Download PDF
Semin Musculoskelet Radiol 2010; 14(5): 559-566
DOI: 10.1055/s-0030-1268066
© Thieme Medical Publishers

Peripheral Nerves: Ultrasound-Guided Interventional Procedures

Alberto Tagliafico1 , Gerd Bodner2 , Ilan Rosenberg3 , Federigo Palmieri4 , Isabella Garello4 , Luisa Altafini4 , Carlo Martinoli4
  • 1Department of Radiology, National Institute for Cancer Research, Genoa, Italy
  • 2Department of Radiology, St. Bernard's Hospital, Gibraltar, United Kingdom
  • 3Department of Radiology, Ospedale S. Bartolomeo, Sarzana (SP), Italy
  • 4Department of Radiology–DISC, University of Genoa, Italy
Further Information

Publication History

Publication Date:
11 November 2010 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Specific ultrasound (US)-guided interventional procedures on peripheral nerves are reviewed in this article including regional anesthesia, biopsy of neural lesions, and some injection therapies. For these procedures, US is the best modality to provide a safe imaging guidance because of its excellent spatial resolution and real-time capabilities. With US guidance, the radiologist can visualize the needle tip continuously and ensure that the needle is placed precisely in the desired location, avoiding the risk of inadvertent nerve damage. Practical tips and tricks for US-guided needle placement, biopsy of neural lesions, and US-guided therapy are reviewed in this article. The use of US-guided injections in specific clinical settings, such as the percutaneous treatment of carpal tunnel syndrome, Morton's and saphenous neuromas, painful stump neuromas, piriformis syndrome, and meralgia paresthetica are also illustrated here. US allows the clinician to inject drugs with little or no patient discomfort.

KEYWORDS

Nerve - interventional - ultrasound

REFERENCES

  • 1 Kovacs P, Gruber H. Interventional techniques. In: Peer S, Bodner G High-Resolution Sonography of Peripheral Nervous System. Berlin, Germany; Springer-Verlag 2008: 169-185
    Google Scholar
  • 2 Tagliafico A, Pugliese F, Bianchi S et al.. High-resolution sonography of the palmar cutaneous branch of the median nerve.  AJR Am J Roentgenol. 2008;  191(1) 107-114
    CrossrefPubMedGoogle Scholar
  • 3 Griffin J, Nicholls B. Ultrasound in regional anaesthesia.  Anaesthesia. 2010;  65(Suppl 1) 1-12
    PubMedGoogle Scholar
  • 4 Bloc S, Ecoffey C, Dhonneur G. Controlling needle tip progression during ultrasound-guided regional anesthesia using the hydrolocalization technique.  Reg Anesth Pain Med. 2008;  33(4) 382-383
    PubMedGoogle Scholar
  • 5 Chipman J N, Mott R T, Stanton C A, Cartwright M S. Ultrasonographic Tinel sign.  Muscle Nerve. 2009;  40(6) 1033-1035
    CrossrefPubMedGoogle Scholar
  • 6 Lucchetta M, Briani C, Liotta G A, Martinoli C, Coraci D, Padua L. Ultrasonographic Tinel sign: comment.  Muscle Nerve. 2010;  41(4) 570-571
    CrossrefPubMedGoogle Scholar
  • 7 Bianchi S, Zamorani M P. US-guided interventional procedures. In: Bianchi S, Martinoli C Ultrasound of the Musculoskeletal System. Berlin, Germany; Springer-Verlag 2007: 891-919
    Google Scholar
  • 8 Kransdorf M J. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location.  AJR Am J Roentgenol. 1995;  164(1) 129-134
    CrossrefPubMedGoogle Scholar
  • 9 Gruber H, Glodny B, Bendix N, Tzankov A, Peer S. High-resolution ultrasound of peripheral neurogenic tumors.  Eur Radiol. 2007;  17(11) 2880-2888
    CrossrefPubMedGoogle Scholar
  • 10 Wasa J, Nishida Y, Tsukushi S et al.. MRI features in the differentiation of malignant peripheral nerve sheath tumors and neurofibromas.  AJR Am J Roentgenol. 2010;  194(6) 1568-1574
    CrossrefPubMedGoogle Scholar
  • 11 Singh H K, Kilpatrick S E, Silverman J F. Fine needle aspiration biopsy of soft tissue sarcomas: utility and diagnostic challenges.  Adv Anat Pathol. 2004;  11(1) 24-37
    CrossrefPubMedGoogle Scholar
  • 12 Adams S C, Potter B K, Pitcher D J, Temple H T. Office-based core needle biopsy of bone and soft tissue malignancies: an accurate alternative to open biopsy with infrequent complications.  Clin Orthop Relat Res. 2010;  468(10) 2774-2780
    CrossrefPubMedGoogle Scholar
  • 13 Smith J, Finnoff J T. Diagnostic and interventional musculoskeletal ultrasound: part 1. Fundamentals.  PM R. 2009;  1(1) 64-75
    CrossrefPubMedGoogle Scholar
  • 14 Smith J, Finnoff J T. Diagnostic and interventional musculoskeletal ultrasound: part 2. Clinical applications.  PM R. 2009;  1(2) 162-177
    CrossrefPubMedGoogle Scholar
  • 15 Katz J N, Simmons B P. Clinical practice. Carpal tunnel syndrome.  N Engl J Med. 2002;  346(23) 1807-1812
    CrossrefPubMedGoogle Scholar
  • 16 Wood M R. Hydrocortisone injections for carpal tunnel syndrome.  Hand. 1980;  12(1) 62-64
    PubMedGoogle Scholar
  • 17 Smith J, Wisniewski S J, Finnoff J T, Payne J M. Sonographically guided carpal tunnel injections: the ulnar approach.  J Ultrasound Med. 2008;  27(10) 1485-1490
    CrossrefPubMedGoogle Scholar
  • 18 Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome.  Cochrane Database Syst Rev. 2007;  (2) CD001554
    PubMedGoogle Scholar
  • 19 Milani P, Mondelli M, Ginanneschi F, Mazzocchio R, Rossi A. Progesterone—new therapy in mild carpal tunnel syndrome? Study design of a randomized clinical trial for local therapy.  J Brachial Plex Peripher Nerve Inj. 2010;  5 11
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Lee M J, Kim S, Huh Y M et al.. Morton neuroma: evaluated with ultrasonography and MR imaging.  Korean J Radiol. 2007;  8(2) 148-155
    CrossrefPubMedGoogle Scholar
  • 21 Bourke G, Owen J, Machet D. Histological comparison of the third interdigital nerve in patients with Morton's metatarsalgia and control patients.  Aust N Z J Surg. 1994;  64(6) 421-424
    CrossrefPubMedGoogle Scholar
  • 22 Thomson C E, Gibson J N, Martin D. Interventions for the treatment of Morton's neuroma.  Cochrane Database Syst Rev. 2004;  (3) CD003118
    PubMedGoogle Scholar
  • 23 Quinn T J, Jacobson J A, Craig J G, van Holsbeeck M T. Sonography of Morton's neuromas.  AJR Am J Roentgenol. 2000;  174(6) 1723-1728
    CrossrefPubMedGoogle Scholar
  • 24 Shapiro P P, Shapiro S L. Sonographic evaluation of interdigital neuromas.  Foot Ankle Int. 1995;  16(10) 604-606
    PubMedGoogle Scholar
  • 25 Hughes R J, Ali K, Jones H, Kendall S, Connell D A. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases.  AJR Am J Roentgenol. 2007;  188(6) 1535-1539
    CrossrefPubMedGoogle Scholar
  • 26 Fanucci E, Masala S, Fabiano S et al.. Treatment of intermetatarsal Morton's neuroma with alcohol injection under US guide: 10-month follow-up.  Eur Radiol. 2004;  14(3) 514-518
    CrossrefPubMedGoogle Scholar
  • 27 Greenfield J, Rea Jr J, Ilfeld F W. Morton's interdigital neuroma. Indications for treatment by local injections versus surgery.  Clin Orthop Relat Res. 1984;  185(185) 142-144
    PubMedGoogle Scholar
  • 28 Rasmussen M R, Kitaoka H B, Patzer G L. Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid injection.  Clin Orthop Relat Res. 1996;  326(326) 188-193
    CrossrefPubMedGoogle Scholar
  • 29 Gruber H, Kovacs P, Peer S, Frischhut B, Bodner G. Sonographically guided phenol injection in painful stump neuroma.  AJR Am J Roentgenol. 2004;  182(4) 952-954
    PubMedGoogle Scholar
  • 30 Gruber H, Glodny B, Bodner G et al.. Practical experience with sonographically guided phenol instillation of stump neuroma: predictors of effects, success, and outcome.  AJR Am J Roentgenol. 2008;  190(5) 1263-1269
    CrossrefPubMedGoogle Scholar
  • 31 Kirschner J S, Foye P M, Cole J L. Piriformis syndrome, diagnosis and treatment.  Muscle Nerve. 2009;  40(1) 10-18
    CrossrefPubMedGoogle Scholar
  • 32 Ducic I, Levin M, Larson E E, Al-Attar A. Management of chronic leg and knee pain following surgery or trauma related to saphenous nerve and knee neuromata.  Ann Plast Surg. 2010;  64(1) 35-40
    CrossrefPubMedGoogle Scholar

Alberto TagliaficoM.D. 

Department of Radiology, National Institute for Cancer Research

Largo Rosanna Benzi 10, 16132 Genoa, Italy

Email: atagliafico@sirm.org