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High-resolution ultrasound (US) is a helpful technique for the evaluation of peripheral nerves and literature data show that US may crucially influence diagnosis and clinical care in entrapment in nerve tumours. We report the case of a 48year-old woman complaining of pain and electric shocks radiated in sciatic course and trigger point in the gluteal region. It was suspected radiculopathy due to disk herniation. MRI showed mild L5–S1 bulging. Due to the trigger, US of sciatic nerve was suggested, nevertheless the trigger was in a region where usually sciatic nerve is not depictable (commonly accepted that is not depictable proximally to plica glutea). The clinical examination and EMG were normal. We performed an ultrasound examination to study sciatic nerve from its distal formation by the union of peroneal and tibial nerves and along its proximal tract. The right sciatic nerve was visualizable along all its tract, even proximally to plica glutea. At the middle-third of gluteus the nerve showed a round-oval shape formation with homogeneous hypoechoic US image. After accurate evaluation the formation seemed on the nerve edge and nerve fibers seemed dislocated laterally, moreover the proximal edge was clearly visualizable. The morphology suggested a probable neurinoma. MRI confirmed dislocation of fascicles and surgical excision was planned. This case report shows the importance of trying ultrasound sciatic nerve examination even proximal to plica glutea. [Copyright &y& Elsevier]

Ultrasound (US) can aim clinical and neurophysiologic assessment of the nerve lesions. After a case report we previously reported (Liotta et al., 2010), we present further three cases in which US allowed to depict concomitant nerve lesions far from the trauma sites. The first one is a man with humerus fracture immediately followed by a radial muscles plegia.Three months after the trauma, he presented no clinical/neurophysiologic recovery of fingers and wrist extensor muscles. US showed an enlargement of radial nerve in the fracture site and a contemporary marked enlargement of posterior interosseous nerve close to Frohse’s arcade. The other cases concern two patients with trauma at the level of clavicle and following plexopathy. Clinical/neurophysiologic examination in both cases showed a discrepancy between biceps brachii muscle (complete denervation) and the all other muscles (mild involvement). US showed a marked enlargement of the muscolocutaneous nerve distally to axilla. The nerve damage in a point far from the fracture site is probably due to the nerve traction caused by the trauma. These findings suggest a new mechanism of damage, that must be hypothesized in atypical muscles involvement after trauma, and the role of US in these cases for diagnosis, prognosis and treatment. [Copyright &y& Elsevier]

Immune-mediated neuropathies include Guillain–Barré syndrome (GBS) and its variants, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN), paraproteinemic neuropathies. High-resolution ultrasound (US) is a helpful technique for the evaluation of peripheral nerves. In previous studies on immune-mediated neuropathies, nerve US showed diffuse enlargement of cross sectional area (CSA) of peripheral nerves trunks and cervical roots and morphological alterations at conduction block site. Data are however heterogeneous, correlations with clinical history or disease severity are lacking and there are no longitudinal studies in literature. The objective is to prospectively evaluate, through a multicenter longitudinal study, US findings in newly diagnosed patients with immune-mediated neuropathies and changes during time and relationship with clinical and neurophysiological findings. The proposal of the protocol is to enroll patients with immune-mediated neuropathies. We will perform clinical assessment, neurophysiological examination; US examination will study median, ulnar, radial, fibular, tibial, sural nerves (and brachial plexus in extended protocol). Maximal/minimal CSA for each nerve, inter- and intra-nerve variability, classification depending on echogenicity and fascicles enlargement will be considered. The protocol and its timing of follow-up evaluations, depending on acute/subacute or chronic disease, will be discussed so that the final version will be based on consensus among expert committees or clinical experience. [ABSTRACT FROM AUTHOR]

Neuromas after limb amputation are common. Though high frequency ultrasonography (US) is very useful in evaluation of peripheral nerves, there are a few reports about neuromas after limb amputation. In this study, we aimed to investigate the utility of US in patients after limb amputation. We retrospectively analyzed three patients with limb amputation and evaluated clinical features and US findings, especially cross sectional area (CSA) of nerves. For the US evaluation we used US systems equipped high-frequency (10–18MHz) broadband probes. Patients were three males. The each amputated sites were left shoulder, left forearm and right distal third leg. All showed phantom limb syndrome. In US findings, all demonstrated neuromas, maximum CSA of neuromas in shoulder amputation demonstrated C4 (CSA 42mm2) and C5 root (CSA 80mm2) in the upper part of brachial plexus, neuromas in leg amputation showed superficial peroneal (CSA 38mm2) and sural nerve (CSA 18mm2), neuroma in forearm amputation demonstrated in median (CSA 132mm2) and ulnar nerve (CSA 59mm2). All patients with limb amputation revealed neuromas. US is useful tool in evaluation of neuroma after limb amputation. This information may be very useful for therapeutic approach. [Copyright &y& Elsevier]

We have extensively evaluated nerve ultrasound (US) pattern in different CMT subgroup patients, assessing median, ulnar, fibular, tibial, sural nerves pattern. Sixty-nine patients affected with hereditary neuropathy (including 16 CMT1A, 4 CMT1B, 3 CMT1C, 2 CMT1D, 4 CMT1 not defined, 22 CMT2, 8 CMTX, 10 HNPP) underwent widespread nerve US evaluation. Nerve cross sectional area (CSA) and echotexture were evaluated at four limbs in different sites, both distally and proximally. Data were correlated with age and clinical pictures. Nerve CSA seems to be dependent on the following variables: CMT type, age and site. In particular CSA is very smaller in CMT2 type and larger in the middle aged subjects. Moreover, nerve size appears bigger in the proximal sites. Nerve US evaluation may play a supportive role in the diagnostic process in patients with hereditary neuropathies and poor clinical picture or inconclusive neurophysiological findings. Besides, the extension of US evaluation also to proximal nerve segments helped widen our knowledge in the pathomechanism of the disease. [ABSTRACT FROM AUTHOR]

At the point where it crosses the inguinal ligament, the lateral femoral cutaneous nerve (LFCN) can be entrapped, causing a clinical syndrome (Meralgia Paresthetica) consisting of numbness and sensory disturbances in the territory of nerve distribution. The causes of MP include conditions associated with obesity, pregnancy and orthopedic procedures. The diagnosis of MP is based on clinical history, physical examination, neurophysiological findings and exclusion of other causes of pain or sensory disturbances. Routine neurophysiological tests are not commonly accepted as sensitive although several methods have been developed. Sonographic examination (US) of the LFCN could be useful as a screening test in the diagnosis. The nerve is accessible to US from a few centimeters before it exits the pelvis down to the third proximal part of the thigh. The main US signs of LCFN neuropathy include detection of a fusiform nerve swelling and nerve flattening under or within the ligament. The true sensitivity are not assessed because of absence of gold standard diagnostic test. We present 8 cases of clinical MP confirmed by US. [Copyright &y& Elsevier]