Cross-sectional area and echo intensity values of peripheral nerves: Ultrasonographic and cadaveric correlation.

Introduction: Ultrasonography allows high-resolution visualisation of the peripheral nerves for quantitative and qualitative analyses. We report cross-sectional area values (quantitative measure) and echo intensity values (qualitative measure) for 46 peripheral nerve sites in upper and lower extremities in cadaveric specimens. Objective: To determine cross-sectional area values and echo intensity values of peripheral nerves of upper and lower extremities at 46 nerve sites. Methods: Nerve measurements were obtained using electronic callipers and ultrasonography for linear dimension and cross-sectional area measurements, respectively, in six cadaveric specimens for 46 peripheral nerve sites. Ultrasound images were further analysed to estimate echo intensity percentage values for 46 nerves. Results: We present normal cross-sectional area values of various nerves of upper and lower extremities with their respective echo intensity values. Calculated cross-sectional area values from linear dimensions did not match the measured cross-sectional area values via trace method. Conclusion: Cross-sectional area values (quantitative measure) and echo intensity values (qualitative measure) for 46 peripheral nerve sites in upper and lower extremities in cadaveric specimens are presented. The estimation of cross-sectional area via linear measurement is not a good approximation of the cross-sectional area (cross-sectional area measured by trace method on ultrasound image).

Telehealth and Physical Therapy Clinical Decision Making in a Patient with a Falcine Meningioma.

Telehealth utilizes information technologies and communication networks to deliver healthcare and education with lower costs and improved access, quality, and efficiency of healthcare services. This report describes the application of telehealth for medical screening, clinical decision making, and medical referral in a physical therapy practice. The patient described was a 50-year old man who contacted his physical therapist via telephone for a chief complaint of worsening left sided numbness and tingling that began insidiously 2 days prior. Further questioning revealed that the patient also complained of left ankle weakness, and slight unsteadiness with walking. He had not been feeling well and had been experiencing increasing bouts of unexplained fatigue over the previous two months that were now interfering with his work and recreational activities. The patient was evaluated by his physician the next day. Magnetic resonance imaging of the brain revealed a large (4 cm) falcine meningioma in the right parietal region. The patient was immediately referred to a neurosurgeon and underwent a craniotomy and tumor resection ten days later and subsequent gamma knife radiosurgery of the residual tumor bed two months after craniotomy and tumor resection. Follow-up imaging one year later revealed no evidence of recurrence or residual tumor. This patient case underscores the importance of recognizing signs and symptoms of serious disease, and how referral following telehealth via telephone can inform diagnosis.

Optimized Computed Tomography Angiography Protocol for the Evaluation of Thrombus in Patients with Fontan Anatomy.

The Fontan procedure is the final stage in the palliative surgical approach to patients with single-ventricle physiology. These patients have an increased risk for thromboembolic disease in the Fontan circuit, which can be evaluated by chest computed tomography angiography (CTA) in acute settings. However, false-positive results are common secondary to unusual streaming patterns in the Fontan circuit. A biphasic CTA protocol was evaluated for the capability to clearly identify structures of the Fontan circuit that are critical for the evaluation of thromboembolic disease. The study was a retrospective chart review of Fontan patients with a chest CTA scan obtained between 2011 and 2017. Two pediatric cardiologists with additional training in cardiac CT imaging independently reviewed each CTA and awarded one point for each of 5 Fontan circuit structures clearly identified resulting in a score range of 0-5. A score of 0-2 considered not capable, 3-4 partially capable, and 5 capable to clearly identify critical structures of the Fontan circuit. During the study period, 46 CTA scans were performed on 21 patients. Of the CTA scans using a biphasic protocol, 62.5% (10/16) were considered capable to clearly identify all 5 critical structures of the Fontan circuit vs 27% (8/30) of the CTA scans using a monophasic protocol (p = 0.027). Overall our results suggest that the single-site biphasic CTA protocol has greater diagnostic capability to detect the presence of Fontan thromboembolic disease when compared to the more traditional monophasic CTA protocol. Future prospective studies are needed to confirm these findings.

Musculoskeletal Ultrasonography to Detect a Displaced Fracture of the Fifth Metatarsal.

A 27-year-old man presented to an outpatient physical therapy clinic with left lateral foot pain after playing lacrosse 1 day prior. Ultrasound imaging was performed immediately by the physical therapist, focusing on the fifth metatarsal distal shaft. Images obtained with a 13- to 6-MHz linear transducer demonstrated cortical bone disruption. The patient's primary care physician subsequently ordered radiographs, which demonstrated an obliquely oriented fracture through the shaft of the fifth metatarsal. J Orthop Sports Phys Ther 2018;48(11):903. doi:10.2519/jospt.2018.7884.

The Effects of a 4-Layer Compression Bandaging System on Skin Perfusion Pressure in Healthy Adults.

OBJECTIVE: Current practice precludes compression in patients with wounds and reduced arterial flow; however, this treatment may reduce edema and vascular resistance, thus improving distal circulation. The objective of this study was to determine the effects of compression on skin perfusion pressure (SPP), edema, and ankle range of motion. DESIGN: This was a quasi-experimental time series. SETTING: The study was conducted at The Center for Skin Integrity in Cheektowaga, New York. PARTICIPANTS: The study participants were 20 healthy adults, 10 in a younger age bracket (22.10 [SD, 2.77] years, 23.14 [SD, 5.03] kg/m) and 10 in an older age bracket (55.90 [SD, 4.48] years, 28.84 [SD, 4.83] kg/m). INTERVENTIONS: Sixty minutes of Profore Multi-layer Compression was performed. MAIN OUTCOME MEASURES: Precompression and postcompression measurements: SPP, Ankle Brachial Index, calf circumference (15 cm proximal to lateral malleolus), and static and dynamic ankle dorsiflexion range of motion (DF ROM) compared between young and older adults. MAIN RESULTS: There was a significant main effect for time for SPP (P = .049) and static (P = .02) and dynamic (P = .03) DF ROM. Skin perfusion pressure significantly increased at 40, 50, and 60 minutes of compression compared with precompression. Static and dynamic DF ROM significantly increased from precompression to postcompression. Although not statistically significant, calf circumference decreased by 6 cm in the older-adult group postcompression. CONCLUSION: A 4-layer compression dressing system improved SPP; this may be secondary to the decongestion of a proximal confined space. The 4-layer compression dressing also improves DF ROM postcompression and may reduce lower-extremity edema. Seeing these results in healthy participants suggests the need for future research in a patient population to determine if compression can be used to offload arterial structures and thus promote wound healing in patients.