Sonographic Evaluation Of Nerve Thickness In Traumatic Lower-Limb Amputees
Condition: Amputation, Traumatic
MeSH terms: Amputation, Traumatic
Study type: Observational [Patient Registry]

Summary: 
      Lower limb amputation (LLA) commonly affects young and active people who have long life
      expectancy. It is a major surgery causing many functional deficiencies which can reduce
      overall health quality and physical condition of the wounded persons and necessitating a
      multidisciplinary rehabilitation programme. High-frequency ultrasonography (US) is useful in
      evaluating peripheral nerves because of it has many superiority to other techniques. The
      advantages of US is; it has high resolution but no ionized radiation. It is possible to make
      dynamic and real-time imaging. It was showed that US have the same specificity and more
      sensitivity than magnetic resonance (MR) imaging in evaluating peripheral nerves. The aim of
      this study is to evaluate the sciatic, tibial and peroneal nerves of traumatic lower-limb
      amputees with the help of sonography and find the relationship between sonographic values and
      clinical characteristics.
    

Detailed description: 
      A total of thirty-three participants (age range 18-65) who had lower extremity amputation due
      to traumatic injury and were followed up in tertiary amputee clinic were included in this
      cross-sectional trial. The study was conducted between April 2019 and April 2020.
      Participants were totally volunteers and informed about the nature of the study. Written
      informed consent was obtained prior to assessment from all individuals. The study was
      conducted by the latest version of the principles of the Declaration of Helsinki protocol.
      All procedures were in consistency with the Helsinki Declarations of 1975. The study was
      approved by the local ethical committee.

      All patients had completed stump healing. Patients with any disease affecting the peripheral
      nerves (eg, diabetes mellitus, infections, metabolic problems, inherited causes, and exposure
      to toxins) were excluded.

      Demographic and clinical characteristics of the participants including age, gender,
      amputation findings (etiology, time since amputation, level, and side), prosthesis use
      findings (time since prosthesis use, daily use time, type, type of liner, prosthetic foot
      type), and functional K level of activity after amputation were recorded.

      The presence, etiology, and duration of pain were questioned, and the intensity of pain was
      assessed by visual analog scale (VAS). Leeds Assessment of Neuropathic Symptoms and Signs
      (LANSS) was used to evaluate neuropathic pain for the residual limb. The patient's
      satisfaction with the current prosthesis was evaluated numerically between 0 (not satisfied
      at all) and 10 (completely satisfied).

      All ultrasonographic examinations were performed by a single physiatrist experienced in
      musculoskeletal sonography. A 5-12 MHz linear transducer (Logic e portable; GE Healthcare,
      China) was used. To optimize image quality, minimal pressure was applied to the transducer.
      Each examination was performed bilaterally while patients were in the prone position. The
      full course of the sciatic nerve (SN), tibial nerve (TN), and common peroneal nerve (CPN) was
      assessed in a craniocaudal direction starting from the subgluteal fold to the popliteal
      fossa. The probe was placed axially on the nerves (perpendicular to the nerve) and the
      cross-sectional area (CSA) was measured at the same level proximal to the bifurcation for the
      SN (Figure 1), and at a point distal to the bifurcation of the SN for the TN and CPN (Figure
      2). The values from the normal sides were accepted as controls. The presence of a neuroma was
      also evaluated throughout the nerve, particularly at the distal ends.
    

Intervention name(s): ultrasonography
Intervention type(s): Diagnostic Test
Intervention description(s): All ultrasonographic examinations were performed by a single physiatrist experienced in musculoskeletal sonography. The full course of the sciatic nerve (SN), tibial nerve (TN), and common peroneal nerve (CPN) was assessed in a craniocaudal direction starting from the subgluteal fold to the popliteal fossa. The probe was placed axially on the nerves (perpendicular to the nerve) and the cross-sectional area (CSA) was measured at the same level proximal to the bifurcation for the SN , and at a point distal to the bifurcation of the SN for the TN and CPN (Figure 2). The values from the normal sides were accepted as controls.
Observational model: Case-Crossover
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        A total of thirty-three participants (age range 18-65) who had lower extremity amputation
        due to traumatic injury and were followed up in tertiary amputee clinic were included in
        this cross-sectional trial. All patients had completed stump healing. Patients with any
        disease affecting the peripheral nerves (eg, diabetes mellitus, infections, metabolic
        problems, inherited causes, and exposure to toxins) were excluded.
      
Keywords: Amputation; Prosthesis; peripheral nerves; ultrasonography