Neuromuscular Ultrasound in Correlation to Neurophysiological Findings

Study Overview
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Brief Summary
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Study the neuromuscular ultrasound findings in different types of neuropathies correlation between ultrasound and neurophysiological findings in peripheral nerve diseases correlation between clinical pain scale and severity of neuropathy

Detailed Description
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Ultrasonography is a diagnostic tool that is increasingly used in the work-up of peripheral nerve disease. As many peripheral nerves run a superficial course, especially in the arms. This is a big advantage over Magnetic Resonance Imaging that is relatively expensive, time consuming and not readily available everywhere. Nerve cross-sectional area (CSA) can be determined at multiple sites along the nerve. CSA can be measured at entrapment sites but also at nonentrapment sites. vascularization, echogenicity, fascicular pattern and endoneurial thickness can be investigated as well. All those modalities can give critical insight in the origin and development of various peripheral neuropathies1,2,3 Major peripheral nerves in the extremities, such as the median,ulnar thick enough to reflect the sound beam, resulting in hyperechoic on the US scan 4. The correlation between nerve conduction study parameters and CSA in ultrasound Ultrasound of the peripheral nervous system is an additional useful diagnostic tool in neuromuscular disorders..5,6,7,8,9 In the longitudinal plane, nerves present as long, slim structures with a mixture of parallel hypoechoic and hyperechoic lines. Nerves must be distinguished from other nearby structures to ensure correct identification Muscles are hypoechoic and interspersed with small hyperechoic foci which easily distinguishes muscles from nerves. Tendons, which are sometimes adjacent to nerves, move proportionately with joint movement. US has higher specificity than sensitivity in differentiating myopathic and neuropathic changes The most sensitive diagnostic marker for symptomatic carpal tunnel syndrome patients is an enlarged crosssectional area of the median nerve 10,11,12

Official Title
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Neuromuscular Ultrasound Changes in Neuropathies in Correlation to Neurophysiological Findings

Conditions
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Carpal Tunnel Syndrome, Diabetic Neuropathies, Guillain-Barre Syndrome

Intervention / Treatment
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* Device: ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: above 18 years old males or females diabetic complaining of neuropathy or not carpal tunnel syndrome Guillain-Barré syndrome Exclusion Criteria: Patient refuse to participate The anatomy is altered due to sever trauma,tumor,or surgery Severe spasticity preventing examination

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| diabetic complaining of neuropathy or not<br>using of ultrasound in examination and nerve conduction study | Device: ultrasound<br>* easy new non invasive tool<br>* Other names: ultrasonography;|
| carpal tunnel syndrome<br>using of ultrasound in examination and nerve conduction study | Device: ultrasound<br>* easy new non invasive tool<br>* Other names: ultrasonography;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nerve ultrasound | on median and ulnar nerves | 3 years | 
| muscle Ultrasound | on thenar and hypothenar muscles | 3 years | 
| nerve conduction studies | for median and ulnar nerves (sensory and motor) | 3 years | 
| Electromyogram | for thenar and hypothenar | 3 years |