American Society for Peripheral Nerve
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Ultrasound as a Useful Tool for Peripheral Nerve Surgeons: Examples in Clinical Practice
Pathik Aravind, MBBS1; Rafael Felix P. Tiongco, BA1; Colton McNichols, MD1; Williams Eric, MD2
1Johns Hopkins University School of Medicine, Baltimore, MD; 2Johns Hopkins School of Medicine Division of Plastic Surgery, Dellon Institute for Peripheral Nerve Surgery, Towson, MD

Background: Peripheral nerve surgeons often require additional imaging for examination, diagnostic testing, and preoperative planning. Ultrasonography (US) is a cost-effective, accessible, and well-established technique that can meet this need in patients with select peripheral nerve pathologies. With this knowledge, the properly trained surgeon may perform US-guided nerve blocks to accurately diagnose and treat causes of neuropathic pain. We therefore offer this paper, not as an exhaustive review, but as a selection of various peripheral nerve pathologies, which the senior author treats, and their associated US examination findingsto encourage and inspire surgeons to incorporate US into their practices.
Materials and Methods: We provide various cases from our outpatient peripheral nerve clinic demonstrating relevant USanatomy. We also review techniques for US nerve blocks with relevant anatomic landmarks.
Results: US imaging successfully assisted in identification and injection techniques for various peripheral nerve pathologies in a peripheral nerve surgeonís practice. US examples were presented from the neck, trunk, upper extremity, and lower extremity. Examples include the greater occipital nerve(Fig 1.), genitofemoral, median nerve (Fig 2.), medial antebrachial cutaneous, deep peroneal, sural nerve (Fig. 3), and tibial nerve.
Conclusions: US is a widely available, useful tool for peripheral nerve surgeons to help identify peripheral nerve structures, allowing the surgeon with appropriate training to perform a variety of ultrasound-guided diagnostic measurements and diagnostic and/or therapeutic injections. We believe US is advantageous for the peripheral nerve surgeon, who is ideally suited to perform many of these examinations. The real-time information provided by US may improvesatisfaction to both the surgeon and the patient by potentially increasing diagnostic accuracy and shortening the diagnostic interval for peripheral nerve pathologies including neuromas and nerve compressions. We highly encourage residency programs to increase trainee exposure to US in peripheral nerve surgery, and encourage practicing reconstructive surgeons to seek appropriate training with hands-on US workshops specifically tailored to their clinical needs.



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