Ultrasound of the nerves of the upper extremities. Ultrasound of nerves for tunnel syndromes

Neuropathy ulnar nerve is a lesion of the peripheral nervous system, arising due to various reasons. Traumatologists most often encounter this pathology, since as a result of mechanical impact on the elbow, a nerve is affected. Nerve trunk located in the area elbow joint, is compressed, and the function of the entire upper limb suffers.

Anatomy

The ulnar nerve arises from the medial bundle of the brachial plexus, located in the region of the last cervical and first thoracic vertebrae. Then he goes down inside shoulder and goes around the elbow joint, has no branches.

In the area just below the elbow, the nerve enters the cubital canal, which is formed olecranon and internal epicondyle, as well as ligaments and tendons. Moving from the elbow to the hand, the nerve branches - one branch goes to the flexor muscles of the fingers, the other to the flexor muscles of the hand. The third, dorsal branch innervates skin parts of the brush and outer surface 3-5 fingers.

When moving to the palm, the nerve of the elbow joint branches again, with one branch running superficially and responsible for the innervation of the skin of the 5th finger, the little finger, and partially the 4th, ring finger. The second branch is located deeper and innervates the muscles, ligaments and bones of the hand. It is this deep branch that passes through the Guyon canal, which is formed above and below by the ligament and bones of the wrist, and the lateral surfaces are formed by the pisiform and hamate bones.

When the nerve in this area is damaged, the so-called cubital tunnel syndrome occurs. This pathology is the second most common after carpal tunnel syndrome (neuropathy median nerve).

Causes

A pinched nerve can be caused by injury or diseases of the musculoskeletal system. Post-traumatic neuropathy occurs due to:

bruised limb;
forearm dislocation;
supracondylar fracture of the shoulder;
fracture of the ulna;
dislocation of the hand;
olecranon fracture;
deep cut on the hand.

Compressive neuropathy can occur in the following conditions:

bursitis;
tenosynovitis;
deforming osteoarthritis;
rheumatoid arthritis;
diabetes;
neoplasms;
bone marrow diseases;
chondromatosis.

After an injury to the elbow, scars form in the healing area, which cause compression nerve trunk.

Nerve compression can occur in the cubital tunnel or Guyon's canal, which is located in the wrist. In this case, they talk about tunnel or carpal syndrome. The cause of neuropathy in Guyon's canal may be professional activity associated with prolonged support of the elbow on a working tool - a machine, workbench, or manual labor using screwdrivers, hammers, pliers, scissors, etc.

The development of compression neuropathy is more common in women, with the right ulnar nerve being affected in most cases. The disease can be triggered by hypothyroidism, complicated pregnancy, and endocrine disorders.

Secondary neuritis can occur as a result of surgical manipulations during the reduction of dislocations and the alignment of bone fragments during fractures. Sometimes the ulnar nerve is stretched and damaged during skeletal traction.

Symptoms

When the nerve in the cubital canal is damaged, hand weakness occurs, which manifests itself in the inability to grasp anything or hold an object. In addition, a person cannot perform actions that require active finger motor skills - typing on a keyboard, playing the piano, turning the pages of a book, etc.

Other symptoms of neuropathy include the following:

loss of sensation in the 4th and 5th fingers, as well as the outer edge of the palm;
discomfort and pain in the elbow joint;
pain can radiate to the arm below the elbow, mainly from the outside;
in the morning the pain and discomfort intensify.

It is worth noting that pain and numbness after waking up are caused by bending the elbow during sleep or placing bent arms under the head. When bending the elbow joint, the nerve is compressed even more, the compression increases, and the condition of the limb worsens.

Damage to the ulnar nerve in Guyon's canal is characterized by similar symptoms, but in this case the elbow joint does not hurt and the hand does not lose sensitivity. The pain is localized at the beginning of the hand and in the area of the eminence of the little finger, while numbness inner surface 5th and part of the 4th finger. Guyon's syndrome is also accompanied by impaired motor activity - the fingers bend poorly and are difficult to move apart.

Diagnostics

During the examination, a neurologist uses the Froman test: the patient pinches a piece of paper with his thumb and forefinger. U healthy people the fingers form a ring, but with damage to the ulnar nerve this does not happen, since the upper phalanx of the thumb is too much bent. If you lightly pull the paper with your other hand, it will immediately jump out of the clamp, since the innervation of the corresponding adductor pollicis brevis muscle is disrupted.

To assess the motor ability of the hand, the patient is asked to place his hand on the table, palm down, and, pressing it tightly, try to bend the little finger, spread and close the last two fingers. Difficulties in doing these simple actions confirm the presence of neuropathy.

By tapping with a hammer or fingers, the doctor identifies the presence of hypoesthesia of the 4th and 5th fingers. Incomplete flexion of the 5th, 4th and partially the 3rd fingers, which prevents you from clenching your hand into a fist, also indicates pinching of the ulnar nerve. During the examination, trigger points (painful muscle thickening) along the nerve are also determined.

In order to clarify the extent of damage to the ulnar nerve, the doctor may order the following studies:

magnetic resonance imaging;
radiography of the elbow and wrist joints;
Ultrasound of the nerve;
electromyography;
electroneurography;
computed tomography.

Differential diagnosis is carried out with neuropathy of the median and radial nerve, polyneuropathy of various origins, radicular syndrome for pathologies of the cervical spine, etc.

Treatment

Treatment of ulnar nerve neuropathy can be either conservative or surgical. Therapy without surgery involves the use of the following groups of drugs:

anti-inflammatory;
glucocorticosteroid injections (if a nerve is pinched in Guyon’s canal);
painkillers;
anticholinesterase;
vasoactive;
vitamin complexes.

In the acute phase of the disease, motor activity of the limb should be limited. It is necessary to completely eliminate static and dynamic loads on the hand so as not to provoke strengthening clinical symptoms. To avoid excessive bending of the elbow, patients are advised to tie a towel roll to the elbow at night.

After cupping acute symptoms Ulnar nerve neuropathy continues to be treated with physiotherapeutic methods and is referred for the following procedures:

phonophoresis;
magnetic therapy;
electromyostimulation;
limb massage;
therapeutic exercises.

Conservative therapy is effective in the initial stages of neuropathy, when muscle dystrophy and persistent deformation of the fingers are not observed. Otherwise do surgical intervention, during which scars, hematomas and tumors that compress the musculoskeletal canal or the nerve trunk itself are removed. If there is a high risk of re-injury to the elbow joint, the nerve is transferred from outside hands to the inside (transposition).

Excision of pathological structures is performed in case of ineffectiveness conservative therapy. For patients who are unable to interrupt professional activity for long-term treatment, surgery is also recommended. For example, athletes cannot take a break from training for a long time if they plan to participate in important competitions and Olympics.

IN rehabilitation period after surgical intervention are appointed medications, compresses with paraffin, thermal procedures and electrical myostimulation. In addition, the limbs are kept at rest for a week and a splint or splint is applied. After removing the fixator, first introduce passive movements joint, and after about a month active movements of the arm are allowed. After another month, you can do weight-bearing exercises.

Treatment at home

There are several proven recipes that help relieve pain and inflammation using home remedies:

Mix ½ cup of chopped horseradish or black radish and the same amount of potatoes and add 2 tbsp. l. honey Spread the resulting mixture thin layer on gauze and wrap. Apply to the sore arm for one hour;
spicy tincture of bay leaf used for grinding and prepared as follows: 20 leaves are poured into a glass of vodka and left in a dark place for three days;
50 gr. propolis pour ½ cup of alcohol or vodka, leave for 7 days and shake periodically. After this, strain and add corn oil in a ratio of 1:5. Compresses with propolis are one of the most effective means, you can wear them without taking them off all day. The course of treatment is 10 days;
pour rosemary leaves with vodka and leave in a dark place for 3 weeks, shaking from time to time. Then strain the infusion and rub it injured hand before bedtime;
An infusion of cloves is best made in a thermos; to do this, you need to put a tablespoon of the dried plant in it and pour ½ liter hot water. After 2 hours you can take it. For two weeks, drink the infusion 3 times a day, one glass, then take a break for 10 days. The total duration of treatment is 6 months;
Burdock root in the amount of one tablespoon is poured into a glass of red wine and left for two hours. You need to take the product 2 times a day, 1/3 cup;
cocktail of alcohol, camphor and sea salt for compresses prepare as follows: 150 gr. ammonia, 50 gr. camphor, 1 glass of medical alcohol is diluted with a liter of water and a glass of sea salt is poured into the solution. Before each use, the jar of cocktail should be shaken, and a compress of gauze or bandage soaked in the solution should be applied to the sore arm 3 times a day.

Hydromassage

To restore impaired limb functions, it is recommended to massage in water:

the sore hand is lowered into the water, and with the healthy hand they press on the phalanges of the fingers, trying to straighten them;
with the help of a healthy hand, each finger is lifted in turn;
make rotational movements with your fingers alternately to the left and right sides;
circular movements with the hand (you can help with your healthy hand if it doesn’t work yet);
raising and lowering the hand;
the hand is placed perpendicular to the bottom on the tips of the fingers, in this position the healthy hand bends and straightens the fingers;
You need to put an object at the bottom of a container of water and try to pick it up with your sore hand. First, the item must be large enough - a towel or large sponge will do. As recovery progresses, smaller and different shaped objects are placed.

All exercises are performed 10 times, there are no restrictions on the number of approaches.

To speed up the recovery process it will be very useful and regular massage, with the help of which blood circulation is normalized and congestion is eliminated.

Therapeutic exercises

Special exercises will help restore muscle volume and tone:

sit at the table so that your shoulder lies completely on the table, and bend your arm at the elbow. Let down thumb down, while raising the index finger. Then vice versa - forefinger goes down, and the big one goes up;
sitting in the same position, raise middle finger, lowering the index finger down. And in the reverse order: middle - down, index - up;
Grab the main phalanges of all fingers, except the thumb, with your healthy hand. Bend the captured fingers at the main, lower joints 10 times. Then repeat the same with the middle phalanges, bending and unbending them with your healthy hand;
With your healthy hand, clench and unclench the hand of your injured hand into a fist.

The number of repetitions of each exercise is 10 times.

To prevent ulnar nerve neuropathy, it is necessary to avoid injury to the limb as much as possible, avoid hypothermia, and maintain immunity. To increase protective functions body, it is recommended to eat a healthy and balanced diet, exercise regularly and not neglect hardening procedures.

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Electroneuromyography (ENMG) is a research method that is carried out to determine the state of the peripheral nervous and muscle tissue. Also performed to identify pathology in early stages at the stage of functional disorders.

The technique includes EMG and ENG. EMG – electromyography, which is aimed at studying the activity and functional features muscle tissue during contraction and at rest. ENG is electroneurography, which evaluates the speed and correctness of impulse transmission along nerve fibers.

The examination is done in neurology, as it helps to identify diseases of the peripheral nervous system: mononeuritis, polyneuritis, neuropathy and others.

The essence of the method

Muscle movement occurs as follows: the impulse originates in the brain in the centers that are responsible for motor activity. Then the signal goes through neurons, nerve pathways, plexuses, reaches the muscles and, thanks to special synapses, passes from electrical to mechanical form - the muscle contracts.

In the presence of pathology at the nerve level, nerve pathways, synapse functionality of the muscle is impaired: may be observed increased fatigue, involuntary contraction, slow relaxation, lack of movement.

During ENMG, the device produces an impulse and checks the response of the muscle fiber to the signal, which allows you to determine the following:

The ability of a muscle to contract in response to a stimulus.
The quantity and quality of impulse transmission along nerve fibers.
Impulse conduction speed.
Localization of nerve damage, if present.

Myography will help determine the lesion at one of 8 levels in the motor pathway: suprasegmental, anterohorn, radicular, at the level of the plexus, nerve column, terminal nerve branches, synapses, myofibers.

No other diagnostic will give a complete picture of the condition of the axon. ENMG allows the doctor to find out where the problem is.

Methodology

The examination is carried out in mandatory in the morning, preferably empty stomach. If you managed to eat, then the procedure is done after 2 hours. 3 hours before EMG, you should not smoke or eat foods that contain caffeine (coffee, tea, cola, chocolate).

It is also equally important to warn the doctor before the EMG:

About the presence of an artificial heart pacemaker.
About taking medications that affect the nervous system (for example, muscle relaxants) and anticoagulants.

During ENMG it may appear slight pain or tingling, about which the doctor must warn the patient.

There are 3 ways to conduct ENMG:

Superficial. It is performed with the application of cutaneous electrodes.
Local. It is performed by introducing electrodes into muscle tissue.
Stimulating. When the examination is carried out by applying both surface and needle intramuscular electrodes.

Local myography is considered more effective and informative, since a needle-shaped electrode is inserted directly into the muscle tissue. However, this method may cause slight discomfort.

Superficial myography is considered less uncomfortable. Usually used for significant bleeding, coagulopathies, thrombocytopenia, high sensitivity, infections that are transmitted through blood.

Muscles and nerves are considered separate areas to be examined when performing EMG. facial area, upper and lower limbs, one upper and one lower limb.

How is myography performed?

The doctor performs myography as follows: the patient lies down (in some cases sits). A cutaneous electrode is placed on the surface of the skin, and a needle electrode is immersed into the muscle. The electrode is connected to a special recorder - an electromyograph, which records the electrical activity of the muscle.

Skin electrodes are applied as follows: the skin is wiped with alcohol, then with a special gel. An indifferent electrode is placed over the tendon, the main electrode is placed over the muscle belly, the third is placed between the two previous ones as grounding.

Myography is usually carried out in half an hour to an hour (the time depends on the volume of the muscles being examined). In this case, an electromyogram is recorded, which in its properties is similar to an electrocardiogram.

Carrying out electroneurography

During an ENG, a metal electrode is placed on the surface at the site of projection of the nerve being studied. The second electrode is placed in the area of the muscle fiber where the nerve being studied innervates.

The impulse is sent to the first electrode, continues to the nerve and causes muscle contraction. The device records the time it takes for the signal to travel from the nerve to the muscle—the speed of the impulse. The procedure is carried out in 15–60 minutes.

Electroneurography is considered safe method diagnostics of nerves and muscles. The only thing is that there will be a bruise in the place where the needle was inserted. The procedure is harmless to health, because the strength of the electrical signal is small.

Indications

ENMG is necessary in cases of neurological pathology. However, the study is used in rheumatology and orthopedics, neurosurgery, ophthalmology, and dentistry. Also used in rehabilitation and sports medicine.

Indications for ENMG include the following conditions:

Polyneuropathy or mononeuropathy.
Back injury.
Traumatic brain injury.
Various neuropathies and neuritis.
Osteochondrosis.
Vibration disease (especially with damage to the lower extremities).
Syringomyelia.
Multiple sclerosis.
Pathological processes of muscle tissue (myositis, myasthenia).
Parkinson's disease.
Diabetes mellitus (to confirm the presence of neuropathy of the upper and/or lower extremities).

Also, an examination such as electroneuromyography is used in the field of orthopedics to assess impaired motor functions after their restoration.

In medicine, electroneuromyography helps to identify the level of damage to the neuromuscular system, determine the localization of tissue damage, and determine the prevalence of the process. With its help, it is possible to determine the nature of the pathology, severity, and dynamics of the process.

Electromyography of the lower extremities

Myography, used to examine the lower extremities, will help to find out the cause of leg weakness and gait disturbances, decreased/increased sensitivity. It will be possible to find the source pain. For greater information, you can supplement with ultrasound of the nerves of the lower extremities.

This examination of the lower extremities is carried out to determine the function of the following nerves:

Isciatic – conduction disturbances can occur if carried out incorrectly intramuscular injections, pinched nerve by the pelvic muscles, infectious lesions (herpes), injuries after a fall, incorrect body position (sitting at a table).
Obturator - pathology is observed when there is strangulation in the canal if there is a hernia there.
Subcutaneous - disturbances can be observed when a nerve is pinched in the canal or with thrombophlebitis of the saphenous vein.
Femoral - pathology due to damage during operations, after physical activity, in case of infection.
Lateral cutaneous - conductivity decreases with significant pressure (the so-called jeans disease).
Tibial (which is responsible for the movements of the lower leg and foot) - damage, injury, inflammation of this nerve are one of the causes of clubfoot and pain in the lower legs.
Peroneal - often the function is impaired due to injuries in people who often walk in high heels and like to sit cross-legged.
Nerves of the foot - pathology appears after fractures, foot dislocations, operations, tumors, as a result of wearing uncomfortable shoes.

This type of examination of the lower extremities is used most often, since now people rarely pay attention to the choice of the right shoes, do not pay attention to their gait, and mostly walk sedentary image life. All this contributes to stagnation in the lower extremities and the appearance of inflammatory and degenerative phenomena.

EMG of the upper limbs

ENMG includes the study of the functional integrity of the median, ulnar and radial nerves. Stimulation myography provides information about the location (scar after a wound, deformation, fracture, place of nerve entrapment by a tendon, ligament, or due to an inflammatory process) and the amount of nerve damage upper limbs.

Needle EMG is effective in studying the current state nerve fiber, determining the dynamics of recovery processes. It is also used to make a prognosis and to determine indications for surgery.

Myography of the upper extremities can help in choosing adequate treatment: is it sufficient? current treatment, are additional methods needed, what are the prognosis for recovery.

Electroneuromyography of the face

The facial and trigeminal nerves are responsible for facial expressions and other facial movements. Once a disorder occurs in the nerves or muscles, partial paralysis of the face is possible. To find out the reason why the face has lost mobility, ENMG is performed.

Electroneuromyography includes the following stages:

Diagnostics facial nerve(responsible for facial expressions) – the etiology of weakness/increased activity of the facial muscles can be identified.
Diagnostics trigeminal nerve(responsible for sensitivity and chewing) – the etiology of pain, pathology of facial sensitivity and dysfunction can be detected masticatory muscles.
Examination of the facial and masticatory muscles - this stage is informative for paresis/paralysis of the facial nerve, joint dysfunction, and pain.

Such a study will help to find out the cause of the pathology and provide information for prescribing effective treatment.

Contraindications

Electromyography is a procedure that is absolutely safe for any patient and special contraindications does not have. But you need to be careful if there are inflammatory or tumorous skin lesions at the site where the electrode is placed.

TO relative contraindications Myography applications include:

Mental disorders.
Hypertension of the third stage.
Epilepsy.
Patient use of a pacemaker, angina pectoris.

In addition, needle myography is performed with caution in patients with HIV, AIDS, hepatitis, etc. The fact is that there is a risk of transmitting the disease through blood to medical personnel. Therefore, in such cases, you just need to carefully follow the procedure according to all the rules. personal protection medical worker.

Electroneuromyography will help not only to identify pathology, but also to predict the further course of the disease and select more effective treatment.

Research costs: -joints (for one joint) - doctor - 3500 rubles, professor - 6000 rubles - nerves (for one nerve) - doctor - 3500 rubles, professor - 6000 rubles

Brief information. Nerves are bundles of nerve fibers (processes nerve cells), through which nerve impulses are carried from the center to the periphery and vice versa. Nerves can suffer as a result of injury, external compression, tumor growth, and sometimes they are affected due to lack of blood supply. Among all the causes, vertebrogenic lesions of the roots are leading spinal cord. Often there are primary processes that lead to disturbances in nerve conduction, in particular those of inflammatory origin.

Joints provide mobility to various segments of the body and limbs and overall mobility of a person by connecting bones to each other. Joints are quite complex: the contacting surfaces of the bones are covered with cartilage, and between them there is renewable joint fluid. The framework of the joints and the direction of movement in them are supported by numerous ligaments. Over time, individual structures (primarily cartilage) undergo degenerative changes and can ossify (osteoarthrosis). In addition, there are numerous inflammatory diseases joints - arthritis. Articular syndrome is part of a syndrome complex of various general somatic diseases, for example, systemic rheumatoid diseases. Frequently pathological changes associated with injuries. Other diseases, including neoplastic ones, also occur.

The ligamentous apparatus helps maintain position, as well as provide directed movements (stabilization of joints, etc.). Ligaments can suffer due to inflammatory changes, injuries and other causes (tumors, etc.).

Role ultrasound examination in the diagnosis of diseases peripheral nerves, joints, ligaments.

Ultrasound examination is the method of choice, as well as an auxiliary technique for certain types of lesions of joints, ligaments and peripheral nerves. Despite the enthusiasm for these studies in last years, their resolution is not enough in many diagnostic situations.

Titles of studies: Ultrasound examination (US), duplex scanning (DS) of joints, ligaments, peripheral nerves.

Scope of research*:

Ultrasound examination of the joint:

two-dimensional gray scale echography of the joint and ligaments
duplex scanning of the joint and ligaments

Ultrasound examination of the peripheral nerve:

two-dimensional greyscale echography of the peripheral nerve
duplex scanning of a peripheral nerve

________________

* In the Multidisciplinary Professorial medical center « Vascular clinic At Patriarch's, isolated ultrasound examinations in mono modes are not practiced. In the interests of the patient, Doppler scanning modes are used for all types of studies.

Purpose of the study:

For the joint and ligaments:

determining the condition of the articular surface, assessing the amount and nature of the joint fluid, determining the presence and properties of additional formations, studying the echographic characteristics of the soft tissues surrounding the joint
in the presence of additional formations - determination of their size, shape, location, structure, as well as the nature of the distribution of color cartograms of flows and linear characteristics blood flow in their vessels

For peripheral nerves:

study of the contour, diameter, structure, continuity, echogenicity of the nerve, the state of the surrounding tissues, in the presence of additional formations - their properties, as well as the nature of the distribution of color cartograms of flows and linear characteristics of blood flow in their vessels

Indications for ultrasound (US) of peripheral nerves, joints, ligaments:

The most common conditions and diseases of the joints for which ultrasound examination is performed:

exclusion (confirmation) of dysplasia hip joint in children (up to 3 - 4 months)
joint pain
restrictions on joint movement
joint deformity
swelling of the joints
additional education
joint injury

The most common conditions and diseases of the nerves for which it is performedultrasonography:

nerve injury
suspected nerve compression
the need to exclude a tumor
nerve inflammation

Preparing for the study.

Ultrasound of joints, ligaments and nerves using modern diagnostic equipment, available in our center “Vascular Clinic on Patriarch’s”, in most cases does not require special training.

Ultrasound modes and technologies used when conducting ultrasound examination of peripheral nerves, joints and ligaments at the Vascular Clinic on Patriarch's Center:

two-dimensional gray scale echography (B-mode);
color Doppler coding - by speed, intensity or energy, convergent or directed energy (CD - mode);
spectral Doppler analysis (PW - mode);
duplex scanning;
triplex duplex scanning mode - triplex scanning.

Based on the research results, the following are issued:

conclusion (hard copy) - included in the base price
conclusion in in electronic format (additional service)
Ultrasound images - static black and white (hard copy), printed on a video printer (additional service)
ultrasound images - static color (hard copy) (additional service),
ultrasound images- static or dynamic on the client’s magnetic media (additional service),
on magnetic media provided by the center (additional service)

Using modern high-frequency matrix and broadband sensors, it is possible to process the ultrasonic signal. Thanks to ultrasound of the nerves, you can examine the condition of your peripheral nerves. For example, a specialist will examine your tailbone or other area at a time convenient for you.

In what cases is an examination prescribed?

Not all patients are conscientious and go to the doctor at the first signs of illness. Many people ignore pain in the elbow. Ultrasound only sciatic nerve shows problems in this area. When the pain becomes constant and severe, the patient urgently needs an ultrasound scan and comes in for examination.

Peripheral nerves need to be examined if you feel:

Painful lumbago;
Your limbs go numb;
You feel a burning sensation;
Your arms and legs don't obey you as much as they used to;
Your foot is now “slapping.” This is such a syndrome;
You were injured at home or in an accident, you were deeply cut due to which parts of your body lost sensitivity;
The doctor suspects you have a tumor (no matter what type), for example, near the tailbone or elsewhere, a neuroma.

Main characteristics of the survey

The doctor, watching the ultrasound examination on the screen, will see where your problem areas are and what the deviations from the norm are. With ultrasound, the following indicators are considered basic:

There are changes in the structure;
The echogenicity of the trunk becomes less or increases, the fibers are heterogeneous in density and are abnormally highlighted;
How flattened the nerve is. The trunk is pre-measured to determine its thickness and width. The largest width is divided by the thickness index. You will receive the coefficient. So, you will find out how much it flattens if you click on it certain place. A cross section is made and compared with the standards for a specific area.

"Advice. If, after such a detailed examination, a pathology is discovered, the doctor will know how to best treat it and will prescribe medications for you.”

The examination will show where there is inflammation of the nerve tissue (for example, in the buttock), a neoplasm or abnormal vascularization or a break in the fibers. You will get rid of your illness faster than if you were treated according to general symptoms at random. The doctor will find out where it is pinched and select treatment.

Preparation and methodology

No special preparation is required for ultrasound of nervous tissue. If you have wounds or irritations on your skin, postpone the examination for a while. The doctor will schedule a re-examination for you later.

At stage 1, the doctor will find your nerves. Large trunks are much more noticeable than small ones. The doctor will perform texts during which you will move your limbs. You will be tested to determine your symptoms.

To make the examination easy and pleasant, a gel will be applied to your skin. A sensor with a frequency of 3 to 5 MHz will be moved to the locations of the nerves. The ischium is examined at a frequency of 7 to 15 MHz. First, a topographic search is carried out and scanning is carried out. If there are problems, it is clear why pain occurs in the coccyx area.

If you need to find the medial one, then it is located at the wrist, in the area of the palm tendon. If the specialist stops seeing it on the screen, he can return to the starting point and continue the examination. The doctor makes a transverse section, examines it enlarged, and then makes the image larger and examines the longitudinal one.

Nerves that can be seen with the machine

An ultrasound of the peripheral nerves will show their structure in the patient’s hands:

Located on the shoulder;
Ray. What is the condition of its fibers?
Located under the arms;
Median;
Muscular with skin;
Elbow. Its trunk;
Located in the wrist area;
The fingers have flexors.

An ultrasound will also show the condition of the nerves in the legs, specifically the trunks with branches:

Sciatica (pain in the coccyx area);
Passing in the gluteal region (bottom and top);
Located in the thigh;
Passing through the genitals;
Obturator;
Ileum with hypogastric;
Ileum with inguinal;
Malonetsovy;
Bolshebtsovogo;
Located on the sole;
On the skin of the foot (medial).

The nerves in the lower back with the sacrum and on the hips are deep in the tissues. Access to them is difficult and ultrasound cannot always clearly show what condition they are in.

"Advice. Then you can pass additional examination other methods: Doppler mapping, with neuromyelography.”

Norms

An ultrasound of the ulnar nerve with the radial nerve and any others, if they are not affected by the disease, will perfectly show their fibers. They will look dense. If there is pathology, then the trunks become thicker and the nervous tissue less dense. The specialist will locate the affected area.

It is important that a person can move his arms and legs freely without experiencing pain. If the patient has something that hurts, it may be inflammation or pinching. With an osteophyte that blocks normal functionality, a person feels discomfort, and with ultrasound, the nerve appears to be pinched.

A specialist, conducting an ultrasound examination, will evaluate the thickness and width of the trunks and branches of the nerves. If you take the ratio of width to thickness, the doctor will determine a coefficient that will show that the trunk and its branches are flattened. If it comes out 3.3, then this is the norm. The above indicators indicate pathological processes.

"Advice. Immediately after diagnosis, begin treatment for inflammation and other pathologies.”

Problems that can be diagnosed

When studies are carried out using ultrasound, the following pathologies can be seen:

The nerve becomes inflamed. The device will show exactly where the abscess is occurring. The patient feels: pain with numbness, low sensitivity and other symptoms. Many people have problems with those located in the wrist area or with the elbow, sciatic. There is pain in the coccyx area or disturbances in the area of the median nerve or an ultrasound of the radial nerve is required;
Pinching most often occurs in the ridge. Especially if you are injured or bend over unsuccessfully, etc. A compression area is formed. Bone tissue becomes deformed and osteophytes develop, which aggravates the patient’s condition. It may get pinched and soft tissues when a tumor develops;
Neoplasms most often affect the sheath of the nerve bundle. An ultrasound will show a schwannoma with a neurofibroma;
Injury to an arm or leg, both. When you have a sprain or fracture, the nerve fibers are often stretched or torn.
Morton's neuroma. The tumor is growing and nerve endings thicken between the fingers.
In the nervous system. These could be: a hematoma with a cyst, a tumor with a fracture, many inflammatory formations with osteophytes, aneurysms and thromboses, and other pathologies. They arise due to compression.
Tunnel neuropathy. It may occur due to the fact that tendons with bones compress the nervous tissue. Those who do a lot of typing at the computer often suffer from carpal tunnel syndrome.

Nerve ultrasound is available and safe procedure. Can be combined with Doppler mapping and neuromyelography. If you have an abscess or a pinched nerve, consult a doctor and get an ultrasound. A trained specialist will find the affected area, for example, around the wrist, and your doctor will prescribe treatment.

This site is intended for persons over 18 years of age; it contains a number of photos and videos that are not intended for viewing by persons with an unprepared psyche.

The materials on the site are for informational purposes only. For staging correct diagnosis and the choice of further treatment tactics requires consultation with a specialist.

Clinical examination
Electromyography
Magnetic resonance imaging
X-ray

Possibilities of ultrasound diagnostics in studies of peripheral nerves

In recent years, as an additional method instrumental diagnostics increasingly used for peripheral nerve diseases sonography. The emergence of wideband multi-frequency linear sensors (from 11.0 to 17.0 MHz) and latest developments software Ultrasound devices made it possible to obtain a sonographic image of the nerve trunk and surrounding anatomical structures With high level tissue differentiation.

Normal nerve: uniform thickness, moderate echogenicity, clear differentiation of epineurium, perineurium and nerve fiber bundles

Advantages of ultrasound compared to other imaging methods:

Ease of execution and data interpretation. Low cost

No effect on the body ionizing radiation(compared to CT and radiography)

The highest in comparison with all existing methods visualization of the level of differentiation of the nerve trunk and its fibrous structure

No restrictions associated with the presence of: metal implants, pacemakers, claustrophobia (compared to MRI)

Ability to evaluate in real time the dynamic characteristics of moving structures

Possibility of conducting multiple studies

Using Doppler techniques to assess blood flow

On the limbs available for visualization:

Median, Ulnar, Radial, Femoral, Ischial, Tibial,
Peroneal nerves.

Brachial plexus. In pathology, due to the thickening of the nerve trunk and a decrease in its density, the level of visualization increases, which makes it possible to analyze smaller nerves that are normally inaccessible ( lateral cutaneous nerve thighs, branches of the radial and peroneal nerves, interdigital

and other nerves).

Lipoma (dashed arrows) of the popliteal fossa with compression of the peroneal nerve (white arrows). Nerve thickening and loss of fibrous structure proximal and distal to the compression site

Ganglion cyst (dashed arrow) in the distal carpal tunnel with compression of the median nerve (white arrows)

Limitations of the sonographic method: Inability to visualize nerve trunks in places where they pass under bone structures

(subclavian brachial plexus) Reduced visualization quality with a deep location of the nerve trunk, especially in patients with large body weight ( tibial nerve

in the middle 1/3 of the leg, sciatic nerve in the gluteal region)

Diagnostic capabilities of ultrasound:

Determining the location of nerve compression by a combination of three signs: Nerve flattening

at the point of compression.

For the median nerve, the flattening coefficient is calculated, defined as the ratio of the maximum width of the nerve to its thickness. Values above 3.3 are considered pathological. Nerve thickening

proximal and distal to the compression site.

The increase in cross-sectional area is higher than the statistical norm and, in comparison with the contralateral nerve, is assessed as pathological. Structural changes nerve:

decreased echogenicity of the nerve, thickening of individual bundles of nerve fibers, and later loss of fibrous structure. Visualizing the cause of nerve compression

with an assessment of its sonographic characteristics (size, structure, vascularization, relationship with the nerve trunk). Visualization of a nerve trunk rupture . Assessment of the size of diastasis and the condition of the ends at complete break

nerve. Detection of intraneural hypervascularization

Determining the cause of chronic nerve irritation during the movement of perineural anatomical structures (tendons, muscles, fascia, bone protrusions).

Carpal tunnel syndrome. Flattening of the nerve in the tunnel (dashed arrow). Swelling and thickening of the nerve proximal and distal to the compression site
(white arrows). Reduced echogenicity.
Loss of fibrous echostructure.

Well-defined education
(dashed arrows) originating from the ulnar nerve
(Ultrasonic signs of schwanoma)

Causes of nerve damage available for sonographic analysis:

Conditions predisposing to development compression syndrome: More often these are abnormal muscles and vessels in the tunnels.

Factors directly causing acute or chronic nerve compression:

o Intraneural and perineural tumors and cysts

o Synovitis with expansion of the cavity of the joints and tendon sheaths

o Vascular pathology (thrombosis, aneurysm)

o Thickening of the ligament or fascia limiting the tunnel

o Osteophytes

o Perineural edema or hematoma

o Infiltration and compaction of the soft tissues surrounding the nerve in a number of diseases (endocrinopathies, storage diseases, multiple myeloma, gout, etc.)

o Fractures and dislocations of bones

o Metal structures

Ultrasound examination of nerves is a new diagnostic method that has arisen as a result of the advent of improved ultrasound equipment equipped with high-frequency transducers. The sensitivity of the device allows you to create a clear picture of the nerves of the upper and lower extremities and the bundles of fibers that form them, and evaluate characteristics such as structure, contours, thickness and blood supply. The ultrasound technique of peripheral nerves has long been successfully used in European countries.

Ultrasound of the nerves of the upper extremities allows you to see the most complete characteristics of the fibers, including their size and structure

Diagnostic ultrasound procedure

Usually, the diagnostic procedure is preceded by special tests and tests, a thorough study of neurological symptoms. Only then to establish accurate diagnosis procedure is being carried out ultrasound diagnostics. Before the ultrasound begins, the skin is lubricated with a special gel that improves contact with the sensor. The study of the sciatic nerve is carried out by emitting a wave whose frequency ranges from 3 to 5 MHz, peripheral trunks are studied at wave frequencies from 7 to 15 MHz. At the beginning of the procedure, a topographic search for the nerve is performed. This is necessary to reduce scanning time. So, knowing the location of the nerve, during scanning, in case of loss of the visual image, it is possible to return to the beginning. Diagnostics consists of scanning the fiber in longitudinal and cross sections. Then the obtained sections are studied and the data decrypted.

Doppler mapping is used to determine the vascularization of a sciatic nerve tumor, to search for small nerve branches, accompanied by arteries. Dynamic functional testing is often the only way to identify certain diseases.

Thus, medial displacement of the ulnar nerve can occur exclusively during elbow flexion. A decrease in its displacement in the frontal projection of the carpal tunnel occurs when the fist is clenched. The appearance of such a symptom indicates carpal tunnel syndrome. Functional test allows us to detect the development of osteophyte, which damages the nerve fiber during joint movement.

Parameters determined during diagnostics

Using ultrasound diagnostics, it is possible to visualize the median, ulnar, radial, femoral, sciatic, tibial and peroneal nerves, as well as the brachial plexus. In the case of the development of pathological conditions accompanied by an increase in the thickness of the nerve trunk and a decrease in its density, the possibility of mapping increases significantly. Due to this property it becomes possible analysis smaller endings that are inaccessible for research in normal healthy condition.

The study allows you to visualize individual areas of the peripheral nervous system and identify disturbances in their functioning.

During the ultrasound examination The location of nerve trunk compression is determined based on several parameters:

The amount of flattening at the point of compression. Usually the flattening coefficient is calculated using the formula: the maximum width is divided by its thickness. A coefficient exceeding 3.3 is considered pathological.
Thickening area. A cross-sectional area exceeding the generally accepted standard value is regarded as a sign of a pathological process.
Structural change, decreased echogenicity, increased thickness of some nerve bundles, fibrous structure.

Using ultrasound examination of the extremities, it is possible to visualize the causes of compression of the sciatic nerve, followed by determination of its size, structure, and vascularization. The rupture of the nerve trunk, the size of the diastasis, and the condition of the ends are also determined.

Pathological conditions determined by ultrasound

The formation of schwannomas and neurofibromas of tumors that can develop on nerve sheaths.
Post-traumatic conditions. An acute injury that occurs when a nerve is stretched or torn during a bone fracture. A rupture is characterized by a violation of an integral structure. At the ends of the torn nerve fiber, the formation of neuromas occurs - thickenings, which are a consequence of the regenerative process of cells. Reason for change nerve structure there may be a dissection of the nerve fiber when cut wounds, infringement as a result of fractures.
Compression of nerve fibers. Typically, the development is caused by the presence of abnormal muscles and blood vessels in the tunnels. A sign of compression is the manifestation of severe deformation, the development of neuroma, and atrophy of the deformed nerve fiber. Nerve thickening is visualized. The development of carpal tunnel syndrome is characteristic.
Morton's neuroma. As the pathology develops, the interdigital nerves thicken. Diagnosis of Morton's neuroma occurs only in connection with the occurrence of pain symptoms. This is usually a round-shaped neoplasm, so it is often confused with inflammatory process in the metatarsal bursa.
Pathologies that cause the development of acute or chronic compression of the sciatic and other nerves. This may be a tumor or cyst, synovitis, thrombosis, aneurysm, osteophyte, edema, hematoma, bone fracture or joint dislocation, the development of thickening of the ligaments, the occurrence of infiltration or compaction of the soft tissues that surround the nerve bundle.

Ultrasound of the nerves is necessarily prescribed for post-traumatic damage to the nervous system. This may be due to bone fractures or soft tissue tears

Functional tests allow analysis of the displacement of the sciatic nerve and the tissues that surround it. Based on the test results, it is possible to diagnose a dislocation of the sciatic nerve, accompanied by constant trauma to the bone formation.

Advantages and disadvantages of the survey

TO positive aspects method of ultrasound diagnostics of nerves of the upper and lower extremities can be attributed to the ease of examination and low cost examinations. Due to the absence of harmful radiation, as with radiography, and contraindications, repeated procedures are allowed without negative consequences for the body even in children and pregnant women. The technique allows you to study the dynamic indicators of organs and visualize them in real time. The use of Dopplerography makes it possible to assess blood flow indicators.

Some disadvantages of the technique include limited visualization in subosseous areas. Low quality of research into nerve trunks located deep in the tissues. Often this problem interferes with overweight patients. Thus, it is problematic to examine the sciatic and tibial nerves.