Examination of Postoperative Peripheral Nerve Lesions with High-Resolution Sonography
Siegfried Peer1,
Gerd Bodner1,
Romed Meirer2,
Johann Willeit3 and
Hildegunde Piza-Katzer2
1
Department of Radiology, University Hospital Innsbruck, Anichstraße 35,
A-6020 Innsbruck, Austria.
2
Department of Plastic and Reconstructive Surgery, University Hospital
Innsbruck and Ludwig Boltzmann Institute of Quality Control in Plastic
Surgery, A-6020 Innsbruck, Austria.
3
Department of Neurology, University Hospital Innsbruck, A-6020 Innsbruck,
Austria.
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Fig. 1A. —57-year-old man after ulnar nerve decompression. Longitudinal
sonogram through ulnar nerve shows thickening and markedly edematous swelling
of single nerve fascicles but unimpaired perineurium and surrounding soft
tissues (arrows).
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Fig. 1B. —57-year-old man after ulnar nerve decompression. Longitudinal
sonogram of unaffected side shows normal fascicular pattern
(arrows).
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Fig. 2A. —79-year-old man with persistent pain after ulnar nerve
decompression. Longitudinal sonogram through ulnar nerve at level of elbow
shows marked edematous swelling of nerve, with hypoechoic fascicles
(arrows).
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Fig. 2B. —79-year-old man with persistent pain after ulnar nerve
decompression. Transverse sonogram shows enlarged diameter of nerve (short
arrow) and encasing scar (long arrows).
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Fig. 2C. —79-year-old man with persistent pain after ulnar nerve
decompression. Operative photograph confirms marked edematous swelling of
nerve.
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Fig. 3A. —70-year-old woman after repair of humeral shaft fracture.
Longitudinal sonogram shows radial nerve stretched across compression plate
(short arrow) and markedly swollen (long arrows).
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Fig. 3B. —70-year-old woman after repair of humeral shaft fracture.
Operative photograph with surgical correlation confirms radial nerve
(arrows) stretched alongside compression plate.
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Fig. 4. —20-year-old woman with radial nerve palsy after repair of
humeral shaft fracture. Longitudinal sonogram reveals swollen fascicles of
radial nerve (short thin arrows) traversing under encasing
hypertrophic callus with posterior acoustic shadowing (thick
arrow).
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Fig. 5. —55-year-old man after lower leg amputation due to severe
arteriosclerotic disease. Longitudinal sonogram shows nerve with globular mass
on one end and distal discontinuity consistent with stump neuroma.
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Fig. 6. —18-year-old woman with primary nerve suture after traumatic
dissection of ulnar nerve at level of forearm. Longitudinal sonogram shows
part of nerve fascicles in normal continuity (long arrows), but gap
at surface of nerve, with discontinuity of some nerve fibers. Although
continuous fascicles appear normal, there is marked edematous swelling of
discontinuous elements (short arrow).
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Fig. 7A. —Decompression of ulnar nerve at level of Guyon's canal
compared with normal nerve. Transverse sonogram of affected side in
27-year-old man reveals that decompressed nerve is markedly swollen and
surrounded by scar tissue (arrows). Internal architecture of nerve is
disorganized; therefore, neuroma was suspected. On subsequent surgery, only
swollen fascicles and tight scar formation, but no neuroma, were seen.
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Fig. 7B. —Decompression of ulnar nerve at level of Guyon's canal
compared with normal nerve. Transverse sonogram of unaffected side in
27-year-old man (same patient as in A) shows normal nerve diameter and
internal structure (arrow) and normal surrounding soft tissues.
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Fig. 7C. —Decompression of ulnar nerve at level of Guyon's canal
compared with normal nerve. Transverse sonogram of surgically proven neuroma
(arrow) in 40-year-old man who underwent tbial correction osteotomy
is shown for comparison.
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Copyright © 2001 by the American Roentgen Ray Society.
