Ultrasonographic Appearance of Idiopathic Radial Nerve Constriction Proximal to the Elbow

Rossey-Marec, Dominique; Simonet, Jacques; Beccari, R.; Michot, C.; Bencteux, Philippe; Dacher, J.-N.; Milliez, P.-Y.; Thiébot, J

doi:10.7863/jum.2004.23.7.1003

Cited by 30 publications

(23 citation statements)

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“…An ultrasound series with surgical correlation of 14 patients demonstrated a significant association between lack of functional nerve recovery in PTS and hourglass‐like abnormalities . Other studies have reported similar findings . In our series of 6 patients who failed to recover after an average of 12.4 months, we identified 1 or more HGCs in each affected nerve and confirmed these findings at surgery.…”

Section: Discussionsupporting

confidence: 86%

“…The cause of absent or incomplete recovery in some patients is unknown. Over the past decade, an increasing number of reports have described hourglass constrictions (HGCs) or torsion of peripheral nerves, which have been documented surgically in patients with mononeuropathy . Some authors have drawn a connection between PTS and HGCs, but an etiologic link has not been established.…”

mentioning

confidence: 99%

“…While their etiology still remains a mystery, HGCs have been reported as surgical findings during nerve exploration for the past half century . Most reports of HGCs have not included pre‐operative imaging, and those in which imaging identified such a finding involved ultrasound . A recent literature search by the authors revealed only 3 reports documenting identification of HGCs with MRI .…”

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confidence: 99%

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MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage‐turner syndrome

et al. 2017

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

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confidence: 99%

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MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage‐turner syndrome

et al. 2017

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“…However, the recent introduction of high‐resolution nerve ultrasound (HRUS) has given a new impetus to this area of investigation. Similar to the surgical findings, it was found that preoperative ultrasound can detect single or multiple hourglass‐like constrictions on the nerve . Moreover, another peculiar phenomenon, the surgical finding of nerve torsion, has occasionally been described in patients with neuralgic amyotrophy‐like clinical presentation .…”

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confidence: 55%

Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion

et al. 2015

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Objective: To characterize the ultrasonographic findings on nerves in neuralgic amyotrophy.Methods: Fourteen patients with neuralgic amyotrophy were examined using high resolution ultrasound.Results: Four types of abnormalities were found: 1. Focal or diffuse nerve / fascicle enlargement (57%), 2. incomplete nerve constriction (36%), 3. complete nerve constriction with torsion (50%) (hourglass-like appearance), and 4. fascicular entwinement (28%). Torsions were confirmed intraoperatively and occurred on the radial nerve in 85% of the patients. A significant correlation was found between no spontaneous recovery of nerve function and constriction / torsion / fascicular entwinement (p=0.007). Conclusion:Ultrasonographic nerve pathology in neuralgic amyotrophy varies in order of severity from nerve enlargement to constriction to nerve torsion, with treatment moving from conservative to surgical. We postulate that the constriction caused by inflammation is the precursor of torsion and that the development of nerve torsion is facilitated by rotational movements of limbs.

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“…Nerve caliber increase at proximal arm positions can well be detected by ultrasound experts and has been described in the literature to detect RN lesions. 37–39 Caliber-neutral lesions are much harder to identify, and MRN likely has better sensitivity for these lesions. 17 Generally, ultrasound seems feasible for detection of distal nerve lesions while MRN is likely necessary for far proximal lesions.…”

Section: Discussionmentioning

confidence: 99%

Posterior interosseous neuropathy

Bäumer

Kele

Xia³

et al. 2016

Neurology

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Objective:To investigate the spatial pattern of lesion dispersion in posterior interosseous neuropathy syndrome (PINS) by high-resolution magnetic resonance neurography.Methods:This prospective study was approved by the local ethics committee and written informed consent was obtained from all patients. In 19 patients with PINS and 20 healthy controls, a standardized magnetic resonance neurography protocol at 3-tesla was performed with coverage of the upper arm and elbow (T2-weighted fat-saturated: echo time/repetition time 52/7,020 milliseconds, in-plane resolution 0.27 × 0.27 mm2). Lesion classification of the radial nerve trunk and its deep branch (which becomes the posterior interosseous nerve) was performed by visual rating and additional quantitative analysis of normalized T2 signal of radial nerve voxels.Results:Of 19 patients with PINS, only 3 (16%) had a focal neuropathy at the entry of the radial nerve deep branch into the supinator muscle at elbow/forearm level. The other 16 (84%) had proximal radial nerve lesions at the upper arm level with a predominant lesion focus 8.3 ± 4.6 cm proximal to the humeroradial joint. Most of these lesions (75%) followed a specific somatotopic pattern, involving only those fascicles that would form the posterior interosseous nerve more distally.Conclusions:PINS is not necessarily caused by focal compression at the supinator muscle but is instead frequently a consequence of partial fascicular lesions of the radial nerve trunk at the upper arm level. Neuroimaging should be considered as a complementary diagnostic method in PINS.

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Ultrasonographic Appearance of Idiopathic Radial Nerve Constriction Proximal to the Elbow

Cited by 30 publications

References 12 publications

MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage‐turner syndrome

MRI bullseye sign: An indicator of peripheral nerve constriction in parsonage‐turner syndrome

Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion

Posterior interosseous neuropathy

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