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).

Schwannoma of the Posterior Tibial Nerve.

A 61-year-old woman was referred to physical therapy by a podiatrist who suspected a posterior tibialis degenerative tear. To further examine the irritable posterior tibial nerve, a musculoskeletal ultrasound examination was performed, showing a vascularized focal lesion suggestive of a nerve tumor. The patient was referred back to the referring podiatrist, who ordered magnetic resonance imaging, which confirmed the schwannoma of the posterior tibialis nerve. J Orthop Sports Phys Ther 2020;50(2):111. doi:10.2519/jospt.2020.9103.

Impact of electrodiagnostic (EMG/NCS) tests on clinical decision-making and patient perceived benefit in the outpatient physical therapy practice.

BACKGROUND: Utilizing Electromyography and Nerve Conduction Study (EMG/NCS) tests, when indicated, may have implications for efficient patient management and assist in more efficient referral to appropriate providers or specialists. OBJECTIVE: To investigate the impact of Electromyography and Nerve Conduction Studies (EMG/NCS) on clinical decision-making and patient perspectives within PT practice settings. METHODS: 462 patients, who were candidates for diagnostic testing (EMG/NCS) were included in this outcome study and questionnaire-based survey design. Pre-test diagnosis was compared to post-test diagnosis. Post-test, patients were asked to rate their perceived benefit of the testing. RESULTS: Management was changed in 60.61% of patients post EMG/NCS testing (p < 0.0001). The diagnosis was changed post-EMG/NCS test in 39% of the patients with a change in management, which is greater than expected (p < 0.0004). There was no effect of gender or age (p > 0.05) on change in treatment (tx) or diagnosis (dx). 89.8% of patients agreed, or strongly agreed, that they were better able to understand their condition; 92.4% strongly agreed, or agreed, that they were reassured about their condition; 89.1% strongly agreed, or agreed, that they were better able to manage their condition and 92% reported very high, or high, value perceived from the EMG/NCS test administered. CONCLUSION: This study demonstrates that EMG/NCS testing appears to have a significant impact on clinical decision-making, and higher scores on the patient perceived benefit.

Anomalous muscles within the first dorsal extensor compartment of the wrist.

A 73-year-old woman presented with a 12-month history of a tender first dorsal extensor compartment of her right wrist along with swelling which extended proximally. Caring for her grandchildren exacerbated her pain, and rest relieved it. Over a 2-month period, two injections and splint immobilization failed to provide pain relief and swelling reduction. An ultrasound showed anomalous muscles within the first dorsal extensor compartment. Surgical release of the first compartment showed the abductor pollicis longus and extensor pollicis brevis tendons flanked by muscles within an inflamed sheath. Releasing the compartment resulted in complete pain relief. Anatomic variations within the first dorsal extensor compartment have been reported, but there has been no report on double anomalous muscles within the compartment. The details of the case, utility of ultrasound, and a brief review of the literature are described.