Role of Sonography in the Diagnosis and Treatment of Common Peroneal Neuropathy Secondary to Fabellae

The fabella is a sesamoid bone situated in the posterolateral knee, which may contribute to posterolateral knee pain by impinging on the adjacent common peroneal nerve (CPN). Although anatomic studies have established an relationship between the fabella and CPN, we present 4 cases of posterolateral knee pain radiating into the anterolateral leg in which sonography was able to determine the source of the pain as CPN compression by an adjacent fabella. In 2 of these cases, resolution of symptoms was achieved with ultrasound‐guided CPN blocks, whereas 1 case was surgically treated, and another was managed with oral analgesics. These cases illustrate the utility of diagnostic and interventional sonography in the evaluation and treatment of posterolateral knee pain secondary to fabellar impingement of the CPN.     

Sonographic Evaluation of the Median Nerve in Diabetic Patients

Objective. Diabetes mellitus is becoming a major cause of premature disability in Japan, and peripheral neuropathy is a common complication of diabetes. The aim of this study was to evaluate the relationship between the results of nerve conduction studies (NCS) and the size of the nerve determined by sonography in diabetic patients. Methods. Twenty diabetic patients (mean age ± SD, 57.1 ± 13.6 years) and 20 healthy volunteers (mean, 61.1 ± 8.9 years) were enrolled in this study. Patients' wrists that had symptoms of carpal tunnel syndrome were not included in the study; those that were included had negative Phalen test results. We then divided the patients into 2 groups (patients with and without diabetic symmetric polyneuropathy [DPN]). The cross‐sectional area (CSA) was measured in the carpal tunnel 5 cm proximal to the wrist and elbow joint of the median nerve. Results. There was a significant increase in the CSA in patients with DPN in the carpal tunnel compared with the control participants (P < .01) and patients without DPN (P < .01). The CSA in the carpal tunnel showed a significant correlation with the motor nerve conduction velocity (r = ?0.473). Conclusions. The CSA of the median nerve in the carpal tunnel of patients with DPN is greater than that in patients without DPN and healthy individuals and correlates with NCS.     

功能性电刺激对脑卒中足下垂患者步行能力的影响

目的:探讨功能性电刺激对脑卒中足下垂患者下肢步行能力的影响。方法:脑卒中足下垂患者55例,随机分为观察组28例和对照组27例。2组均给予常规康复训练,观察组加用功能性电刺激进行训练。2组均治疗5周,治疗前后进行下肢运动功能评定量表(FMA)、功能性步行量表(FAC)评定及足印步态分析。结果:治疗5周后,2组FMA、FAC评分及步行参数均较治疗前明显提高(P<0.05),且观察组优于对照组(P<0.05)。结论:功能性电刺激结合常规康复治疗对脑卒中足下垂患者下肢步行能力的恢复较常规康复治疗效果更好。     

Sonographic Evaluation of Lisfranc Ligament Injuries

Objective. This study characterized the sonographic appearances of Lisfranc injuries. Methods. Sonography reports (2000–2007) were searched for “Lisfranc,” resulting in 10 patients. Sonographic images of affected and asymptomatic contralateral feet were reviewed, recording the thickness of the dorsal ligament between the first (medial) cuneiform (C1) and second metatarsal (M2) ligaments, distance between C1 and M2, and change in this distance with weight bearing, hyperemia, and fractures. Correlations were made to clinical, surgical, and other imaging findings. Results. In 5 asymptomatic feet, the dorsal C1‐M2 ligament was 0.9 to 1.2 mm thick, and the C1‐M2 distance was 0.5 to 1 mm. Of the symptomatic feet, 1 group (n = 3) had normal sonographic findings (thickness, 0.9–1.1 mm; distance, 0.6–0.7 mm; all had normal radiographic findings and follow‐up, and 1 had normal magnetic resonance imaging [MRI] findings). Another group (n = 3) had abnormal hypoechogenicity and thickening of the dorsal C1‐M2 ligament (1.4–2.3 mm), a normal C1‐M2 distance (0.6–0.7 mm), and no widening with weight bearing (1 of 1), consistent with a ligament sprain (1 had normal computed tomographic [CT] findings, and all had uneventful follow‐up). The third group (n = 4) had nonvisualization of the dorsal C1‐M2 ligament, an increased C1‐M2 distance of 2.5 to 3.1 mm, and further widening with weight bearing (3 of 4) from Lisfranc ligament disruption (shown at surgery in 2, MRI in 1, and CT in 1). Conclusions. Nonvisualization of the dorsal C1‐M2 ligament and a C1‐M2 distance of 2.5 mm or greater were indirect signs of a Lisfranc ligament tear. Dynamic evaluation with weight bearing showed widening of the space between C1 and M2.     

Sonographic Evaluation of the Peripheral Nerve in Diabetic Patients

Objective. Early detection of nerve dysfunction is important to provide appropriate care for patients with diabetic polyneuropathy. The aim of this study was to assess the echo intensity of the peripheral nerve and to evaluate the relationship between nerve conduction study results and sonographic findings in patients with type 2 diabetes mellitus. Methods. Thirty patients with type 2 diabetes (mean ± SD, 59.8 ± 10.2 years) and 32 healthy volunteers (mean, 53.7 ± 13.9 years) were enrolled in this study. The cross‐sectional area (CSA) and echo intensity of the peripheral nerve were evaluated at the carpal tunnel and proximal to the wrist (wrist) of the median nerve and in the tibial nerve at the ankle. Results. There was a significant increase in the CSA and hypoechoic area of the nerve in diabetic patients compared with controls (wrist, 7.1 ± 2.0 mm², 62.3% ± 3.0%; ankle, 8.9 ± 2.8 mm², 57.6% ± 3.9%; and wrist, 9.8 ± 3.7 mm², 72.3% ± 6.6%; ankle, 15.0 ± 6.1 mm², 61.4% ± 5.3% in controls and diabetic patients, respectively; P < .05). Cross‐sectional areas were negatively correlated with reduced motor nerve conduction velocity and delayed latency. Conclusions. These results suggest that sonographic examinations are useful for the diagnosis of diabetic neuropathy.     

重复经颅磁刺激与肌电生物反馈电刺激疗法联合治疗脑卒中后足下垂的疗效观察

目的:观察重复经颅磁刺激联合肌电生物反馈电刺激疗法治疗卒中后足下垂的疗效是否优于单纯应用肌电生物反馈电刺激。方法:将120例脑卒中后足下垂患者随机分为3组各40例,A组给予单纯肌电生物反馈电刺激治疗,B组给予肌电生物反馈电刺激联合重复经颅磁刺激治疗,C组给予肌电生物反馈联合假重复经颅磁刺激治疗。治疗前及治疗8周后对3组患者进行疗效评定,采用肌力测定仪评定踝关节背伸肌力;表面肌电分析仪处理表面肌电信号,记录最大踝关节背屈时,胫骨前肌等长收缩状态下相关肌群的肌电积分值;Gaitwatch三维步态分析与训练系统记录行走时的步态参数,主要评定指标:步速、患侧支撑相百分比、踝关节最大背伸角度。结果:通过8周的康复训练,3组患者的肌力、步态及胫骨前肌iEMG值均较治疗前明显改善(P0.05),B组各项指标均优于A组、C组(P0.05),A、C两组间治疗效果差异无统计学意义。结论:重复经颅磁刺激联合肌电生物反馈电刺激疗法治疗卒中后足下垂疗效显著,明显优于单纯肌电生物反馈电刺激。     

脑卒中足下垂患者日常生活活动能力现状及其影响因素分析

目的 调查脑卒中足下垂患者日常生活活动能力现状,并分析其影响因素。方法 采用便利抽样法,于2020年12月—2021年10月选取乌鲁木齐市某三级甲等医院康复医学科159例脑卒中足下垂住院患者作为研究对象,使用一般情况调查表、简明国际跌倒效能感量表、Holden步行能力分级、Berg平衡量表以及改良Barthel指数进行调查,采用多元线性回归分析脑卒中足下垂患者日常生活活动能力的影响因素。结果 脑卒中足下垂患者的日常生活活动能力得分为（58.74±19.16）分。多元线性回归分析结果显示：平衡功能、步行能力及跌倒效能进入回归方程（F=95.361,P<0.001）,共解释日常生活活动能力总变异的64.2%。结论 脑卒中足下垂患者日常生活活动能力处于中等水平,平衡功能、步行能力及跌倒效能是日常生活活动能力的主要影响因素。临床康复计划中不仅要加强患者平衡功能及步行能力的训练,也要重视对患者跌倒恐惧心理的干预,以更好地恢复患者的日常生活活动能力。     

糖尿病患者正中神经的超声评估

目的 观察糖尿病患者正中神经高频超声参数特征,以及超声特征与电生理结果的相关性.方法 2019年6月至11月,本院糖尿病住院患者79例根据是否存在糖尿病周围神经病变(DPN)分为DPN组(n=37)和非DPN组(n=42).采用高频超声分别于距右腕横纹5 cm和10 cm处测量正中神经横截面积(CSA)、低回声区域比例...     

Role of Ulnar Nerve Sonography in Leprosy Neuropathy With Electrophysiologic Correlation

Objective. The purpose of this study was to evaluate the diagnostic usefulness of ulnar nerve sonography in leprosy neuropathy with electrophysiologic correlation. Methods. Twenty‐one consecutive patients with leprosy (12 men and 9 women; mean age ± SD, 47.7 ± 17.2 years) and 20 control participants (14 men and 6 women; mean age, 46.5 ± 16.2 years) were evaluated with sonography. Leprosy diagnosis was established on the basis of clinical, bacteriologic, and histopathologic criteria. The reference standard for ulnar neuropathy in this study was clinical symptoms in patients with proven leprosy. The sonographic cross‐sectional areas (CSAs) of the ulnar nerve in 3 different regions were obtained. Statistical analyses included Student t tests and receiver operating characteristic curve analysis. Results. The CSAs of the ulnar nerve were significantly larger in the leprosy group than the control group for all regions (P < .01). Sonographic abnormalities in leprosy nerves included focal thickening (90.5%), hypoechoic areas (81%), loss of the fascicular pattern (33.3%), and focal hyperechoic areas (4.7%). Receiver operating characteristic curve analysis showed that a maximum CSA cutoff value of 9.8 mm² was the best discriminator (sensitivity, 0.91; specificity, 0.90). Three patients with normal electrophysiologic findings had abnormal sonographic findings. Two patients had normal sonographic findings, of which 1 had abnormal electrophysiologic findings, and the other refused electrophysiologic testing. Conclusions. Sonography and electrophysiology were complementary for identifying ulnar nerve neuropathy in patients with leprosy, with clinical symptoms as the reference standard. This reinforces the role of sonography in the investigation of leprosy ulnar neuropathy.     

Sonographic diagnosis of urethral anomalies in infants: value of perineal sonography.

OBJECTIVE: To assess the value of urethral sonography including a perineal approach in evaluating urethral anomalies in infants. METHODS: A radiology database review identified 88 patients (mean age +/- SD, 64 +/- 84 days) who underwent voiding cystourethrography (VCUG) and urethral sonography as part of extended sonography of the urinary tract. Sonographic and VCUG images and reports were reviewed to assess agreement between both modalities for detection of urethral anomalies. RESULTS: Sonography facilitated the correct diagnosis of all 3 posterior urethral valves. The only urethral diverticulum, the only ectopic ureteric insertion into the urethra, the only urogenital sinus, and the only urethrovaginal fistula were also shown on sonography. In 73 (94%) of 78 cases, sonography correctly showed the absence of anomalies. In 5 infants, sonography could not reliably assess the urethra and showed indirect signs of urethral anomalies; however, these patients had normal urethras on VCUG. CONCLUSIONS: Our data show that sonography of the urethra is a valuable tool for diagnosis of urethral anomalies. Especially, negative findings on sonography are highly suggestive of the absence of urethral anomalies. Positive or equivocal sonographic findings should indicate VCUG.     

Sonographic Findings for the Common Extensor Tendon of the Elbow in the General Population

Objective. To describe structural characteristics and sonographic alterations of the common extensor tendon (CET). Methods. In 240 patients, we determined the body mass index; sonographic CET thickness, morphologic characteristics, and alterations; and color Doppler measurements of the epicondylar artery width and peak systolic velocity. Age, sex, epicondylalgia history, activities (work, sports, and hobbies), and dominant and nondominant elbows were noted. Results. The CET was thicker in the dominant elbow (4.77 versus 4.61 mm [P = .023]), male patients (dominant, 5.09 versus 4.46 mm [P < .001]; nondominant, 5.00 versus 4.21 mm [P < .001]), patients involved in risk activities (dominant, 5.21 versus 4.70 mm [P < .001]; nondominant, 5.12 versus 4.53 mm [P < .001]), and those with a history of epicondylalgia (right, 5.27 versus 4.70 mm [P < .001]; left, 4.86 versus 4.60 mm [P = .316]). Thickness correlated weakly with age (dominant, r = 0.284; nondominant, r = 0.215) and moderately with weight (dominant, r = 0.492; nondominant, r = 0.502). The mean epicondylar artery diameter was 1.35 mm (SD, 0.96 mm); mean peak velocity, 13.01 cm/s (SD, 4.90 cm/s). Morphologic abnormalities were found in 79.5% of patients with a history of epicondylalgia; 7.7% with no history had abnormalities; and 55.9% with abnormalities but no history were older than 55 years. Bone spurs (49.2% versus 16.4% [P < .001]), tendon calcifications (21.5% versus 3.9% [P < .001]), and bone cortex abnormalities (12.3% versus 1.7% [P < .001]) were found more often in non‐normal elbows; 79.4% of bone spurs in normal elbows occurred in patients older than 55 years. Conclusions. Mild sonographic alterations in the CET and bone spurs should be considered with caution when assessing epicondylar pain, especially in patients older than 55 years and those with a history of epicondylalgia.     

功能矫正贴扎技术改善脑卒中后足下垂患者步行功能的即刻效果观察

目的:评价肌内效贴中较常用的功能矫正贴扎技术改善脑卒中后足下垂患者步行功能的即刻效果。方法:选取60例脑卒中后足下垂患者,随机分为试验贴扎组(KT组)、安慰贴扎组(PT组)、空白贴扎组(ZT组)各20例。KT组使用肌内效贴布实施足下垂功能矫正贴扎技术,PT组使用相同品牌、规格、颜色的肌内效贴布施行安慰性贴扎,ZT组不实施任何贴扎。KT组、PT组患者贴扎前后分别进行评估,ZT组患者间隔20min进行2次评估,评估指标采用10m步行测试(10MWT)、TUGT起立-行走计时测试及Berg平衡量表(BBS)等。结果:3组患者行功能矫正贴扎后,KT组10m步行及TUGT所需的时间较贴扎前及PT组和ZT组均明显减少(P0.05),PT组和ZT组干预前后比较差异无统计学意义。3组贴扎前后及组间的BBS评分比较均差异无统计学意义。结论:功能矫正贴扎技术能即刻改善脑卒中后足下垂患者步行功能,在平衡能力的改善及长期疗效方面仍有待进一步研究。     

Sonographic Features of Sinus Pericranii in 4 Pediatric Patients

Sinus pericranii is a rare venous anomaly, which shows abnormal communication between the intracranial and extracranial venous systems. Sonograms of sinus pericranii in 4 children were retrospectively reviewed to evaluate the following imaging findings: the overall sonographic appearance, change in size and shape, Doppler flow pattern, and associated anomalies. All 4 patients had irregularly shaped anechoic lesions with lobulating and bulging contours. They all showed intracranial and extracranial venous communication through a calvarial defect. Two patients had changes in the sizes and shapes of the lesions, and 2 patients had bidirectional turbulent flow on Doppler images. Two patients had isolated sinus pericranii, and the other 2 were associated with Crouzon syndrome. By identifying a venous scalp mass with intracranial and extracranial venous communication and changes in its size, shape, and venous flow pattern, radiologists will be able to make a definitive diagnosis of sinus pericranii by using gray scale and Doppler sonography.     

Cognitive Function Is Not Associated With Recurrent Foot Ulcers in Patients With Diabetes and Neuropathy

OBJECTIVE

To study whether there is an association between cognitive impairment and the relapse rate of foot ulcers in diabetic patients and those with previous foot ulcers.

RESEARCH DESIGN AND METHODS

This single-center prospective study assessed the association of cognitive function and risk for ulcer relapse in 59 patients with diabetes (mean age 65.1 years, diabetes duration 16.5 years, and A1C 7.4%), peripheral neuropathy, and a history of foot ulceration. Premorbid and current cognitive functions were measured (multiple-choice vocabulary test [Lehrl], number-symbol test, mosaic test [HAWIE-R], and trail-making tests A and B [Reitan]). Prevalence of depression was evaluated retrospectively (diagnoses in patient files or use of antidepressive medication). Patients were re-examined after 1 year.

RESULTS

Three patients (5%) died during follow-up (one of sepsis and two of heart problems). The remaining 56 patients (48%) developed 27 new foot ulcerations (78% superficial ulcerations [Wagner stage 1]). Characteristics of patients with and without ulcer relapse were not different. In a binary logistic regression analysis, cognitive function is not predictive of foot reulceration.

CONCLUSIONS

Cognitive function is not an important determinant of foot reulceration.Diabetic patients and those with a history of foot ulcers are at risk for foot reulceration (1,2). Although cognitive function is known to be impaired in patients with diabetes compared with that in nondiabetic control subjects (3), no studies have examined the potential role of cognitive impairment, an important factor for educational success (4), in the development or recurrence of diabetic foot ulcers. Our hypothesis is that cognitive function is associated with the relapse rate of foot ulcers in patients with diabetes and previous foot ulcers.