Multimodality Imaging Approaches for Evaluating Traumatic Extremity Injuries: Implications for Military Medicine

Abstract

Military service members are susceptible to traumatic extremity injuries that often result in limb loss. Tremendous efforts have been made to improve medical treatment that supports residual limb function and health. Despite recent improvements in treatment and novel prosthetic devices, many patients experience a wide range of clinical problems within residual limbs that can negatively impact the progress of rehabilitation programs while also impairing functional capacity and overall quality of life. In addition to existing standard imaging modalities that are used for clinical evaluation of patients suffering from traumatic extremity injury, novel noninvasive imaging techniques are in development that may facilitate rapid and sensitive assessment of various aspects of traumatic extremity injuries and residual limb health. Despite recent advances, there remains a clinical need for noninvasive quantitative imaging techniques that are capable of providing rapid objective assessments of residual limb health at the time of initial presentation as well as after various forms of medical treatment. Ongoing development of imaging techniques that allow for assessment of anatomical and physiological characteristics of extremities exposed to traumatic injury should greatly enhance the quality of patient care and assist in optimizing clinical outcomes.

Ultrasonographic reference values for assessing normal sciatic nerve ultrasonography in the normal population

“…[ 12 ] With the newer high-frequency probes with different footprints which allow high-resolution imaging at relatively superficial location, HRUS can detect and evaluate traumatic, inflammatory, infective, neoplastic, and compressive pathologies of the peripheral nerves. [ 13 ] Movement of the limb helps to differentiate nerve from tendons, whereas color Doppler helps to differentiate nerves from vessels. The current approach for localizing and assessing the severity of traumatic peripheral nerve injuries involves clinical evaluation and electrodiagnostic studies.…”

Reference values for the cross sectional area of normal tibial nerve on high-resolution ultrasonography

“…Additionally, with the availability of power doppler imaging, it is now possible to assess vascular changes within major nerve segments (10) . Reference values for the cross sectional area of normal tibial nerve on high-resolution ultrasonography Therefore, US helps in early detection of neuropathy and its causes, such as traumatic, inflammatory, infective, neoplastic and compressive pathologies, which previously required resource-intensive nerve conduction studies (1,11) . In the case of traumatic peripheral nerve injuries, both clinical and electrodiagnostic assessment is needed, but the magnitude of injury cannot be well determined in the first six months due to the limitations of these approaches (12) .…”

“…Therefore, US helps in early detection of neuropathy and its causes, such as traumatic, inflammatory, infective, neoplastic and compressive pathologies, which previously required resource-intensive nerve conduction studies ( 1 , 11 ) . In the case of traumatic peripheral nerve injuries, both clinical and electrodiagnostic assessment is needed, but the magnitude of injury cannot be well determined in the first six months due to the limitations of these approaches ( 12 ) .…”

Reference values for the cross-sectional area of the normal sciatic nerve using high-resolution ultrasonography

“…The cross-sectional area (CSA) tends to be symmetrical in both lower limbs, and it is larger in the lower limb motor nerves than in the sensory nerves at similar sites ( 5 ) . Recent imaging techniques allow for the assessment of anatomical characteristics of extremities exposed to a traumatic injury, greatly enhancing the quality of patient care, and help in optimizing clinical outcomes ( 6 ) .…”