Is ultrasonography useful in the diagnosis of the polyneuropathy in diabetic patients? (original) (raw)
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BMC Medical Imaging, 2012
BackgroundUsing high-resolution ultrasonography (US) to measure the median nerve cross-sectional areas (CSAs) such as in the “inching test” conducted in nerve conduction studies is a valuable tool to assess carpal tunnel syndrome (CTS). However, using this US measurement method to assess the median nerve CSA in diabetic patients with CTS has rarely been reported. Therefore, we used this US measurement method in this study to measure median nerve CSAs and to compare the CSAs of idiopathic, diabetic and diabetic polyneuropathy (DPN) patients with CTS.Methods124 hands belonging to 89 participants were included and assigned into four groups: control (32), idiopathic (38), diabetic (38) and DPN (16) CTS. In the latter two groups, only patients with mild and moderately severe CTS were included. The median nerve CSAs were measured at 8 points marked asi4,i3,i2,i1,w,o1,o2, ando3 in the inching test. The measured CSAs in each group of participants were compared.ResultsCompared with the CSAs ...
Ultrasonographic Examination of Peripheral Nerves in Diabetic Peripheral Neuropathy
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Diabetes has been a major problem in India. Its slow growth is associated with many complications, most common being peripheral neuropathy. An easy and cheap investigation to diagnose the neuropathy may help in early diagnosis and decrease the economic burden on the society. The purpose of the study was to assess the usefulness of ultrasonography (USG) in the evaluation of diabetic peripheral neuropathy (DPN). METHODS Fifty adult diabetic patients with clinically diagnosed DPN and 50 diabetics without DPN were included in the study. USG of the medial, ulnar, and common peroneal nerves was done. The mean cross-sectional area (CSA) of the involved nerves was measured in the two groups at identical positions. The CSA was compared between the two groups, and Student t-test was applied to assess statistical significance. RESULTS The mean thickness of median nerve among diabetics without DPN was significantly less at 5 cms proximal to wrist (7.34 ± 1.24 vs 11.12 ± 1.56, p<0.0001); was significantly less at mid-forearm (6.84 ± 0.77 vs 10.36 ± 1.72, p<0.0001); and was significantly less at elbow (7.36 ± 0.75 vs 10.2 ± 1.64, p<0.0001). The mean thickness of ulnar nerve among diabetics without DPN was significantly less at wrist joint (6.98 ± 0.89 vs 8.44 ± 1.34, p<0.0001); and was significantly less behind medial epicondyle (7.44 ± 0.93 vs 9.36 ± 0.98, p<0.0001). The mean thickness of common peroneal nerve among diabetics without DPN was significantly less at neck of fibula (7.26 ± 1.34 vs 9.3 ± 1.67, P<0.0001); and the mean thickness of posterior tibial nerve was also significantly less at 5 cms above medial malleolus (7.06 ± 1.25 vs 9.16 ± 1.61, P<0.0001). There was a significant increase in the CSA of the median, ulnar, posterior tibial and common peroneal, in DPN patients as compared to diabetics without DPN (p<0.05). CONCLUSIONS USG demonstrates a morphological change in patients with DPN in the form of an increase in CSAs, which was statistically significant. USG can objectively complement other diagnostic investigations such as nerve conduction studies. High resolution ultrasonography of peripheral nerves has the potential to become the investigation of first choice for the evaluation of DPN.
Diabetology
Background: Carpal tunnel syndrome is the most prevalent peripheral nerve entrapment condition of the upper limb. Among metabolic risk factors, diabetes is considered the most relevant. Although wrist ultrasound assessment of the median nerve has demonstrated a good correlation with the gold standard for the diagnosis of this syndrome, neurophysiological study, its usefulness in patients with diabetes is questionable because the compressive phenomenon is not the predominant one. Method: We conducted a retrospective study to compare the clinical and median nerve ultrasound features of patients with carpal tunnel syndrome previously diagnosed or not diagnosed with diabetes. Additionally, a linear multivariate regression analysis was performed to determine to what extent the cross-sectional area of the median nerve was dependent on the condition of diabetes by fixing other variables such as sex, age, or time of evolution. Results: We included 303 records of patients (mean age 44.3 ± 11...
Journal of Ultrasonography
Aim: To evaluate and measure the mean cross-sectional area of the tibial and median nerves in patients with diabetic peripheral neuropathy, and to study the association between high-resolution ultrasonographic findings in diabetic peripheral neuropathy with the duration of illness, glycosylated haemoglobin values, random blood sugar levels, and aesthesiometry (using monofilament examination). Material and methods: A prospective observational study was conducted among 63 patients who were diagnosed with type 2 diabetes mellitus and underwent ultrasound and monofilament examinations. The cross-sectional area of the median nerve of the dominant hand and the tibial nerves was calculated on ultrasound examination. Results: The mean cross-sectional area of the median and tibial nerves was higher in patients with poor glycaemic control, with the mean cross-sectional area of the median nerve being 10.9, 12.8, 13.0, and 12.9 mm2 at various points in the leg in cases where the monofilament ex...
Rheumatology Research
Diabetes mellitus (DM) is a common metabolic disease associated with carpal tunnel syndrome (CTS) and tendinopathy. This study aimed to assess the ultrasonographic (US) parameters of the flexor tendon and median nerve in asymptomatic subjects with diabetes in comparison with controls without diabetes. In this study, 22 DM and 22 non-DM subjects with no symptoms or manipulations in non-dominant hands and wrists were assessed. Ultrasound evaluations of the length, width, cross-sectional area, and circumference of the fourth flexor tendon and the median nerve were performed in the two groups. There was no statistically significant difference in age (P value= 0.473), gender (P value= 0.364), or wrist circumference (P value= 0.1921) between the groups. This study showed no significant difference between the two groups in median nerve length (P value= 0.35), width (P value= 0.17), cross-sectional circumference (P value= 0.23), or cross-sectional area (P value= 0.16). Also, a comparison of the sonographic data of the fourth flexor tendon between the two groups presented no significant difference in length (P value = 0.68), width (P value= 0.80), cross-sectional circumference (P value= 0.70), or cross-sectional area (P value= 0.80). In conclusion, data from the present study showed that sonographic values of the median nerve and fourth flexor tendon in asymptomatic subjects with DM did not differ significantly with those of non-diabetics. These findings demonstrate that still more case studies and more evaluations are required to validate the applicability of ultrasonography in the prediction of carpal tunnel syndrome and tendinopathy in diabetic patients.
Muscle & Nerve, 2013
Introduction: Diabetic polyneuropathy (DPN) is increasingly prevalent in the USA, but nerve ultrasound (US) findings have not been assessed systematically. Our aim was to establish the sonographic characteristics of lower extremity nerves in DPN and correlate them with electrodiagnostic (EDx) findings. Methods: Consecutive patients (n ¼ 25) with evidence of DPN and 25 patient controls without DPN underwent blinded US imaging of the fibular and sural nerves. Nerve cross-sectional area (CSA), diameter and echogenicity were recorded. Results: There were no differences in fibular or sural nerve CSA, diameter, or echogenicity between the 2 groups. No correlations between nerve CSA and EDx studies were found. In DPN, there were moderate inverse correlations with age (r ¼ À0.44 sural ankle, r ¼ À0.39 sural leg, r ¼ À0.45 fibular ankle). Conclusions: US measurements of lower extremity nerves in DPN do not differ from controls or correlate with EDx findings. Novel US techniques and/or pedal nerve US may be necessary to detect differences.
Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine, 2009
Objective. Diabetes mellitus is becoming a major cause of premature disability in Japan, and peripheral neuropathy is a common complication of diabetes. The aim of this study was to evaluate the relationship between the results of nerve conduction studies (NCS) and the size of the nerve determined by sonography in diabetic patients. Methods. Twenty diabetic patients (mean age ± SD, 57.1 ± 13.6 years) and 20 healthy volunteers (mean, 61.1 ± 8.9 years) were enrolled in this study. Patients' wrists that had symptoms of carpal tunnel syndrome were not included in the study; those that were included had negative Phalen test results. We then divided the patients into 2 groups (patients with and without diabetic symmetric polyneuropathy [DPN]). The cross-sectional area (CSA) was measured in the carpal tunnel 5 cm proximal to the wrist and elbow joint of the median nerve. Results. There was a significant increase in the CSA in patients with DPN in the carpal tunnel compared with the control participants (P < .01) and patients without DPN (P < .01). The CSA in the carpal tunnel showed a significant correlation with the motor nerve conduction velocity (r = -0.473). Conclusions. The CSA of the median nerve in the carpal tunnel of patients with DPN is greater than that in patients without DPN and healthy individuals and correlates with NCS.
Alexandria Journal of Medicine, 2017
Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Nerve conduction studies (NCS) is the most valid way of diagnosing CTS in combination of these clinical symptoms together with positive signs by physical examination. Ultrasonography is a useful non-invasive diagnostic method for CTS and there is considerable correlation between the electrophysiological tests and the measurements of cross-sectional area (CSA) by ultrasonography. Many studies have shown that the carpal tunnel syndrome seems to occur more frequently in patients with diabetes mellitus and might be associated with the duration of diabetes mellitus, microvascular complications and degree of glycemic control. Although diabetes mellitus is a risk factor for CTS, reports about median nerve CSA measurements between CTS patients with and without DM are scant. This prospective study aimed to evaluate whether or not ultrasonographic findings of the median nerve is different between DM and non-DM-CTS patients. To correlate the diagnostic results in both DM and non-DM-CTS patients. Patients and methods: Thirty six non-diabetic patients and twenty five diabetic patients with CTS were assessed. All patients were subjected to thorough history taking, full clinical examination, electrophysiological assessment of wrists and gray scale ultrasonography (US). Results: High mean cross sectional area of median nerve (CSA) on ultrasonographical studies was detected with non-significant difference between both groups. Additionally, a non-significant difference for flattening ratio was found between two groups. Moreover, there was a highly significant positive correlation between electro diagnostic and ultrasonographic results in diabetic patients. Conclusion: The CSA of median nerve is larger in CTS hands in both DM and non-DM patients. Mean electro-diagnostic parameters were not significant predictors of CTS in patients with diabetes. The combination of electrophysiological and ultrasonography provides diagnostic effective tools across the entire spectrum of CTS in diabetic and non-diabetic patients. Nevertheless, screening for DM in patients with CTS is not recommended.
BIRDEM Medical Journal, 2017
Background: Patients with diabetic peripheral neuropathy (DPN) have distal, symmetrical form of the disorder characterized by numbness, burning feet, pins-and-needles sensations and lightning pain. This study was designed to find out the difference between 2 Dimentional (D)-Brightness (B) mode high resolution ultrasonographically measured cross sectional areas of median nerve in type 2 diabetic patients with peripheral neuropathy and those of non-diabetic healthy adult subjects.Methods: This case-control study was done on 180 subjects aged 27-67 years in the department of Radiology and Imaging, BIRDEM from January 2012 to December 2013. Out of them 90 diabetic patients with peripheral neuropathy diagnosed electrophysiologically by nerve conduction study (NCS) were considered study group and age, sex and weight compatible 90 healthy subjects were considered as control group. Measurement of cross sectional areas of median nerve was performed first by the investigator himself purposefu...
Ultrasonographic Assessment of Carpal Tunnel Syndrome Severity
American Journal of Physical Medicine & Rehabilitation, 2019
Background: Using high-resolution ultrasonography (US) to measure the median nerve cross-sectional areas (CSAs) such as in the "inching test" conducted in nerve conduction studies is a valuable tool to assess carpal tunnel syndrome (CTS). However, using this US measurement method to assess the median nerve CSA in diabetic patients with CTS has rarely been reported. Therefore, we used this US measurement method in this study to measure median nerve CSAs and to compare the CSAs of idiopathic, diabetic and diabetic polyneuropathy (DPN) patients with CTS. Methods: 124 hands belonging to 89 participants were included and assigned into four groups: control (32), idiopathic (38), diabetic (38) and DPN (16) CTS. In the latter two groups, only patients with mild and moderately severe CTS were included. The median nerve CSAs were measured at 8 points marked as i4, i3, i2, i1, w, o1, o2, and o3 in the inching test. The measured CSAs in each group of participants were compared. Results: Compared with the CSAs of the control group, enlarged CSAs were found in the idiopathic, diabetic and DPN CTS groups. The CSAs were larger at i4, i3 and i2 in the diabetic CTS group compared to the idiopathic CTS group. The CSAs measured at the i1 and w levels of the DPN CTS group were smaller than those of the diabetic CTS group. In the diabetic CTS group, the cutoff values of CSAs measured at the inlet, wrist crease, and outlet were 15.3 mm 2 , 13.4 mm 2 and 10.0 mm 2 , respectively, and 14.0 mm 2 , 12.5 mm 2 and 10.5 mm 2 , respectively, in the DPN CTS group.