Role of sonography in the diagnosis of posttraumatic neuropathies and complications after surgeries involving peripheral nerves

1 Private Specialist Practice Berta Kowalska, Krakow, Poland
2 Department of Radiology, Institute of Rheumatology, Warsaw, Poland. Head of the Department: Professor Iwona Sudoł-Szopińska, MD PhD
Correspondence: Berta Kowalska, Słomczyńskiego 12/8, 31-234 Krakow, Poland, e-mail: berta.kowalska@gmail.com

Pediatr Med Rodz Vol 10 Numer 3, p. 265–269
DOI: 10.15557/PiMR.2014.0029
ABSTRACT

The most common causes for surgical procedures involving peripheral nerves are injuries and carpal tunnel syndrome. Carpal tunnel decompression surgery consists in cutting the transverse carpal ligament thereby releasing the nerve entrapped by this ligament. Following the procedure, pain symptoms should subside immediately. If the patient complains about pain that does not subside with time, it is necessary to conduct a diagnostic process. Until recently, electrophysiological tests, which determine the ability to conduct impulses, have been the gold standard. In the recent years, however, ultrasound examinations with the use of high-frequency transducers, which precisely specify the cause of postoperative complications, have been used more and more often as the first choice examination. Such an examination also enables assessment of the adjacent tissues which may be the source of persisting symptoms. This facilitates designing proper treatment. In the case of posttraumatic changes in the nerves, the neurological status (the return of sensation and motor function of the muscles innervated by a given nerve trunk) depends on the time from the procedure since nerve tissue regenerates gradually. If the healing process is incorrect, “a neuroma-in-continuity” may form when the regenerate does not penetrate to the peripheral stump and forms a chaotic scar at the reconstruction level. An ultrasound examination enables assessment of the nerve suturing site in terms of nerve trunk continuity restoration, identification of neuromas and control of their growth. Moreover, it enables adhesions to be diagnosed. Based on the interview, clinical examination as well as neurophysiological and ultrasound examinations in posttraumatic or postoperative neuropathies, one can precisely plan the management, i.e. decide whether a wait-and-see attitude should be assumed or a surgical procedure should be conducted as soon as possible.

Keywords: sonography, diagnosis, postoperative neuropathies, posttraumatic neuropathies, carpal tunnel syndrome