Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity

Lori A. Stolz, Josie G. Acuña, Kevin Gaskin, Amanda M. Murphy, Lucas Friedman, Summer Stears-Ellis, Parisa Javedani, Uwe Stolz, Srikar R Adhikari

Research output: Contribution to journalArticle

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Abstract

Aim: Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves. Material and methods: This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales. Results: 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves. Conclusions: Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.

Original languageEnglish (US)
Pages (from-to)199-204
Number of pages6
JournalMedical Ultrasonography
Volume20
Issue number2
DOIs
StatePublished - Jan 1 2018

Fingerprint

nerves
Peripheral Nerves
Forearm
visibility
Upper Extremity
Brachial Plexus
Body Mass Index
Neck
circumferences
Radial Nerve
forearm
Ulnar Nerve
Median Nerve
Aptitude
Conduction Anesthesia
Neuralgia
Observational Studies
Hospital Emergency Service
Diabetes Mellitus
Arm

Keywords

  • Nerve block
  • Peripheral nerve injection
  • Regional anesthesia
  • Ultrasonography

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Acoustics and Ultrasonics

Cite this

Stolz, L. A., Acuña, J. G., Gaskin, K., Murphy, A. M., Friedman, L., Stears-Ellis, S., ... Adhikari, S. R. (2018). Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. Medical Ultrasonography, 20(2), 199-204. https://doi.org/10.11152/mu-1240

Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. / Stolz, Lori A.; Acuña, Josie G.; Gaskin, Kevin; Murphy, Amanda M.; Friedman, Lucas; Stears-Ellis, Summer; Javedani, Parisa; Stolz, Uwe; Adhikari, Srikar R.

In: Medical Ultrasonography, Vol. 20, No. 2, 01.01.2018, p. 199-204.

Research output: Contribution to journalArticle

Stolz, LA, Acuña, JG, Gaskin, K, Murphy, AM, Friedman, L, Stears-Ellis, S, Javedani, P, Stolz, U & Adhikari, SR 2018, 'Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity', Medical Ultrasonography, vol. 20, no. 2, pp. 199-204. https://doi.org/10.11152/mu-1240
Stolz LA, Acuña JG, Gaskin K, Murphy AM, Friedman L, Stears-Ellis S et al. Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. Medical Ultrasonography. 2018 Jan 1;20(2):199-204. https://doi.org/10.11152/mu-1240
Stolz, Lori A. ; Acuña, Josie G. ; Gaskin, Kevin ; Murphy, Amanda M. ; Friedman, Lucas ; Stears-Ellis, Summer ; Javedani, Parisa ; Stolz, Uwe ; Adhikari, Srikar R. / Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. In: Medical Ultrasonography. 2018 ; Vol. 20, No. 2. pp. 199-204.
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abstract = "Aim: Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves. Material and methods: This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales. Results: 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95{\%} CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves. Conclusions: Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.",
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AU - Acuña, Josie G.

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AU - Friedman, Lucas

AU - Stears-Ellis, Summer

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AB - Aim: Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves. Material and methods: This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales. Results: 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves. Conclusions: Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.

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