Ultrasound in the diagnosis and management of fibular mononeuropathy

Bucklan, Julie N; Morren, John Anthony; Shook, Steven J.

doi:10.1002/mus.26652

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…One study compared diagnostic performance of US and MRI [32]. Seven papers focused on diagnostic performance of US [32–38], and four papers reported on diagnostic performance of MRI [32,39–41].…”

Section: Resultsmentioning

confidence: 99%

“…Seven papers focused on diagnostic performance of US [32][33][34][35][36][37][38], and four papers reported on diagnostic performance of MRI [32,[39][40][41].…”

Section: Source Characteristics and Level Of Evidencementioning

confidence: 99%

“…Even single fascicular involvement can be assessed with CSA measurements [42]. Studies measured CSA at the level of maximal nerve diameter [32,33,36], at the level of the fibular head [37] or at and above the fibular head [33,34] Other authors reported CSA ratios [35,38], including CSA measures of the healthy contralateral peroneal nerve [38]. Cutoff values for CSA measures and ratios are summarized in Table 2.…”

Section: Diagnostic Performance Of Us and Mrimentioning

confidence: 99%

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Evidence in peroneal nerve entrapment: A scoping review

Oosterbos

Decramer

Rummens

et al. 2021

Euro J of Neurology

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Background and purpose Daily management of patients with foot drop due to peroneal nerve entrapment varies between a purely conservative treatment and early surgery, with no high‐quality evidence to guide current practice. Electrodiagnostic (EDX) prognostic features and the value of imaging in establishing and supplementing the diagnosis have not been clearly established. Methods We performed a literature search in the online databases MEDLINE, Embase, and the Cochrane Library. Of the 42 unique articles meeting the eligibility criteria, 10 discussed diagnostic performance of imaging, 11 reported EDX limits for abnormal values and/or the value of EDX in prognostication, and 26 focused on treatment outcome. Results Studies report high sensitivity and specificity of both ultrasound (varying respectively from 47.1% to 91% and from 53% to 100%) and magnetic resonance imaging (MRI; varying respectively from 31% to 100% and from 73% to 100%). One comparative trial favoured ultrasound over MRI. Variable criteria for a conduction block (>20%–≥50) were reported. A motor conduction block and any baseline compound motor action potential response were identified as predictors of good outcome. Based predominantly on case series, the percentage of patients with good outcome ranged 0%–100% after conservative treatment and 40%−100% after neurolysis. No study compared both treatments. Conclusions Ultrasound and MRI have good accuracy, and introducing imaging in the standard diagnostic workup should be considered. Further research should focus on the role of EDX in prognostication. No recommendation on the optimal treatment strategy of peroneal nerve entrapment can be made, warranting future randomized controlled trials.

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Section: Resultsmentioning

confidence: 99%

“…Seven papers focused on diagnostic performance of US [32][33][34][35][36][37][38], and four papers reported on diagnostic performance of MRI [32,[39][40][41].…”

Section: Source Characteristics and Level Of Evidencementioning

confidence: 99%

Section: Diagnostic Performance Of Us and Mrimentioning

confidence: 99%

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Evidence in peroneal nerve entrapment: A scoping review

Oosterbos

Decramer

Rummens

et al. 2021

Euro J of Neurology

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“…Neuromuscular ultrasound has proven value in the assessment of fibular neuropathies as well. The accuracy of NMUS for fibular neuropathies has only been studied well in patients presenting with a foot drop, where it was found to have an 86% sensitivity and 73% specificity, 77 although the cutoff value used is inconsistent with other studies, 70 and these results may not apply to most laboratories. Neuromuscular ultrasound accurately identifies purely axonal fibular neuropathies that cannot be localized by NCS, 77,78 in a manner similar to ulnar neuropathies.…”

Section: Fibular Neuropathymentioning

confidence: 99%

Neuromuscular Ultrasound

Jorgensen

Cartwright

Norbury

2021

Am J Phys Med Rehabil

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Accurate assessment of neuromuscular disorders is critical to facilitate timely treatment and achieve the best outcomes. Historically, electrodiagnostic studies have filled this role, but recently, neuromuscular ultrasound is being used in the electrodiagnostic laboratory. This review discusses the uses of neuromuscular ultrasound in the electrodiagnostic laboratory that have strong evidence, emphasizing those that could be adopted in a typical electrodiagnostic laboratory with a reasonable level of equipment and training. The evidence currently supports using neuromuscular ultrasound to diagnose carpal tunnel syndrome and ulnar neuropathies at the elbow and as a supplementary test when electrodiagnostic studies are suspected to be falsely negative or in axonal nonlocalizing lesions. Neuromuscular ultrasound can identify the causes of focal mononeuropathies, which can change treatment in specific cases. It is sensitive at identifying fasciculations and providing complementary evidence of autoimmune demyelinating polyneuropathies. It is particularly helpful in assessing nerves after trauma. Neuromuscular ultrasound is likely to prove even more useful in the electrodiagnostic laboratory as the technology continues to advance.

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“…Imaging plays a key role in the diagnosis and treatment planning in these patients by the identification of masses, cysts, and entrapment of the nerve at the fibular tunnel. 2 , 3 In some cases, these lesions may be small or occult, 4 or may occur in anatomical locations apart from the fibular neck that makes proper localization and characterization of the pathology with appropriate imaging and clinical examination important. Intraneural cysts can spontaneously partially regress or rupture; therefore, they may be subtle at the time of imaging.…”

mentioning

confidence: 99%

The value of high-resolution imaging in an occult peroneal intraneural ganglion cyst: illustrative case

Lenartowicz

Amrami²,

Strakowski

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Foot drop is a common complaint with a broad differential diagnosis making imaging a key part of the diagnostic workup. The authors present a patient with an occult peroneal intraneural ganglion cyst who underwent imaging with high-frequency ultrasound (US) and high-resolution magnetic resonance imaging (MRI) to highlight the role of such techniques in cases of peroneal neuropathy. OBSERVATIONS Intraneural ganglion cysts are emerging as a common cause of common peroneal neuropathy. Imaging with US and MRI is a valuable tool used to illustrate the pertinent anatomy and identify the articular branch joint connection and cyst as part of the surgical planning and definitive management. LESSONS Intraneural ganglion cysts can be small or nearly invisible and failure to appreciate the intraneural cyst can lead to symptom or cyst persistence or recurrence. High-resolution modalities can be useful in the diagnosis and surgical planning of difficult cases.

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Ultrasound in the diagnosis and management of fibular mononeuropathy

Cited by 12 publications

References 17 publications

Evidence in peroneal nerve entrapment: A scoping review

Evidence in peroneal nerve entrapment: A scoping review

Neuromuscular Ultrasound

The value of high-resolution imaging in an occult peroneal intraneural ganglion cyst: illustrative case

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