Stroke Rehabilitation Recovery Botox Neal S. Taub, MD, PA Physiatrist

 

 

 

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Ultrasound for evaluation of the carpal tunnel syndrome and other painful conditions of the wrist

 

 

 

 

 

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Seven Requirements for Prescribing Opiates

 

 

 

 

 

 

 

 

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Doctor Shopping and Your Patients with Chronic Pain

 

 

A Letter Released to Physicians on March 9, 2007

 

Ultrasound for Evaluation of the Wrist

 

Over the past few years, advancements in transducers, frequency, and technique of ultrasound have made ultrasonography a valuable tool in the diagnosis of specific conditions of the wrist such as carpal tunnel syndrome.  However, ultrasonography of the wrist is detailed.  Ultrasonography has a long learning curve, and multiple authorities have commented on the importance of examiner expertise in the use of diagnostic ultrasound.1-3  For these reasons, when you seek further testing for confirmation of your clinical evaluations, I invite you to refer patients to me, Dr. Neal Taub.  I am a medical doctor, board certified in both physical medicine and electromyography.  At my physiatry practice, I can provide ultrasonography complimented by electromyography and follow-up muscle testing for a definitive diagnosis or rule out of carpal tunnel syndrome or cubital tunnel syndrome.

What Every Practitioner Should Know About Ultrasonography and Upper Extremity Evaluation

 

·        Published research over the past seven years demonstrates that ultrasonography can diagnostically image the anatomy of the carpal tunnel, cubital tunnel, median nerve, and most superficial body structures.4-7

·        Ultrasonography can detect entrapment neuropathies, nerve enlargement, traumas, infectious disorders, tumors, expandable lesions, and muscle atrophy.5,8,9   Ultrasound proves more accurate than MRI at measuring the size of nerves.  This is important in diagnosing nerve inflammation.

·        When diagnosing neuropathies, ultrasonography serves as a more comfortable, less costly, faster alternative to MRI.

·        Ultrasound provides the option of dynamic imaging examinations.

·        Ultrasound and EMG are mutually complimentary diagnostic tools.  In 15% to 27% of symptomatic patients with focal neuropathies, only one of the two techniques revealed pathologic findings.3,8  Researchers showed nerve conduction studies to have a sensitivity of 78% when trying to verify ulnar neuropathy at the elbow.  When ultrasound and EMG are used together, sensitivity rises to 98%.10

·        Ultrasound and EMG can help predict the value of conservative treatment.  More pronounced nerve thickening as seen with ultrasonography correlates with poor outcome.  Electrodiagnostic signs of demyelination correlate with more favorable outcomes.11

·        Ultrasound can differentiate neuropathies from myopathies and facilitate disease tracking and therapy.13

 

Please tell your patients about

Neal S. Taub, MD, Physiatrist

 

 

References

1.        Jayaraman S, Naidich T. “The carpal tunnel: ultrasound display of normal imaging anatomy and pathology.” Neuroimaging Clin N Am. 2004; 14 (1): 103-13.

2.        Bianchi S, Martinoli C, Montet X. “Sonography of the hand and wrist.” Radiologe. 2003; 43 (10): 831-40.

3.        Bargfrede M; Schwennicke A, Tumani H. “Quantitative ultrasonography in focal neuropathies as compared to clinical and EMG findings.” Eur J Ultrasound. 1999; 10 (1): 21-9.

4.        Beekman R; van den Berg L, Franssen H. et al. “Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy.” Neurology. 2005; 65 (2): 305-7.

5.        Wiesler E, Chloros G, Cartwright M. “Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel.” J Hand Surg [AM]. 2006; 31 (7): 1088-93.

6.        Bianchi S, Martinoli C, Sureda D. “Ultrasound of the hand.” Eur J Ultrasound. 2001; 14 (1): 29-34.

7.        Doohi L, Dauphinee D. “Using Diagnostic Ultrasound and Neurosensory Testing to Select Candidates for Nerve Decompression.” J Am Podiatr Med Asso. 2005; 95 (5): 433-437.

8.        Schwennicke A, Bargfrede M, Reimers C. “Clinical, electromyographic, and ultrasonographic assessment of focal neuropathies.” J Neuroimaging. 1998; 8 (3): 136-43.

9.        Bacigalupo L, Bianchi S, Valle M. “Ultrasonography of peripheral nerves.” Radiologe. 2003; 43 (10): 841-9.

10.      Beekman R, Van Der Plass j, Uitdehaag B, et al. “Clinical, electrodiagnostic, and sonographic studies in ulnar neuropathy at the elbow.” Muscle Nerve. 2004; 30 (2): 202-8.

11.      Beekman R; Wokke J, Schoemaker M, et al. “Ulnar neuropathy at the elbow: follow-up and prognostic factors determining outcome.” Neurology. 2004; 63 (9): 1675-80.

12.      Marquardt G, Angles S, Leheta F. “Median nerve compression caused by a venous aneurysm. Case report.” J Neurosurg. 2001; 94 (4): 624-6.

13.      Maurits N, Bollen A, Windhausen A. “Muscle ultrasound analysis: normal values and differentiation between myopathies and neuropathies.” Ultrasound Med Biol. 2003; 29 (2): 215-25.

 

 

 

 

Phone: (704) 442-9805          3535 Randolph Rd, Ste 208          Charlotte, NC  28211

 

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