Neuromuscular Ultrasound and Electrodiagnostic Correlates: Upper Limb, Lower Limb, and Disorders of the Phrenic Nerve/ Diaphragm Muscle

Friday, October 21, 2022

8:00 AM – 9:15 AM ET

Location: 324-326

Session Director(s)

Susan Kim, DO

Adjunct Associate Professor
UT Health at San Antonio, PM&R Program
Castroville, Texas

Disclosed no relevant financial relationships.

PDF of Slides

Faculty(s)

Colin Franz, MD, PhD

Physician-Scientist
Shirley Ryan AbilityLab
Chicago, Illinois

Disclosed no relevant financial relationships.

PDF of Slides
TL

Todd Lefkowitz, DO

Assistant Professor
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Bay Shore, New York

Disclosed no relevant financial relationships.

PDF of Slides

This session will focus on the integration of diagnostic ultrasound and electrodiagnostic studies in patients with suspected peripheral entrapment neuropathies.
We will discuss the historical background, clinical context, current controversies and expert opinions on diagnosing various peripheral entrapment neuropathies.
Specifically, we will focus on 'problem areas' encountered in electrodiagnostic practice including the determination of severity of median mononeuropathies at the wrist, attempted localization of previously designated 'non-localizable' ulnar mononeuropathies to region of the elbow and suspected entrapments of the deep motor branch or posterior interosseous nerve branch of the radial nerve at the elbow.
Given the elusive nature of etiology for fibular neuropathy at the fibula head and the difficulty with localization of pathology in tarsal tunnel syndrome, we will show how ultrasound can provide insight to better treatment options of these conditions.

In cases of phrenic motor neuropathies, we will demonstrate how ultrasound can be utilized to diagnose, monitor and prognosticate the disorders of diaphragm.
Integrated throughout the session will be 'photoessays' depicting both normal and pathological ultrasound images from the referenced medical literature and from patients in each speaker’s academic physiatric practice to further enhance learners' understanding of the presented material.
Lastly, we will briefly review current literature on how ultrasound is being utilized in PMR fields and share how each speaker has incorporated ultrasound in his/her practice.

Learning Objectives:

Define what specific ultrasound measurements are utilized in confirming focal peripheral entrapment neuropathies. Describe the specific anatomical locations and how these measurements should be made.
Describe how ultrasound can be utilized to diagnose phrenic mononeuropathy. Define what is actually being monitored when prognosticating disorders of phrenic nerve/diaphragm muscle.
As a result of attending this session, participants will be able to appreciate the strengths and shortcomings of standard electrodiagnostic techniques in diagnosing common entrapment neuropathies in the upper and lower limbs.
As a result of attending this session, participants will learn how ultrasound can complement the electrodiagnostic evaluation of peripheral focal entrapment neuropathies.
As a result of attending this session, participants will be able to visualize normal and pathological ultrasound appearances of the median, ulnar and radial nerves.