Ultrasonography in Peripheral Nervous System Diagnosis

Francis O. Walker, MD, FAAN Peripheral Nerve and Motor Neuron Disorders p. 1276-1294 October 2017, Vol.23, No.5 doi: 10.1212/CON.0000000000000522
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Purpose of Review: High-resolution ultrasound has made it possible to view most nerves and muscles in real time and to identify pathologic change in size, echo texture, and vascularity. This article focuses on the principles underlying ultrasound imaging and the application of ultrasound imaging to clinical disorders commonly seen in an electrodiagnostic laboratory.

Recent Findings: Ultrasound is a sensitive and specific tool for evaluating myopathic and neurogenic muscle disease. It provides useful information about muscles difficult to study with other technologies, such as the tongue and diaphragm, and is also helpful in evaluating smaller muscles in the hands or feet where correlation with electrodiagnostic studies is possible. For nerves, the resolution of ultrasound is such that it can sensitively identify focal nerve enlargement, which is accurate in the diagnosis of entrapment neuropathies. Furthermore, it can recognize diffuse or multifocal nerve enlargement seen in hereditary and inflammatory neuropathies.

Summary: Neuromuscular ultrasound is an informative noninvasive tool for evaluating nerve and muscle disease. As the technology continues to advance and becomes widely available, it may become a routine part of residency training, neuromuscular research, and clinical practice.

Address correspondence to Dr Francis O. Walker, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, [email protected].

Relationship Disclosure: Dr Walker serves on the editorial boards of the Journal of Clinical Neurophysiology and Muscle & Nerve and has received personal compensation for speaking engagements for Grifols. Dr Walker has received research/grant support from CHDI, Pfizer Inc, Teva Pharmaceutical Industries Ltd, and Vaccinex Inc and receives publishing royalties from Elsevier and UpToDate, Inc. Dr Walker has provided expert legal testimony on botulinum toxin indications.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Walker reports no disclosure.

Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and app versions of this article; the URLs are provided in the print version. Video legends begin on page 1291.

Copyright © 2017 by the American Academy of Neurology.