A standardized ultrasound approach in neuralgic amyotrophy.
Natalie E CignettiRebecca S CoxVanessa BauteMarissa B McGheeNens van AlfenJeffrey A StrakowskiAndrea J BoonJohn W NorburyMichael S CartwrightPublished in: Muscle & nerve (2022)
Neuralgic amyotrophy (NA), also referred to as idiopathic brachial plexitis and Parsonage-Turner syndrome, is a peripheral nerve disorder characterized by acute severe shoulder pain followed by progressive upper limb weakness and muscle atrophy. While NA is incompletely understood and often difficult to diagnose, early recognition may prevent unnecessary tests and interventions and, in some situations, allow for prompt treatment, which can potentially minimize adverse long-term sequalae. High-resolution ultrasound (HRUS) has become a valuable tool in the diagnosis and evaluation of NA. Pathologic HRUS findings can be grouped into four categories: nerve swelling, swelling with incomplete constriction, swelling with complete constriction, and fascicular entwinement, which may represent a continuum of pathologic processes. Certain ultrasound findings may help predict the likelihood of spontaneous recovery with conservative management versus the need for surgical intervention. We recommend relying heavily on history and physical examination to determine which nerves are clinically affected and should therefore be assessed by HRUS. The nerves most frequently affected by NA are the suprascapular, long thoracic, median and anterior interosseous nerve (AIN) branch, radial and posterior interosseous nerve (PIN) branch, axillary, spinal accessory, and musculocutaneous. When distal upper limb nerves are affected (AIN, PIN, superficial radial nerve), the lesion is almost always located in their respective fascicles within the parent nerve, proximal to its branching point. The purpose of this review is to describe a reproducible, standardized, ultrasonographic approach for evaluating suspected NA, and to share reliable techniques and clinical considerations when imaging commonly affected nerves.
Keyphrases
- peripheral nerve
- upper limb
- high resolution
- ultrasound guided
- neuropathic pain
- magnetic resonance imaging
- neoadjuvant chemotherapy
- spinal cord
- physical activity
- randomized controlled trial
- lymph node
- mental health
- chronic pain
- multiple sclerosis
- pulmonary embolism
- skeletal muscle
- locally advanced
- intensive care unit
- emergency department
- contrast enhanced ultrasound
- computed tomography
- respiratory failure
- mass spectrometry
- early onset
- drug induced
- spinal cord injury
- minimally invasive
- sentinel lymph node
- case report
- extracorporeal membrane oxygenation
- smoking cessation
- optic nerve
- optical coherence tomography
- high speed
- mechanical ventilation
- peripheral artery disease