Peripheral Nerves: Ultrasound-Guided Interventional Procedures

Alberto Tagliafico; Gerd Bodner; Ilan Rosenberg; Federigo Palmieri; Isabella Garello; Luisa Altafini; Carlo Martinoli

doi:10.1055/s-0030-1268066

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2010; 14(5): 559-566
DOI: 10.1055/s-0030-1268066

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

Abstract

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

Full Text

References

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
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
3 Griffin J, Nicholls B. Ultrasound in regional anaesthesia. Anaesthesia. 2010; 65(Suppl 1) 1-12
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
5 Chipman J N, Mott R T, Stanton C A, Cartwright M S. Ultrasonographic Tinel sign. Muscle Nerve. 2009; 40(6) 1033-1035
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
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
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
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
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
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
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
13 Smith J, Finnoff J T. Diagnostic and interventional musculoskeletal ultrasound: part 1. Fundamentals. PM R. 2009; 1(1) 64-75
14 Smith J, Finnoff J T. Diagnostic and interventional musculoskeletal ultrasound: part 2. Clinical applications. PM R. 2009; 1(2) 162-177
15 Katz J N, Simmons B P. Clinical practice. Carpal tunnel syndrome. N Engl J Med. 2002; 346(23) 1807-1812
16 Wood M R. Hydrocortisone injections for carpal tunnel syndrome. Hand. 1980; 12(1) 62-64
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
18 Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007; (2) CD001554
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
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
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
22 Thomson C E, Gibson J N, Martin D. Interventions for the treatment of Morton's neuroma. Cochrane Database Syst Rev. 2004; (3) CD003118
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
24 Shapiro P P, Shapiro S L. Sonographic evaluation of interdigital neuromas. Foot Ankle Int. 1995; 16(10) 604-606
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
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
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
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
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
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
31 Kirschner J S, Foye P M, Cole J L. Piriformis syndrome, diagnosis and treatment. Muscle Nerve. 2009; 40(1) 10-18
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

Alberto TagliaficoM.D.

Department of Radiology, National Institute for Cancer Research

Largo Rosanna Benzi 10, 16132 Genoa, Italy

Email: atagliafico@sirm.org