Disclosures: Ryan P. Nussbaum, DO: No financial relationships or conflicts of interest

Objective: The goal was to determine how neuromuscular ultrasound is being used in clinical practice to augment the care of patients with peripheral nerve injury (PNI). To this end, we retrospectively analyzed a series of clinical cases treated in a PM&R-based PNI specialty clinic. Neuromuscular ultrasound evaluations were either completed in point of care fashion by neuromuscular-certified Physiatrist, or completed as part of a formal diagnostic imaging order by the radiology department. PNI ultrasound evaluations were frequently performed to augment the localization of lesions as well as to evaluate for multifocal lesions, which can be challenging to determine by electrodiagnostic methods alone.

Design: Case Series Setting : Inpatient neuromuscular consult service and outpatient peripheral nerve injury specialty clinic Participants : 10 participants to date. The majority had experienced a traumatic incident resulting in circumstances such as: brachial plexopathy with superimposed mononeuropathy, single or multiple mononeuropathy requiring lesion localization, and differentiating single extremity weakness from spinal cord syrinx versus mononeuropathy lesion. There were 2 non-traumatic cases involving compression from a neurofibroma and ganglion cyst.

Interventions: Peripheral nerve consultation including physical exam, electrodiagnostic study, and diagnostic ultrasound.

Main Outcome Measures: These include comparing the peripheral nerve evaluation results between physical exam, electrodiagnostic assessment, and ultrasound examination. Also, the treatment plan was identified based upon the consultation evaluation.

Results: All patients had congruent findings on physical exam, electrodiagnostic study, and ultrasound. The ultrasound examinations were able to improve the peripheral nerve evaluations and provide pertinent information that changed the care plans. Treatment plans for peripheral nerves ranged from conservative care involving physical therapy to intervention with plastic surgery such as neuroplasty of nerve roots, neuroplasty of brachial plexus, individual nerve release, and nerve transfers. Conclusions: This case series provides evidence for ultrasound examination in combination with electrodiagnostic studies and physical exam to determine a precise diagnosis and management plan for acute plexopathies and mononeuropathies.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/seeing-is-believing-neuromuscular-ultrasound-as-an-ancillary-to-electrodiagnostics-to-improve-the-management-of-peripheral-nerve-injuries/