A Guide for Clinicians Involved in Diagnosis and Management of Peripheral Nerve Disorders
Author: Einar P. Wilder-Smith
Publisher: World Scientific
The past 10 years have seen the explosive expansion of the field of high-resolution imaging of the peripheral nervous system because of technical advances in sonography, allowing for good resolution, rapid imaging and (relatively) inexpensive images of the peripheral nervous structures. This timely volume presents the rapid advances and clinical relevance of high-resolution sonography for peripheral nerve diagnostics in a precise and clinically relevant way. The book begins by describing the characteristics of normal and diseased peripheral nerves, and then discusses the value of sonography in common conditions, with the help of clear and easy-to-understand illustrations to explain how to proceed to identify structures. The topics covered include common entrapment neuropathies (carpal tunnel syndrome, ulnar neuropathy, radial neuropathy, peroneal neuropathy) and other conditions in which sonography can play a role in diagnosis, such as CIPD, motor neuropathy with multiple conduction blocks, leprosy, and brachial plexus disorders. High-Resolution Ultrasonography for Peripheral Nerve Diagnostics is an essential guide for those involved in the diagnostic work-up of peripheral nerve disorders. It gives a precise and practical overview of this rapidly emerging field whilst maintaining a practical bent. Clinical neurophysiologists, neurologists, orthopedic surgeons, hand surgeons and rehabilitation medicine specialists will all benefit from having this book. Sample Chapter(s). Chapter 1: Introduction (208 KB). Contents: Introduction; Finding the Nerve; Clinical Applications. Readership: Neurologists, clinical neurophysiologists, orthopedic surgeons, hand surgeons, rehabilitation medicine specialists.
In recent years, sonography of the peripheral nervous system has gained widespread acceptance. New diagnostic applications have emerged, and the field of ultrasound-guided interventions has expanded significantly: regional anesthesia, peripheral nerve blocks, and similar techniques are now frequently performed under ultrasound guidance by anesthesiologists and pain physicians alike. This atlas of peripheral nerve ultrasound is designed to meet the daily needs of both radiologists and clinicians by allowing rapid review of typical features, knowledge of which is important for successful diagnosis and intervention. The side by side presentation of ultrasound images with anatomical cryosections and photographs of transducer positions allows for reliable sonographic identification of even tiny nerves in regions of complex topography. The practical value of the atlas is further enhanced by correlations with high-resolution MRI scans.
Diagnostic sonography of the peripheral nervous system is an evolving specialty of musculoskeletal ultrasound. This book provides an in-depth description of sonographic examination technique - how to access an individual nerve with sonography and how to interpret local findings. A particular focus is on sonographic-anatomic correlations. All currently possible clinical applications are addressed, including the evaluation of nerve compression syndromes, traumatic lesions, tumors, and postoperative complications. The book contains a huge number of high-quality patient sonograms, all derived from cases with clinical and in many instances surgical correlation.
Chapter 8. Imaging of the peripheral nervous system
Author: Guido Stoll
Publisher: Elsevier Inc. Chapters
This chapter summarizes progress in the evaluation of peripheral nerve (PN) lesions and disorders by imaging techniques encompassing magnetic resonance imaging (MRI) and nerve ultrasound (US). Due to the radiation exposure and limited sensitivity in soft tissue contrast, computed-tomography (CT) plays no significant role in the diagnostic work-up of PN disorders. MRI and US are complementary techniques for the evaluation of peripheral nerves, each having particular advantages and disadvantages. Nerve injury induces intrinsic MRI signal alterations on T2-weighted sequences in degenerating or demyelinating nerve segments as well as in corresponding muscle groups exhibiting denervation which can be exploited diagnostically. Nerve US is based on changes in the nerve echotexture due to tumor formation or focal enlargement caused by entrapment or inflammation. Both MRI and US provide morphological information on the precise site and extent of nerve injury. While US has the advantage of easy accessibility, providing images with superior spatial resolution at low cost, MRI shows better soft tissue contrast and better image quality for deep-lying nerve structures since imaging is not hindered by bone. Recent advances have remarkably increased spatial resolution of both MRI and US making imaging indispensible for the elucidation of causes of nerve compression, peripheral nerve tumors, and focal inflammatory conditions. Both MRI and US further guide neurosurgical exploration and can simplify treatment. Importantly, imaging can reveal treatable conditions even in the absence of gross electrophysiological alterations, illustrating its increasing role in clinical practice. In experimental settings, novel molecular and cellular MRI contrast agents allow in-vivo assessment of nerve regeneration as well as monitoring of neuroinflammation. Depending on further clinical development, contrast-enhanced MRI has the potential to follow cellular responses over time in vivo and to overcome the current limitations of histological assessment of nerve afflictions. Further advances in contrast-enhanced US has the potential for developing into a tool for the assessment of nerve blood perfusion, paving the way for better assessments of ischemic neuropathies.
Diagnostic sonography of the peripheral nervous system is an evolving specialty of musculoskeletal ultrasound. This book provides an in-depth description of sonographic examination technique -- how to access an individual nerve with sonography and how to interpret local findings. A particular focus is on sonographic-anatomic correlations, based on the use of anatomic cadaver cryosections and comparative sonograms. All currently possible clinical applications are addressed, including the evaluation of nerve compression syndromes, traumatic lesions, tumors, and postoperative complications. A special section is dedicated to interventional procedures and sonographic guidance in anesthesia. In addition, two experts give a basic introduction to electrophysiologic testing and peripheral nerve surgery. The book contains a huge number of high-quality patient sonograms, all derived from cases with clinical and in many instances surgical correlation.
As a hot topic in ultrasound medicine, peripheral nerve ultrasound has its wide applications in clinical field. This book firstly introduces the anatomy of peripheral nerves, method and normal sonograms for peripheral nerve scanning. In the following chapters, common and typical cases of peripheral nerves diseases are presented with useful clinical information and relevant data, for example, ultrasound, MRI, clinical operation and pathology results. At the end of each disease, video with detailed explanation of diagnostic procedure and 2-3 bullet points in practical differential diagnosis are included to help readers taking notes. This book will be a valuable reference for physicians in ultrasound, anesthetists, neurologists, pain specialists, and practitioners interested in related field.
Honorable Mention, 2015 PROSE Award in Clinical Medicine Practice With a ìhow-toî approach, the author meticulously describes the clinical evaluation of the peripheral nerves throughout the body using high-frequency ultrasound. Evaluations include both normal and pathologic findings, as well as discussions of relevant non-neurologic tissue. The book opens with an introduction to ultrasound physics, instrumentation, and image optimization. The remainder of the text is a highly visual tour through the multiple nerves of the shoulder, neck, and upper and lower limbs, focusing on sonographic technique and correct interpretation of findings. Clinical cases that integrate anatomic localization with clinical and electrodiagnostic assessment are incorporated throughout. Also includes a bound-in DVD with live motion video loops of the examinations to correspond with stills in the book to demonstrate the important dynamic information ultrasound provides. Ultrasound Evaluation of Focal Neuropathies features: Comprehensive yet practical text and atlas with detailed discussion of the strengths and weaknesses of clinical and electrodiagnostic assessments Thorough guide to ultrasound techniques and appearance of normal and abnormal peripheral nerves Clinical cases that pair the imaging information with clinical and electrodiagnostic findings are interwoven throughout with analysis of anatomy relevant to the peripheral nerves being studied Hundreds of high-quality images and line drawings to correlate anatomy and reflect probe placement Companion DVD with motion loops is provided to facilitate understanding of the dynamic image
Disorders of the peripheral nervous system (PNS) are the cause of prominent neurological symptoms including weakness, sensory loss, pain and autonomic dysfunction associated with deficits, morbidity and mortality. These disorders may be primary hereditary or cryptogenic neurologic disorders confined to the PNS or part of the pathology of both the central nervous system and the PNS. Most PNS disorders are secondary to other system disorders and may be responsive to treatment of the primary disease. Important advances have been obtained in several areas including molecular genetics, biochemistry, immunology, morphology and physiology that have enhanced our understanding of the causes and consequences of damage to peripheral nerve. Understanding of both these groups of PNS diseases has greatly expanded over recent years and has led to important advances of treatment both to protect and to repair damages of peripheral nerve. This volume provides an overview of the state-of-the-art of examination, diagnosis and treatment of these very diverse disorders and will be of interest to both the research and clinical neuroscience and neurology communities. Covers both hereditary and cryptogenic neurologic disorders Includes advances in the basic science of PNS from molecular genetics, biochemistry, immunology, morphology and physiology Detailed coverage of neuropathy in connective tissue disorders, infectious disorders, metabolic disorders and malignancy
In the past, radiographs of the hand have been described as the “skeleton’s calling card”, showing manifestations of many different diseases. As hand and wrist imaging has become increasingly sophisticated, this observation has become more true than ever. This is a comprehensive, up-to-date textbook on imaging of the hand and wrist. In the first part of the book, the various imaging techniques are discussed in detail. Individual chapters are devoted to radiography, ultrasound, CT, MRI and nuclear medicine. The second part of the book gives an authoritative review of the various pathologies that may be encountered in the hand and wrist, encompassing congenital and developmental abnormalities, trauma, and the full range of localized and systemic disorders. Each chapter is written by an acknowledged expert in the field, and a wealth of illustrative material is included. This book will be of great value to musculoskeletal and general radiologists, orthopaedic surgeons and rheumatologists.
Tumors involving peripheral nerves may be extremely challenging lesions to diagnose and treat. In order to optimize their management, physicians should have a thorough knowledge of peripheral nerve anatomy and pathology (both gross and microscopic), as well as familiarity with microsurgical techniques and intraoperative neurophysiological recording. This compendium deals with all aspects of tumors affecting peripheral nerves, from diagnosis to treatment; the topics it addresses range from epidemiology, anatomy, physiology, pathology, and clinical diagnosis to electrophysiology, imaging, genetic/cytomolecular aspects. Surgical approaches, biopsies and resection of various benign, malignant and pseudo-tumoral lesions, plexus tumors (both brachial and lumbosacral), and adjunctive treatment modalities and pain-related issues are described in detail. The book is intended not only for neurosurgeons, hand surgeons, plastic and orthopedic surgeons new to the field, but also for seasoned specialists who wish to update their knowledge with new insights based on robust experimental and clinical material. In addition, it will be a helpful tool for general and oncological surgeons who are sometimes faced with the treatment of mass lesions that may be potential nerve tumors, and for all practitioners who are engaged in the arduous struggle to bring relief to patients affected by these lesions.