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Imaging of the nerves in the cervical region is more complicated than those of the extremities. Although high-resolution ultrasound enables the depiction of peripheral nerves' morphology and their associations with the adjacent soft tissues, precise identification of the nerves in the neck is still challenging. Familiarization with the cervical nerve tracking techniques can help interventional physiatrists explore/treat relevant entrapment syndromes, so does guiding proper electrode placement during nerve conduction studies. The present article integrates serial ultrasound images and videos to demonstrate how to scan brachial plexus, superficial cervical plexus, cranial nerves in the neck region, and certain branches of the major cervical nerves.

Objective The purposes of this study were to determine the best cutoff value for bicipital peritendinous effusion (BPE) and to test its diagnostic performance as regards shoulders with and without rotator cuff pathology. Design We reviewed the sonographic reports of 1352 patients with suspected shoulder disorders between January 2011 and June 2012. The associations between BPE and rotator cuff abnormalities were explored by logistic regression and adjusted for age, sex, affected side, and clinical diagnosis of frozen shoulder. The receiver operating characteristic curves were constructed to assess the ability of BPE to discriminate certain rotator cuff pathologies. Maximal Youden indexes were used to define the best cutoff points, which were later applied on the validation data set for its discriminative ability. Results Sonographic findings of subscapularis tendinopathy, subdeltoid bursitis, supraspinatus full-thickness tear, and supraspinatus articular-sided partial-thickness tear were found to be associated with BPE. The cutoff values of BPE to differentiate those lesions were 1.0, 0.9, 1.5, and 1.5 mm, respectively. Validation of the diagnostic performance of BPE at defined thicknesses yielded good negative predictive values for the aforementioned rotator cuff abnormalities. Conclusions Sonographically detected BPE seems to be in association with certain rotator cuff pathologies, and it can be utilized as an adjuvant finding to rule out such rotator cuff abnormalities.

To the Editor, We read the retrospective case series conducted by Clendenen and colleagues and appreciate their efforts in exploring a patient population with infrapatellar saphenous neuralgia after TKA [1]. Their research indicates ultrasound-guided injection to the infrapatellar branch of the saphenous nerve is a potential approach for recalcitrant pain following TKA. In their results, the response rate to the injection combining corticosteroid and local anesthesia was 56.3% (9 out of 16). Since there was no comparative group, we are unaware that this advanced approach is superior to conservative treatments like manual exercise or physical therapy. However, a more-than-50% success rate with nerve block draws attention to the neuropathic component in patients with persistent knee pain after TKA. Peripheral and central sensitization could potentially be associated with chronic intractable pain in knee osteoarthritis [2]. Although the present research supports the role of peripheral neuralgia in relentless postarthroplasty knee pain [1], central sensitization might partly account for the patients failing to respond to nerve block. Therefore, oral medication modifying central pain perception can be considered in combination with medication targeting nociceptive pain [3]. Additionally, evaluation tools designed for measuring neuropathic pain, such as the PainDETECT score and the DN4 questionnaire [2], should be implemented to monitor treatment effectiveness. Another concern is the diagnosis for entrapment of the infrapatellar branch of the saphenous nerve, which was made by the response to injection in the present study. The potential segment of nerve entrapment is from the vastoadductor membrane to the medial femoral epicondyle [4]. Whether the entrapped nerves presented with swelling, hypoechogenicity, or hypervascularity is of interest, but this information is lacking in this case series. Besides recording the sonographic images of the affected side, we suggest the authors also compare the nerve echotexture with the asymptomatic side, which is the easiest way to identify nerve damage by ultrasound.

The Continuity Assessment Record and Evaluation (CARE) item set is a standardized, integrative scale for evaluation of functional status across acute and postacute care (PAC) providers. The aim of this study was to develop a Chinese version of the CARE (CARE-C) item set and to examine its reliability and validity for assessment of functional outcomes among stroke patients. The CARE-C was administered in two samples. Sample 1 included 30 stroke patients in the outpatient clinic setting for the purpose of examining interrater and test–retest reliabilities and internal consistency. Sample 2 included 138 stroke patients admitted to rehabilitation units for the purpose of investigating criterion-related validity with the Barthel index, Lawton Instrumental Activities of Daily Living (IADL) scale, EuroQOL five dimensions questionnaire (EQ-5D), and Mini-Mental State Examination (MMSE). The CARE-C was categorized into 11 subscales, 52 items of which were analyzed. At the subscale level, the interrater reliability and test–retest reliability expressed by intraclass correlation coefficient (ICC) ranged from 0.72 to 0.99 and 0.60 to 1.00, respectively. Six of the 11 subscales met acceptable levels of internal consistency (Cronbach alpha > 0.7). The criterion-related validity of the CARE-C showed moderate to high correlations of its subscales of cognition and basic and instrumental activities of daily living with the Barthel index, IADL scale, and MMSE. The CARE-C is a useful instrument for evaluating functional quality metrics in the Chinese stroke population. The development of the CARE-C also facilitates the assessment of the PAC program in Taiwan and future research is warranted for validating the capability of CARE-C to identify patients’ functional change over time and its generalizability for nonstroke populations.