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Targeted muscle reinnervation (TMR) was originally developed as a means for increasing intuitive prosthesis control, though later found to play a role in phantom limb pain and neuroma prevention. There is a paucity of literature describing the clinical course of patients with poor TMR surgical outcomes and the value of imaging in the postoperative recovery period. This report will illustrate the potential utility of ultrasound neurography to accurately differentiate TMR surgical outcomes in two patients that received upper extremity amputation and subsequent reconstruction with TMR. Ultrasound evaluation of TMR sites in patient 1 confirmed successful reinnervation, evident by nerve fascicle continuity and eventual integration of the transferred nerve into the target muscle. Conversely, the ultrasound of patient 2 showed discontinuity of the nerve fascicles, neuroma formation, and muscle atrophy in all three sites of nerve transfer, suggesting an unsuccessful procedure and poor functional recovery. Ultrasound neurography is uniquely able to capture the longitudinal trajectory of rerouted nerves to confirm continuity and eventual reinnervation into muscle. Therefore, the application of ultrasound in a postoperative setting can correctly identify instances of failed TMR before this information would become available through clinical evaluation. Early identification of poor TMR outcomes may benefit future patients by fostering the discovery of failure mechanisms and aiding in further surgical planning to improve functional outcomes.
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http://dx.doi.org/10.1007/s00256-023-04441-1 | DOI Listing |
Eur J Radiol
December 2024
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China. Electronic address:
Objects: To investigate the specific manifestations of neurogenic and non-neurogenic tumors involving peripheral nerves on contrast-enhanced magnetic resonance neurography (CE-MRN) and explore the potential of CE-MRN in aiding differential diagnosis.
Materials And Methods: Twenty-nine patients with neurogenic tumors and 23 with non-neurogenic tumors involving peripheral nerves were enrolled in this study. Both routine MRI and CE-MRN scanning were performed on all subjects.
J Hand Surg Glob Online
November 2024
Department of Orthopaedic Surgery, Hospital for Special Surgery, Hand and Upper Extremity Service, New York, NY.
Purpose: Historically, infraclavicular brachial plexus injuries (IBPIs) were considered neuropraxic injuries that would improve with nonsurgical intervention. However, more recent studies suggest that these injuries may benefit from surgical intervention. The aims of this retrospective study were to (1) describe injury patterns and associated injuries of isolated, traumatic IBPIs, (2) evaluate the concordance of preoperative ultrasound and magnetic resonance neurography with surgical findings of patients who underwent surgical intervention for IBPIs, and (3) describe outcomes of surgical intervention for these injuries.
View Article and Find Full Text PDFJ Comput Assist Tomogr
December 2024
From the Department of Radiology.
Aim: This study aimed to analyze the differences in radiomic features of the anterior scalene muscle and evaluate the diagnostic performance of MRI-based radiomics model for neurogenic thoracic outlet syndrome (NTOS).
Materials And Methods: Imaging data of patients with NTOS who underwent preoperative brachial plexus magnetic resonance neurography were collected and were randomly divided into training and test groups. The anterior scalene muscle area was sliced in the T1WI sequence as the region of interest for the extraction of radiomics features.
Skeletal Radiol
December 2024
Royal Orthopedic Hospital, Birmingham, UK.
Peripheral nerve imaging is a powerful tool in evaluating peripheral neuropathy. This review aims to provide an overview of the anatomy, clinical significance and pathologies of small peripheral nerves, typically less than 2 mm in diameter. High frequency ultrasound probes offer the best assessment of these nerves whilst permitting real-time clinical correlation, while the role of MRI is inherently limited by spatial resolution constraints and the lack of patient contact.
View Article and Find Full Text PDFMagn Reson Imaging Clin N Am
February 2025
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, 3rd Floor, Baltimore, MD 21287, USA. Electronic address:
Entrapment neuropathies of the hip (ENH) can occur due to a variety of causes with clinical symptoms that may mimic musculoskeletal disorders. Etiologies include entrapment in a fibromuscular canal, tethering due to posttraumatic fibrosis and extrinsic compression from muscle hypertrophy or a mass. Magnetic resonance (MR) imaging enables detection and characterization of peripheral nerve pathology.
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