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The Examination of Muscles and Nerves Using Ultrasound

With the advancement in ultrasound technology during last two decades, we are now able to acquire higher resolution images of different anatomical structures. Besides blood vessels, these also include peripheral nerves and muscles. The standard method for diagnosing peripheral nerve pathology is electrophysiological evaluation, including electromyography (EMG) and nerve conduction studies (NCS). The downside of mentioned methods is that they frequently, due to their functional approach, do not provide precise data on the location or type of the nerve lesion. This is where high-resolution ultrasound (HRU) comes in, supplying additional data on possible etiology of the lesion and sometimes even its precise location. Most prominent usage of HRU in recent literature is in diagnosing mononeuropathies ; carpal tunnel syndrome (CTS) and ulnar neuropathy at the elbow. Currently, different criteria for confirmation of CTS are suggested and investigated. Commonly used is cross-sectional area of median nerve measured at the level of distal wrist crease (normal < 10 mm2 ). Other larger peripheral nerves can also be visualized on sonogram, with level of detail depending on depth of the nerve and echogenicity of the surrounding tissue. High resolution ultrasound also seems to be a promising tool in detection of various muscle pathology, such as muscle denervation, changes in muscle structure or volume due to neuromuscular disorders, myopathies, drug intake and acute muscle problems. In investigation of peripheral nerve and muscle disorders, HRU should be used alongside electrophysiological methods (EMG, NCS) to obtain both anatomical and functional information, and therefore improve diagnostic value of the examination.

peripheral nerve ; median nerve ; sonography ; ultrasound

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