-
Recent Posts
- MAKE THE MATH REAL
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 11)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 10)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 9)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 8)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 7)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 6)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 5)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 4)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 3)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 2)
- BRINGING VSI IMAGING to the AMAZON of PERU (Chapter 1)
- Trends in Medical Ultrasound: Fetal Echocardiography
- Distance-Learners Ask….
- The Rapid Remaking of Online Learning
- Adaptability & Being Better
- PART III – New Paradigms for Ultrasound: Why MSK ?
- PART II – New Paradigms for Ultrasound: Assessing Peripheral Nerves
- New Paradigms for Ultrasound: Assessing Peripheral Nerves
- Semi- Interactive (and partially confusing) Console Questions
- Quick Concepts: Acrania vs. Anencephaly
- Quick Concepts: Fetal Cranial Anatomy
- A Statistical Look at What Students Do and Don’t Know
- New Paradigms for Ultrasound: Alzheimer’s Disease
- LEARNING FROM ‘FAILURE’ … ?
-
Recent Comments
No comments to show.
PART II – New Paradigms for Ultrasound: Assessing Peripheral Nerves
NEW PARADIGMS FOR ULTRASOUND: ASSESSING PERIPHERAL NERVES
CONTINUED FROM PART I
We covered the rapid technological improvements over the past 4-5 years, and briefly outlined how this offers many advantages to both the patient and the examining medical professional. Aside from the inherent cost-advantages previously discussed, creating a less imposing or obtrusive examination environment fulfills the fundamental goal of improving patient care by facilitating communication and feedback in addition to reducing stress/anxiety.
BEST PRACTICES PRE-EXAM –
It is important to ascertain if the patient has undergone any surgical procedures that may have altered the normal anatomy. The examiner should be familiar with the normal post-surgical sonographic characteristics of affected tissue so that it is not mistaken for pathology.
While obtaining a detailed patient history, try to determine the mechanism of injury in order to concentrate on the most likely structure(s) creating pain. Additionally, encourage the patient to discuss any accident, sports-related or overuse injury, acute trauma, or chronic microtrauma which may point you toward a specific muscle/nerve group.
If none of the above conditions is identified, it is critical to understand the types of symptoms the patient is experiencing. For example, exercise-related pain can be caused by a degenerative joint disease or tendinopathy. Night pain could be related to an inflammatory condition. Burning, tingling or numbness could be suggestive of nerve entrapment.
Having identified the likely-affected muscle or nerve group, inspect and palpate the proximate skin and subcutaneous tissue for bruising or ecchymosis, tenderness, inflammation or dysfunction. Ascertain what kind of movement produces pain and evaluate a full range of movements, attempting to reproduce the conditions associating with the patient’s discomfort.
In summary, a detailed history and physical exam are critical to determining what areas and structures to scan.
TRANSDUCER SELECTION –
Depending on the area of interest, you should select either a linear or curved linear transducer. As referenced previously, higher frequency transducers are appropriate to provide the precise detail resolution specific to nerve studies. This superior spatial resolution comes at the expense of penetration, unfortunately. Therefore, in evaluating deeper structures (e.g. abdomen or hip) a lower-frequency transducer may be required.
EXAMINATION –
In evaluations of nerve/muscle structures with bilateral counterparts, ultrasound images should be captured from each “side” for comparative purposes, especially when subtle pathology is suspected. This is another inherent advantage of MSK ultrasound exams insomuch as it doesn’t require a complicated, separate imaging procedure.
In the next blog, I will have some final thoughts and insights on evaluating the ultrasound image and optimizing settings.
Jamie Bie is also the author of newly-released Musculoskeletal Ultrasound: A Comprehensive Guide to MSK Imaging and Interventional Techniques, a comprehensive, step-by-step guide to MSK Ultrasound. This textbook includes an overview of MSK Ultrasound physics, illustrated protocols, anatomy review by section, transducer and ultrasound overlays to clarify positioning and structure recognition, and CheckPoints noted throughout the text, providing critical technical tips.