Ultrasound-guided needle electromyography of the extensor carpi radialis longus and brevis muscles for preoperative tendon transfer planning in cervical spinal cord injuries: technique description and case report.

Reconstructive surgery, including tendon transfers, can potentially offer marked improvement in function in those with cervical spinal cord injuries. Given the anatomic redundancy of both the extensor carpi radialis longus (ECRL) and brevis (ECRB) in producing active wrist extension, one muscle can be utilized as a donor for a tendon transfer without sacrificing wrist extension. Needle electromyography (EMG) does not routinely evaluate the ECRL and ECRB, and the functional status of each muscle is difficult to discern based on clinical exam alone.

Diagnostic Neuromuscular Ultrasonography of Spinal Accessory Nerve Injury After Cosmetic Rhytidectomy.

Iatrogenic spinal accessory nerve (SAN) injuries can occur as complications of posterior triangle of the neck surgery, resulting in lateral scapular winging and a shoulder droop. Rarely has this complication been described after a cosmetic rhytidectomy (face-lift procedure). Here, we present two cases of iatrogenic SAN injuries that occurred after cosmetic rhytidectomies.

Ultrasonographic Identification of Pacinian Corpuscles in the Hand: A Pilot Study of Technique and Reliability.

Introduction/aims: Pacinian corpuscles are end organs of the sensory nervous system. The size and superficial location of Pacinian corpuscles allows them to be visualized with high-resolution ultrasound. This pilot study sought to assess the reliability of Pacinian corpuscle counting in the hand using ultrasound.

Neuromuscular Ultrasound Assessment of the Median Nerve at the Wrist and Forearm: A Reproducibility and Reliability Study in Nonphysician Sonographers.

Introduction/aims: Neuromuscular ultrasound (NMUS), initially performed by physicians, is increasingly performed by technicians in many electrodiagnostic (EDX) laboratories for certain studies under physician supervision. The aims of this study were to determine: (1) the reproducibility of nonphysician sonographers' assessments of the median nerve and (2) the need for ongoing training to maintain the reproducibility and reliability of median nerve ultrasound assessments.

Methods: The median nerve was examined sonographically in a healthy volunteer by 12 nonphysicians on 3 separate occasions: Day 1 and then 2 weeks (Day 2) and 4 months (Day 3) later.

Ultra High-Frequency Ultrasound of Median Nerve Fascicles at the Wrist in Amyotrophic Lateral Sclerosis: An Exploratory Study.

Purpose: High-frequency ultrasound (HFUS) of muscle and nerve has the potential to be a reliable, responsive, and informative biomarker of disease progression for individuals with amyotrophic lateral sclerosis (ALS). High-frequency ultrasound is not able to visualize median nerve fascicles to the same extent as ultra-high-frequency ultrasound (UHFUS). Evaluating the number and size of fascicles within a nerve may facilitate a better understanding of nerve diseases.

Determining the degree of proximal nerve fascicle rotation in healthy controls using ultrahigh-frequency neuromuscular ultrasound: A pilot study.

Introduction/aims: Ultrahigh-frequency ultrasound (UHFUS) allows improved visualization and higher resolution images of nerve fascicles than standard high-frequency ultrasound. Dynamic UHFUS may detect the presence of fascicular entwinement, the recently described sonographic phenomenon of pathologic fascicular rotation seen in neuralgic amyotrophy. This pilot study aims to establish normative reference values and degrees of fascicular rotation for the proximal portions of commonly involved upper limb nerves in healthy controls using UHFUS.

The Role of Neuromuscular Ultrasound in the Diagnosis of Peripheral Neuropathy.

The classification of peripheral neuropathies has traditionally been based on etiology, electrodiagnostic findings, or histopathologic features. With the advent of modern imaging, they now can also be characterized based on their varied distribution of imaging findings. We describe the major morphologic patterns of these changes, which include homogeneous enlargement; homogeneous thinning; focal, multifocal, and segmental enlargement; and focal thinning and beading (multifocal thinning).

A Late Diagnosis of Andersen-Tawil Syndrome in Teenage Siblings.

Background: Andersen-Tawil syndrome (ATS) is a rare autosomal dominant disorder characterized by a classic symptom triad, including periodic paralysis, ventricular arrhythmias with associated prolonged QT interval and U waves, and dysmorphic facial and skeletal features. Pathogenic variants of the KCNJ2 gene are linked to ATS.

Methods: We present two siblings with the same pathogenic mutation and facial characteristic of hypotelorism, yet with intrafamilial and sex-specific variability.

Paradoxical thinning of the diaphragm on ultrasound is a risk factor for requiring non-invasive ventilation in patients with neuromuscular diaphragmatic dysfunction.

Introduction/aims: Point-of-care ultrasound of the diaphragm is highly sensitive and specific in the detection of neuromuscular diaphragmatic dysfunction. In some patients with neuromuscular diaphragmatic dysfunction, paradoxical thinning of the diaphragm during inspiration is observed on ultrasound; however, its frequency, electrodiagnostic associations, and prognostic significance remain uncertain.

Methods: Medical records of patients presenting to two electrodiagnostic laboratories (Mayo Clinic, Rochester, Minnesota and University of Alberta, Edmonton, Alberta) from January 1, 2022 to December 31, 2022, for evaluation of suspected neuromuscular respiratory failure, were reviewed.

Ultra high-frequency ultrasound of fascicles in the ulnar and radial nerves.

Introduction/aims: Ultra high-frequency ultrasound (UHFUS) has been demonstrated to allow easy visualization and quantification of median and digital nerve fascicles; however, there is a lack of normative data for other upper limb nerves. The purpose of this study was to use UHFUS to establish normative reference values and ranges for fascicle count and density within selected upper extremity nerves.

Methods: Twenty-one healthy volunteers underwent sonographic examination of the ulnar, superficial branch of the radial, and radial nerves on one upper limb using UHFUS with a 48 MHz linear transducer.

Clinical Utility and Diagnostic Yield of Genetic Testing for Inherited Neuromuscular Disorders in a Single, Large Neuromuscular Center.

Background And Objectives: Most published studies on the clinical utility of genetic testing for neuromuscular diseases (NMDs) focus on disease-specific cohorts and/or involve multiple centers. The aim of this study was to examine the clinical utility and diagnostic yield of genetic testing at a single, large neuromuscular center. Unlike previous studies, this study is unique in that it includes a broad array of patients at a single, large neuromuscular center, providing real-world data that may assist both neuromuscular specialists as well as general neurologists in decision-making regarding the need for genetic testing in patients with suspected NMDs.

Diagnostic Neuromuscular Ultrasound to Confirm Clinical Significance of a Genetic Variant for Charcot-Marie-Tooth Type 4C: A Case Report.

Neuromuscular ultrasound has emerged as a beneficial, complementary tool to electromyography (EMG) in the diagnosis of neuromuscular diseases as it provides high-resolution anatomic imaging of peripheral nerves and muscles. It has been used previously as an adjunct to EMG to diagnose Charcot-Marie-Tooth disease. Here, we present a case of a 64-yr-old man with bilateral sensorineural hearing loss of 14 yrs who presented to an outpatient neuromuscular clinic at a tertiary medical center with very slow progressive paresthesias.

Ultrahigh-frequency ultrasound of fascicles in the common fibular, superficial fibular, and sural nerves.

Introduction/aims: While ultrasound assessment of cross-sectional area and echogenicity has gained popularity as a biomarker for various neuropathies, there is a scarcity of data regarding fascicle count and density in neuropathies or even healthy controls. The aim of this study was to determine whether fascicles within select lower limb nerves (common fibular, superficial fibular, and sural nerves) can be counted in healthy individuals using ultrahigh-frequency ultrasound (UHFUS).

Methods: Twenty healthy volunteers underwent sonographic examination of the common fibular, superficial fibular, and sural nerves on each lower limb using UHFUS with a 48 MHz linear transducer.