle, gemelli muscles, internal obturator muscle, and medial gluteal muscle. Data included signalment, purpose of the dog, orthopedic examination findings, lameness examination findings, other diagnostic imaging findings, and ultrasonography findings. Irregular margins of the sciatic nerve were recorded in 76% of the dogs. The diameter of the sciatic nerve on the affected limb was significantly larger than the nerve on the contralateral, unaffected side (p < 0.00001). The mean ± standard deviation (SD) of the sciatic nerve inner diameter between the unaffected and affected limbs was 15 ± 14.66%. The mean ± SD in sciatic nerve outer diameter was 12 ± 7.71%. Abnormal ultrasonographic findings in at least one of the examined muscles were found in 28/29 (97%) of the dogs and included changes in echogenicity in 28/29 (97%) of the dogs, loss of detail in muscle fiber pattern in 5/29 (17%) of the dogs, and impingement between the sciatic nerve and piriformis muscle in 6/29 (21%) of the dogs. The most common underlying diagnosis was lumbosacral stenosis in 9/29 (31%) of the dogs. The most common sport was agility for 21/29 (71%) of the dogs. Repetitive jumping may predispose to both lumbosacral disease, through dynamic compression, and changes within the piriformis muscle, due to overuse of the muscle leading to irritation to sciatic nerve. Ultrasonography is considered a safe and non-invasive diagnostic method to evaluate the sciatic nerve and deep gluteal muscles of dogs, and provides additional guidance for diagnostics and rehabilitation planning. This is the first study documenting ultrasonography findings in a case series of the sciatic nerve and deep gluteal muscles and their pathology in dogs.
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Affiliation(s)
| | - Debra A Canapp
- Veterinary Orthopedic and Sports Medicine Group, Annapolis Junction, MD, United States
| | - Sherman O Canapp
- Veterinary Orthopedic and Sports Medicine Group, Annapolis Junction, MD, United States
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Misirlioglu TO, Palamar D, Akgun K. Letter to the Editor Regarding "Feasibility and Reliability of an Ultrasound Examination to Diagnose Piriformis Syndrome". World Neurosurg 2020; 141:544. [PMID: 32871722 DOI: 10.1016/j.wneu.2020.05.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Tugce Ozekli Misirlioglu
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey.
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Kenan Akgun
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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Ultrasound imaging and guidance in the management of post-injection sciatic neuropathy: Love, loss and space. Turk J Phys Med Rehabil 2020; 66:225-226. [PMID: 32760903 DOI: 10.5606/tftrd.2020.5897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/17/2020] [Indexed: 11/21/2022] Open
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Neto T, Freitas SR, Andrade RJ, Vaz JR, Mendes B, Firmino T, Bruno PM, Nordez A, Oliveira R. Shear Wave Elastographic Investigation of the Immediate Effects of Slump Neurodynamics in People With Sciatica. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:675-681. [PMID: 31633231 DOI: 10.1002/jum.15144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/28/2019] [Accepted: 09/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Neurodynamic techniques are often used to treat people with sciatica pain, but their mechanical effects on the sciatic nerve are unknown. Shear wave elastography (SWE) has been shown to effectively estimate the stiffness of peripheral nerves in real time. The aim of this study was to use SWE to assess the effects of slump neurodynamics in the sciatic stiffness of people with sciatica. METHODS Sixteen participants volunteered for this study. The sciatic stiffness of 8 patients with unilateral chronic sciatica and 8 healthy control participants was measured by SWE, with the participants in a prone position and during a dynamic condition (ie, ankle dorsiflexion). These measurements were performed before and immediately after the neurodynamic intervention, which consisted of a static slump position applied to the symptomatic limb of the patients with sciatica and in a randomly chosen limb of the healthy participants. RESULTS The 8 patients with sciatica included 6 male and 2 female patients, and the 8 healthy control participants included 5 male and 3 female volunteers. Slump neurodynamics resulted in an immediate decrease in the sciatic nerve stiffness of the symptomatic limb in people with sciatica by 16.1% (effect size = 0.65; P = .019). The intervention showed no significant changes in the sciatic nerve stiffness of the healthy participants (effect size = 0.05; P = .754). CONCLUSIONS Slump neurodynamics have the potential of decreasing the sciatic nerve stiffness in people with sciatica, and this effect can be quantified by SWE, which may provide valuable information for health professionals.
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Affiliation(s)
- Tiago Neto
- Department of Physiotherapy, LUNEX International University of Health, Exercise, and Sports, Differdange, Luxembourg
| | - Sandro R Freitas
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Ricardo J Andrade
- Movement, Interactions, and Performance Laboratory, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Menzies Health Institute Queensland and School of Allied Health Sciences, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - João R Vaz
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Bruno Mendes
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Telmo Firmino
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
- Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal
| | - Paula M Bruno
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Antoine Nordez
- Movement, Interactions, and Performance Laboratory, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Raúl Oliveira
- Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
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The relationship of the shear wave elastography findings of patients with unilateral lumbar disc herniation and clinical characteristics. BMC Musculoskelet Disord 2019; 20:438. [PMID: 31564252 PMCID: PMC6766175 DOI: 10.1186/s12891-019-2814-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. Methods For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). Results The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). Conclusion According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.
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Sarafraz H, Hadian MR, Ayoobi Yazdi N, Olyaei G, Bagheri H, Jalaei S, Rasouli O. Neuromuscular morphometric characteristics in low back pain with unilateral radiculopathy caused by disc herniation: An ultrasound imaging evaluation. Musculoskelet Sci Pract 2019; 40:80-86. [PMID: 30738362 DOI: 10.1016/j.msksp.2019.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about the neuromuscular morphometric characteristics in patients with sciatica. OBJECTIVE To evaluate the possible changes of nerve and muscle structures in patients with low back pain with unilateral radiculopathy due to lumbar disc herniation by ultrasound imaging. DESIGN A case-control observational study. METHODS Forty individuals were divided into case (n = 20; low back pain with unilateral radiculopathy due to disc herniation), and healthy control groups (n = 20). The thickness of lumbar multifidus at L5 level, and of lower limb muscles (i.e., biceps femoris, medial gastrocnemius, and soleus) was measured during both rest and full contraction to calculate the rest/contraction ratio of these muscles. Additionally, the sciatic nerve cross-sectional area and the echogenicity of the nerve and muscles were measured based on ultrasound imaging. The association between severity of low back pain radiculopathy (i.e., pain and patients' perceived disability) and rest/contraction ratio was assessed. RESULTS Patients with sciatica showed sciatic nerve enlargement, and different contraction ratios for multifidus (at L5)/ankle plantar flexors compared to the controls. The rest/contraction ratio for biceps femoris was similar between the two groups. CONCLUSION According to these findings, ultrasound imaging can be considered a useful tool to detect changes in the sciatic nerve and muscles due to disc herniation. Furthermore, regarding the observation of significant changes in muscle rest/contraction ratio in the multifidus and gastrosoleus, one might attribute these changes to the nerve root compression.
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Affiliation(s)
- Hadi Sarafraz
- Department of Physiotherapy, School of Rehabilitation, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran; Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Hadian
- Department of Physiotherapy, School of Rehabilitation, Brain and Spinal Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, International Campus (TUMS, IC-TUMS), Tehran, Iran.
| | - Niloofar Ayoobi Yazdi
- Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Tehran University of Medical Sciences, Iran.
| | - Golamreza Olyaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran.
| | - Hossein Bagheri
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran.
| | - Shohreh Jalaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, (TUMS), Tehran, Iran.
| | - Omid Rasouli
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
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Çelebi UO, Burulday V, Özveren MF, Doğan A, Akgül MH. Sonoelastographic evaluation of the sciatic nerve in patients with unilateral lumbar disc herniation. Skeletal Radiol 2019; 48:129-136. [PMID: 29982854 DOI: 10.1007/s00256-018-3020-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/21/2018] [Accepted: 06/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare strain elastography (SE) and shear wave elastography (SWE) findings of the sciatic nerve in patients with unilateral lumbar disc herniation (LDH) and healthy control subjects. MATERIALS AND METHODS The study group included patients with complaints of unilateral sciatica for 3-12 months, with foraminal stenosis due to one level of LDH (L4-L5 or L5-S1). An age- and gender-matched control group was formed of healthy subjects. Evaluations were performed on both the axial and longitudinal planes from the bilateral gluteal region using a 5-9 MHz multifrequency convex probe. RESULTS There were 40 patients (20 male, 20 female) with a mean age of 43.1 ± 12.7 years in the study group, and 40 healthy subjects (22 male, 18 female) with a mean age of 42.9 ± 10.7 years in the control group (p > 0.05). The sciatic nerve stiffness assessed on both the axial (12.3 ± 3.7 kPA) and longitudinal (14.3 ± 3.8 kPA) planes of the involved side was significantly higher than non-involved side (axial: 6.8 ± 2.1 and longitudinal: 8.3 ± 2.3 kPA) in the patient group (p < 0.001). CONCLUSIONS Patients with unilateral LDH have increased stiffness of the sciatic nerve compared to healthy control subjects. Although the findings in this preliminary study show that shear wave elastography can detect a change in sciatic nerve stiffness in patients with unilateral LDH, larger studies are required to determine the clinical utility of this technique.
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Affiliation(s)
- Umut Orkun Çelebi
- Department of Radiology, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey
| | - Veysel Burulday
- Department of Radiology, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey.
| | - Mehmet Faik Özveren
- Department of Neurosurgery, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey
| | - Adil Doğan
- Department of Radiology, Kirikkale University School of Medicine, Yahsihan, 71450, Kirikkale, Turkey
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Neto T, Freitas SR, Andrade RJ, Vaz JR, Mendes B, Firmino T, Bruno PM, Nordez A, Oliveira R. Noninvasive Measurement of Sciatic Nerve Stiffness in Patients With Chronic Low Back Related Leg Pain Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:157-164. [PMID: 29732595 DOI: 10.1002/jum.14679] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether sciatic nerve stiffness is altered in people with chronic low back-related leg pain by using shear wave elastography. METHODS In this cross-sectional study, the sciatic nerve shear wave velocity (ie, an index of stiffness) was measured in both legs of 16 participants (8 with unilateral low back-related leg pain and 8 healthy controls). Sciatic stiffness was measured during a passive ankle dorsiflexion motion performed at 2°/s in an isokinetic dynamometer. The ankle range of motion and passive torque, as well as muscle activity, were also measured. RESULTS In people with low back-related leg pain, the affected limb showed higher sciatic nerve stiffness compared to the unaffected limb (+11.3%; P = .05). However, no differences were observed between the unaffected limb of people with low back-related leg pain and the healthy controls (P = .34). CONCLUSIONS People with chronic low back-related leg pain have interlimb differences in sciatic nerve stiffness, as measured by a safe and noninvasive method: shear wave elastography. The changes found may be related to alterations in nerve mechanical properties, which should be confirmed by future investigations.
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Affiliation(s)
- Tiago Neto
- Universidade de Lisboa, Faculdade de Motricidade Humana, Lisbon, Portugal
- LUNEX International University of Health, Exercise and Sports, Department of Physiotherapy, Differdange, Luxembourg
| | - Sandro R Freitas
- Universidade de Lisboa, Faculdade de Motricidade Humana, Lisbon, Portugal
- Human Performance Department. Benfica Laboratory, Sport Lisboa e Benfica, Lisbon, Portugal
| | - Ricardo J Andrade
- University of Nantes, Laboratory of Movement, Interactions, and Performance, Faculty of Sport Sciences, Nantes, France
| | - João R Vaz
- Human Performance Department. Benfica Laboratory, Sport Lisboa e Benfica, Lisbon, Portugal
- Universidade Europeia, Laureate International Universities, Lisbon, Portugal
- Department of Biomechanics and Center for Human Movement Variability, University of Nebraska, Omaha, Nebraska, USA
| | - Bruno Mendes
- Universidade de Lisboa, Faculdade de Motricidade Humana, Lisbon, Portugal
- Human Performance Department. Benfica Laboratory, Sport Lisboa e Benfica, Lisbon, Portugal
| | - Telmo Firmino
- Universidade de Lisboa, Faculdade de Motricidade Humana, Lisbon, Portugal
- Human Performance Department. Benfica Laboratory, Sport Lisboa e Benfica, Lisbon, Portugal
- Escola Superior de Saúde do Alcoitão, Alcabideche, Lisbon, Portugal
| | - Paula M Bruno
- Universidade de Lisboa, Faculdade de Motricidade Humana, Lisbon, Portugal
| | - Antoine Nordez
- University of Nantes, Laboratory of Movement, Interactions, and Performance, Faculty of Sport Sciences, Nantes, France
| | - Raúl Oliveira
- Universidade de Lisboa, Faculdade de Motricidade Humana, Lisbon, Portugal
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Sonographic evaluation of peripheral nerve pathology in the emergency setting. Emerg Radiol 2018; 25:521-531. [DOI: 10.1007/s10140-018-1611-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/01/2018] [Indexed: 12/31/2022]
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Gürçay E, Karaahmet ÖZ, Kara M, Onat SS, Ata AM, Ünlü E, Özçakar L. Ultrasonographic Evaluation of the Radial Nerves in Patients with Unilateral Refractory Lateral Epicondylitis. PAIN MEDICINE 2017; 18:396-402. [PMID: 27477582 DOI: 10.1093/pm/pnw181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the possible radial nerve entrapment of patients with unilateral refractory lateral epicondylitis (LE) by using ultrasound (US) and electroneuromyography. Design Cross-sectional study. Setting Three physical medicine and rehabilitation departments. Subjects Consecutive 44 patients (15 M, 29 F) with unilateral refractory LE. Methods All patients underwent detailed clinical, electrophysiological and ultrasonographic evaluations. Ultrasound imaging was used to evaluate thickness and presence of abnormal findings of the common extensor tendon (CET) and cross-sectional area (CSA) of the radial nerve (at spiral groove and before bifurcation) bilaterally. Unaffected sides of the patients were taken as controls. Results When compared with the unaffected sides, CET thickness and radial nerve CSAs (at both levels) were higher, and abnormal US findings regarding LE (47.7% vs. 6.8%) were more common on the affected sides than nonaffected sides (all P < 0.001). Grip strength values were lower on the affected sides ( P < 0.001). Electrophysiological studies were all normal, and similar between the two sides (all P > 0.05). When subgroup analyses were performed after taking into account the hand dominance, affected and dominant sides were found to be the same in 31 and different in 13 patients. In subgroups, CETs and radial nerve CSAs at both levels were higher on the affected sides (all P < 0.01). Conclusions Radial nerves and the CETs seem to be swollen on the affected sides, independent from the hand dominance of the patients with refractory LE. These results morphologically support the previous literature that attributes some of the chronic complaints of these patients actually to radial nerve entrapment.
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Affiliation(s)
- Eda Gürçay
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Özgür Zeliha Karaahmet
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Sule Sahin Onat
- Ankara Physical and Rehabilitation Medicine Education and Research Hospital, Ankara, Turkey
| | - Ayse Merve Ata
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ece Ünlü
- Department of Physical and Rehabilitation Medicine, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Frost LR, Brown SH. Neuromuscular ultrasound imaging in low back pain patients with radiculopathy. ACTA ACUST UNITED AC 2016; 21:83-8. [DOI: 10.1016/j.math.2015.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 04/30/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022]
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Reckelhoff KE, Li J, Kaeser MA, Haun DW, Kettner NW. Ultrasound Evaluation of the Normal Ulnar Nerve in Guyon's Tunnel: Cross-sectional Area and Anthropometric Measurements. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ultrasonographic Evaluation of the Median and Sciatic Nerves in Hemiplegic Patients After Stroke. Am J Phys Med Rehabil 2015; 94:429-35. [DOI: 10.1097/phm.0000000000000207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tiftik T, Öztürk GT, Kara M, Türkkan C, Ersöz M, Özçakar L. Ultrasonographic evaluation of sciatic nerves in patients with spinal cord injury. Spinal Cord 2014; 53:75-7. [PMID: 25384399 DOI: 10.1038/sc.2014.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional, controlled study. OBJECTIVE To evaluate the sciatic nerves of subjects with spinal cord injury (SCI) by using ultrasound (US) imaging and to explore whether US measurements are associated with clinical and electrophysiological findings. SETTING National Rehabilitation Center in Ankara, Turkey. METHODS Fifteen SCI subjects (12 male (M), 3 female (F)) and 23 (16 M, 7 F) healthy controls were included in the study. After clinical assessment of the subjects, lower limb nerve conduction studies and US imaging of the sciatic nerves were performed. Cross-sectional area (CSA) values of the sciatic nerves were correlated with the clinical and electrophysiologic data. RESULTS Mean CSA values were lower in the patient group when compared with the control group (P=0.042). Reduced compound motor action potentials regarding tibial and peroneal nerves were observed in the patient group (P=0.003 and P=0.005, respectively). US measurements did not correlate with the electrophysiological findings. However, sciatic nerve CSA values were positively correlated with body mass index in the control (r=0.534, P<0.05) and patient (r=0.482, P<0.05) groups. CONCLUSION Sciatic nerves seem to be smaller in subjects with SCI. Together with our electrophysiological data, this preliminary finding could possibly be attributed to primary axonal loss.
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Affiliation(s)
- T Tiftik
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - G T Öztürk
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - M Kara
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - C Türkkan
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - M Ersöz
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - L Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Sonographic measurement of the normal suprascapular nerve and omohyoid muscle. ACTA ACUST UNITED AC 2014; 19:165-8. [DOI: 10.1016/j.math.2013.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/01/2013] [Accepted: 12/17/2013] [Indexed: 11/23/2022]
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